Even though the battleground of the war against terrorism is on the other side of the globe, the American health care system could feel its effects. The mobilization of nurse reservists who serve in the armed forces has driven some hospitals to prepare for the possibility that more nurse reservists may be called to active duty. With hospitals already stretched thin by the nursing shortage, it's a dismal prospect.

About 9,800 nurses belong to the Army, Navy and Air Force Reserves, with 5,250 more in the Individual Ready Reserve (not active, but eligible to be called up if needed). As of Oct. 23, only a small number of nurse reservists had been called to report for duty as a result of President Bush's authorization for a partial mobilization of military troops. The potential remains for many more reservists to be mobilized, depending on the total number of troops deployed and the direction the war takes.

At University Hospital in San Antonio, 22 nurses are among 81 active reservists. Hospital spokeswoman Leni Kirkman said that so far only two of the nurse reservists had been called to active duty. "The best news is that when our human resources department looked at where the reservists work, they saw that they were spread out among the various departments," she said.

One of the hospital's nurse administrators is a reservist; if called up, she would be able to appoint another nurse to temporarily cover her responsibilities. "Our staff is so well cross-trained that they could run things in her absence," Kirkman said.

Soon after Sept. 11, Marianne Kainz, chief nursing officer at Olive View-UCLA Medical Center in Sylmar, Calif., said she checked the number of nurse reservists on her staff who might be called away. "We have only two nurse reservists at this time, although we've had many more in the past," she said.

Her facility is one of six hospitals in the Los Angeles County Department of Health Services, which employs 4,787 RNs. Kainz said about 10 percent of her hospital's nursing positions are unfilled, so she can scarcely afford to have nurses called away. "Any loss of staff affects the overall system," she said.

The Veterans Administration health system typically has employed a large concentration of retired military and reserve personnel. Sixteen nurse reservists out of 1,966 nurse reservists who work in VA health care nationwide had been activated as of Oct. 10.

Frankie Manning, chief nursing officer for the VA Puget Sound Health Care System in Seattle, has 725 nurses under her direction. She said 25 are active reservists, with another five in the Individual Ready Reserve. To date, two nurses have been summoned for active duty.

"We have lots of people on alert, but not called yet," she said. Manning anticipates that more reserve personnel will be mobilized. "If everyone is called at the same time, it would be a significant impact."

Manning said a more likely scenario is for reservists to be called to report in a "staged-out call up" with different military units told to report in a gradual process. "If there's a staged-out call up and we're allowed to replace [nurses], that wouldn't be as hard. Usually, different units are called at different times, and not all the reservists would serve in the same unit."

A recently retired reservist herself, Manning explained that the various scenarios make the situation unpredictable, but at the same time, possibly less arduous from an administrative standpoint.

"Some [reservists] may be called for a short time, such as 30 days. During Operation Desert Storm [in which Manning served in an active capacity], some individuals had to be gone from their civilian jobs for just a week.

"During Desert Storm, we had a significant number of staff called up," she said. "It had a big impact on our organization. We did have to close some beds temporarily, but the hospital continued to operate. Just having support personnel [lab and radiology techs, for example] involved is a big impact."

Like other nursing administrators, in the event of the activation of many of their reserve nurses, Manning would fall back on emergency plans. "We'd be just like every other hospital in town, having to call agencies to try and fill positions. We could call on retirees; it's a complicated process."

At Olive View-UCLA Medical Center, Kainz said her facility has had experience with losing nurses to military call-ups. "We had many more nurses who were in the reserves during the Gulf War; most have retired now."

If the hospital were to lose many nurses to the military for the current war, she said, "we have quite a few options to look at, including hiring temporary fill-in staff, using registries, overtime hours for regular staff. We may even have to cut back on services."

Kainz is keeping a close watch on the situation. "We're gathering information about where our reservists work, who they are, making plans. We've cross-trained for many years," she said. She also observed that recent events have cut the number of nursing applicants at her hospital by one-quarter.

The nursing shortage also is affecting the armed forces reserves, just as it has the civilian sector. Vacancies exist for nurses with med/surg, OR, anesthetist and critical care skills.

About 6,000 nurses are active in the Army Reserve, said Brig. Gen. Kristine Campbell, Ph.D., MS, RN, assistant surgeon general for force management, mobilization and reserve affairs in the Army Nurse Corps. Another 4,000 are in the Individual Ready Reserve, who can be mobilized with the partial mobilization that has been authorized.

"There has not been a large-scale activation of medical people yet," she said.

The U.S. Navy Reserve includes 1,800 active nurses plus 1,250 in the Individual Ready Reserve. Rear Adm. Betsy Morris, RN, deputy director, Navy Nurse Corps, Reserve Component, said that to her knowledge no Navy Nurse Corps officers had been mobilized as of Oct. 22.

As with other branches of the armed forces, when full-time soldiers and Navy nurses are mobilized, reservists are called in to take their places on home soil as well as sent to foreign locations to augment military staff. Morris said that Navy Reserve nurses are trained, as are Army and Air Force reservists, in the basics of soldiering, including biological, chemical and nuclear warfare.

"Training in regard to bioterrorism is important; it always occurs in a reservist's training. It's not something that was implemented after Sept. 11."

Morris and Campbell said inquiries into reserve service in the Navy and Army have noticeably increased since Sept. 11.

"Our naval personnel reserve command has been getting inquiries from people interested in volunteering," Morris said. Manning said her VA facility had been receiving calls from individuals to volunteer for military service, even though the Veterans Administration is not a branch of the military and does not recruit for the armed forces.

"We've had an increase of 197 percent in the number of phone calls of people [with health care backgrounds] asking for information about joining the Air Force Reserve," said Senior Master Sgt. Patrick Dreer, superintendent of health professions recruiting for the Air Force Reserve, which has about 2,000 nurses.

Dreer said he doesn't know how many of the calls are from nurses, but many are about nursing needs. "I'm not surprised. Anytime there's a national emergency, there's an increase in people wanting to participate," Dreer said. "But we didn't expect an almost 200 percent increase."