Lescavage, who spent 22 years as a clinical nurse, wears a second hat as the Navy’s head of training for all medical personnel. She says one of her present challenges is to redesign educational training programs using state-of-the-art technology.

“We’re trying to catapult Navy medicine into the 21st Century,” she says. Although Lescavage will soon be leaving for a new assignment as director of TRICARE Region West, a military insurance plan, she says, “I remain committed to the Navy Nurse Corps; once a Navy nurse, always a Navy nurse.”

Rear Adm. Mary Pat Couig, RN, MPH, FAAN,
chief nurse officer, U.S. Public Health Service

Couig, the Public Health Service’s (PHS) chief nurse officer, was just 10 months into her term as chief nurse when the terrorist acts of Sept. 11, 2001, occurred. The crisis didn’t require her to use different leadership skills but rather to learn new subject matter (terrorism) and to focus on new mission priorities.

“My priorities, both the short- and long- term, needed to be revised,” Couig says. “In the short term, I needed to make sure we had enough nurses to deploy to New York, and then to Washington, after the anthrax exposure, and wherever else we were asked to help. I communicated with the nurses to keep them informed of the department’s activities and offered suggestions about how they could help, especially if they were not going to be deployed.

“Internally, in the long term, we needed to review how our nurses were trained and to formalize deployment roles. Externally, a new priority was to identify key nursing organizations with public health preparedness need, interest, or expertise; to discuss potential areas of collaboration; and to develop and implement such programs,” she says.

Sept. 11 provided the Department of Public Health and Human Services with a critical test of its readiness to respond quickly and decisively in times of national crisis. Because of systems that had already been put in place, Couig’s department immediately deployed, through the National Disaster Medical System, the Commissioned Corps Readiness Force, individual agencies, and public and mental health professionals to New York following the attacks on the World Trade Center.

Since Sept. 11, the government has spent billions of dollars to strengthen the public health infrastructure. The commissioned corps and civil service nursing contingents have been a significant part of those efforts, says Couig.

The increased interest in public health has provided the PHS with many opportunities to talk about its mission and commitment to improving the nation’s health. “Many people do not know we are one of the seven uniformed services,” says Couig.

While Couig lists communications, vision, and prioritization as key skills in her day-to-day duties, she says relationship building is also a large part of her job.

“You have to work with others who may be in virtually any capacity,” she says. “From the start I’ve had to identify medical and health care organizations with which it was important to create or renew a relationship.”

Couig offers advice for nurses looking to explore leadership opportunities. “It’s important for nurses to consider all the different kinds of leadership positions they could aspire to, whether with public or private entities,” she says. “So many nurses just think of nursing as hospital nursing. I see it as so much broader than that. You also need nurses in public health departments and at the state and federal government levels. The opportunities for nurses interested in leadership positions are limitless.”

Nancy McKelvey, RN, MSN,
chief nurse, American Red Cross

McKelvey manages an office responsible for supporting and strengthening paid and volunteer nurse involvement throughout the Red Cross, providing technical expertise to more than 900 local field units, and representing the Red Cross to external health-related organizations.

Under her leadership, systems are established to help local Red Cross chapters recruit and engage nurses and other health professionals who assist the Red Cross as it annually mobilizes relief to victims of more than 70,000 disasters, trains almost 12 million people in lifesaving skills, keeps U.S. military families connected worldwide, supplies blood and blood products to more than 3,000 hospitals, and assists victims of international disasters and conflicts at locations across the globe.

“Sept. 11 pointed out that no one group can be all things to a population,” says McKelvey. “It demonstrated we had to maximize human, financial, and technical resources. One of the ways we’ve done this is by enhancing current strategic partnerships and developing new ones.”

For example, she says, “When we were developing a new organizationwide nursing strategic plan, I invited several leadership nurses from external organizations, including the PHS, to join Red Cross participants. Because of this collaboration, more than 200 PHS nurses and mental health professionals have responded to multiple Red Cross disaster operations during the past two years.

The PHS members were invaluable in supplementing Red Cross volunteer nurses and providing surge capacity when large numbers of responders were needed dur ing the California wildfires, Midwest floods, and hurricanes that affected multiple states.

Cathy Rick, RN, CNAA, FACHE, chief nursing officer,
Department of Veterans Affairs

As a substantial number of injured active-duty military personnel in Iraq and Afghanistan are transitioning from military to veterans’ medical facilities, Rick says she is challenged to create additional resources to assist soldiers and their loved ones during difficult times.

Veterans Affairs (VA) nurses have identified unique health care needs of soldiers wounded in recent conflicts, requiring a flexible and adaptable leadership approach to support programs and priorities for VA nurses and these soldiers. For example, rehabilitation care for a young veteran with multiple trauma requires nursing skills that focus on care coordination and interventions for the patient’s return to a family life with young children and to lifelong employment. This is different from rehabilitation approaches for an older veteran who may have suffered a cerebral vascular incident or stroke.

“We’re working more closely with other departments, like the Department of Defense (DOD), to find ways we can better prepare families for what they can expect in the transition from the DOD’s health care system to the Department of Veterans Affairs’ (DVA) health care system,” she says. “We want to find ways to help them navigate through each system’s paperwork.”

Rick says one of her current projects is the creation of a national database of the DVA’s 58,000 nursing staff members highlighting their particular skills. The VA has the largest nursing workforce of any integrated health care system in the U.S. Its combined nursing force consists of 35,000 staff RNs, 3,500 advanced practice nurses, 10,000 LPNs/LVNs, and 9,000 nursing assistants.

“We want to identify nurses with specific skills for any potential needs, such as trauma management, mental health needs, rehab, and disease treatment,” she says.

Rick says another ongoing effort is finding improved ways to recognize clinical leadership.

“DVA nurses are known for their special skills; and that applies to all areas of care including primary, long-term, mental health, and rehabilitation,” she says. “Are we doing enough to recognize and reward the strong leadership our nurses have to offer?”

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Dan Kening is a Chicago freelance writer, and Janet Boivin, RN, is editorial director for Nursing Spectrum’s Greater Chicago and New England editions.

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