Undaunted by War,
Natural Disaster
Federal nursing chiefs adapt leadership skills to
guide RNs through uncertain times
By Dan Kening and Janet Boivin, RN
March 28, 2005
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.
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?”
Dan Kening is a Chicago freelance writer, and Janet Boivin, RN, is editorial director for Nursing Spectrum’s Greater Chicago and New England editions.