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Federal nursing chiefs from top center clockwise: Rear Adm. Mary Pat Couig, U.S. Public Health Service; Cathy Rick, Department of Veterans Affairs; Nancy McKelvey, American Red Cross; Rear Adm. Nancy Lescavage, Navy Nurse Corps; and Maj. Gen. Barbara Brannon, Air Force Nursing Services.

An unprecedented series of world events during the past four years, both man-made and natural, have challenged in new ways the leadership skills of the members of the Federal Nursing Service Council. Although few people in the civilian world are familiar with their names, or the council itself, this group of select RNs leads government-employed nurses in the Army, Navy, Air Force, Department of Veterans Affairs, U.S. Public Health Service, and Red Cross.

The terrorist attacks of Sept. 11, 2001, and the subsequent start of the war on terrorism, the beginning of Operation Iraqi Freedom in early 2003, last year’s devastating hurricanes in Florida, and December’s catastrophic tsunami in Asia have all affected their agencies in fundamental ways.

Nurseweek spoke with five of the six federal nursing chiefs about how they, as leaders, have adapted or honed their skills and developed new management techniques in today’s radically altered world.

Maj. Gen. Barbara Brannon, RN, MSN,
assistant surgeon general, Air Force Nursing Services

The lives of innumerable soldiers and Marines have been saved by the Air Force’s aeromedical evacuation system linking medical care from battlefields in Afghanistan and Iraq to the U.S. Army hospital in Germany and then on to military hospitals in the U.S.

Much of this success is due to the skills of Air Force nurses, says Brannon. “Air Force nurses have demonstrated a remarkable ability to provide critical care in a field environment and to adapt and adjust to an arduous mission and complex patients,” she says.

As the service’s top nurse, Brannon has been improving communications between top brass and the 19,000 active duty, Air National Guard, and Air Force Reserve nurses under her command since the start of the war on terrorism.

“I think one of the most important things for leaders at a time when their people are particularly challenged and stressed is to make sure you are reaching out and communicating with them,” says Brannon.

Brannon lived that credo this past holiday season when she traveled to southern Germany to visit Air Force nurses working at the Army’s Landstuhl Regional Medical Center and in the contingency air staging facility and flight line at Ramstein Air Base, where wounded service members are transported by air from Iraq and Afghanistan before being transported to Landstuhl.

“My conversations with the nurses and technicians centered on three themes: They were working very hard and they were tired; they recognized the powerful impact their expert care and emotional support had on those [troops] fresh from the battlefield; and they saw a level of trauma they had never experienced before, not even those nurses with civilian experience in major trauma centers,” she says.

Brannon says another of her concerns as a leader is to ensure that her nurses get the best possible training to handle virtually any clinical or field situation they may encounter, such as the devastating traumatic wounds being seen and treated in Iraq’s dirty, dusty, hostile environment.

“You have to make sure your people have the training and tools to do what they need to do,” says Brannon. “In the Gulf War and Bosnia, there were far fewer casualties than anticipated and little need for the level of trauma care we provide in Iraq. So although we anticipated and prepared for casualty support, the medical care needed has been more intense over time than I expected based on our experiences in the past several conflicts.

“I did not anticipate medics and nurses would need to wear helmets and body armor so much of the time. I did not anticipate that they would have to adjust to mortar attacks on the medical compound. Mercifully, there have been only misses so far,” she says.

If teams fail, it is often because of a failure of leadership to provide them with the proper training, Brannon says. This concept has been proven in Operation Iraqi Freedom.

“We received direct feedback from commanders at the beginning of the war that those nurses who had completed our specialized war skills training performed very well from the start, whereas those who hadn’t been able to complete the training before deployment had more of a learning curve,” Brannon says.

Brannon, who recently celebrated her 30-year anniversary in the Air Force, says of her experiences, “I would never have imagined the scope of responsibility and professional challenges I would encounter when I took my oath of office 30 years ago. I see the impact Air Force nursing has on the quality of people’s lives and the tremendous clinical skill our nurses and medical technicians bring to the fight.”

Rear Adm. Nancy Lescavage, RN,
director of the Navy Nurse Corps

Lescavage was named head of the Navy’s 5,000 active duty and Reserve nurses one month before the attacks on the World Trade Center and the Pentagon. Even before Sept. 11, she was working on strategies to match nurses with specific skills to postings where those skills were most urgently needed.

“On Sept. 11, we were able to home in on exactly what critical skills in wartime our Navy nurses needed,” she says. “And that brought about a plan to increase the numbers of nurses in anesthesia, OR, critical care, ER, trauma, basic medical/surgical, and mental health care.

“The latter is particularly important because we don’t want to see another Vietnam, where people didn’t get the kind of mental health care they needed,” she says.

Toward that goal, Navy nurses specializing in mental health are deployed with the Marine Corps on the battlefield in Iraq. The Navy is also monitoring the mental health condition of sailors and Marines returning to the U.S. from Iraq.

The start of Operation Iraqi Freedom in 2003 challenged Navy nurses’ wartime skills in new ways. The Navy’s hospital ship, the USNS Comfort, was floating in the Persian Gulf prepared to receive casualties when the “shock-and-awe” bombing of Iraq signaled the start of combat. The Comfortwas last deployed to a combat zone during the first Persian Gulf War in 1990 but did not receive any casualties.

This time the Comfort did receive casualties — and in large numbers. But, ironically, most of its patients were Iraqi civilians and enemy prisoners of war rather than combat-injured Marines. This not only tested the nurses’ skills in treating combat injuries, but it forced the nurses to draw on any transcultural nursing experiences they might have had since there were few translators on board. They also had to quickly adapt to the special security considerations of caring for prisoners under heavy guard in a ship that had not been fitted to hold prisoners.

“Navy nurses readily adapted and remarkably delivered outstanding care to all those who were entrusted to their care,” says Lescavage.

Many people may not be aware that Navy nurses not only provide nursing care for sailors, but for the Marine Corps as well in mobile surgical units and fleet hospitals established on the ground.

Navy nurses and Marines left Iraq once the Army gained a foothold in Baghdad after the start of the war. But the Marines returned in full force last spring when they were sent to quash insurgencies in Fallujah and elsewhere. Navy nurses were not far behind and helped care for the horrific wounds Marines received during intense battles.