Capt. Bethany Niccum, RN, joined the Army after graduating from Messiah College in Grantham, Pa., admittedly to have a job, gain some nursing experience and travel the world. "I had no idea what I was getting myself into," she said. Certainly, she never imagined that after five years she would be head nurse of a family pediatric clinic in Würzburg, Germany.

"My clinical experience, I believe, is far beyond that of many of the nurses I went to school with, who probably have been in the same job for all five years," Niccum said. With experience in med/surg, orthopedics and pediatrics, she said the nursing and leadership skills she learned in the Army are so diverse that she would feel comfortable anywhere she is assigned.

When RNs go into the Army, through the Reserve Officers Training Corps or by direct commission after graduating from college, their first mission is not medical. It's mental. It's military. In a word, it's leadership. And it permeates all that follows as an Army nurse.

Niccum's training, specifically a pediatric specialty course, ventured into a growing area for the military: state-of-the-art education technology. The didactic part of the course-once offered in the classroom, but eliminated as the Army shifted priorities to more of a wartime mission-was provided via CD-ROM, Niccum said. It featured interactive video, knowledge games and practice tests covering nutrition, growth and development, and fluid and electrolytes. That was followed by hands-on experience at a medical center.

Col. Janet Harris, Ph.D., RN, chief of the nursing science department at the Army Medical Department Center and School at Fort Sam Houston in San Antonio, said the eventual goal of the Army's training and doctrine command is to have a video teleconferencing classroom within 50 miles of every soldier.

"We use a lot of distance learning because our force is scattered all over the world," she said.

The graduate-level nurse anesthesia program she runs from Fort Sam Houston is at the forefront of education technology with online courses and patient simulators.

Harris said she uses Internet Web boards to post instructions and foster synchronous discussions among nurses in classes at eight sites around the country.

At Walter Reed Army Medical Center, the Army's showcase medical facility in Washington, D.C., the nurse anesthesiology program employs high-tech mannequins that Maj. Karen Whitman, MS, RN, calls "as realistic as you can get without having a live patient in the bed. It's like practicing on a real person without fear of killing them."

Anesthesiology nurses' decisions and the consequences are videotaped.

The mannequins are engineered to respond in real time to real-life events. Administering drugs brings "very correct pharmodynamic response, breathing and vital signs, including hemodynamic values," Whitman said. If the "patient" needs to be intubated, nurses can put a tube down the trachea.

"If they misplace it into the esophagus or the right bronchus, they won't hear lung sounds on both sides. You can watch the monitor and the oxygen saturation levels will be dropping."

A lesson
Whitman, head nurse of medical and pediatric intensive care at Walter Reed, said the value of simulator training is just beginning to be realized in the private health care industry.

"It's a very expensive commodity," she said, and suggested that civilian nursing schools could benefit by affiliating with medical schools that use simulators and share costs.

Harris said it is her duty is "to remind nurses that they have two professions: one as a nurse and one as an Army officer."

"Army nurses are very highly regarded … by the civilian world because not only do we receive the professional training, but we receive all the leadership training," she said. "When we go out into the civilian world, we take that with us. A lot of the civilian organizations and nurses just haven't had those opportunities."

The "take-home message" of the Army Nurse Corps model, Harris said, "is that you have to be willing to invest in your employees. By investing in them, then you get a significant return back to the organization.''

In light of that, USANC (U.S. Army Nurse Corps) could signify an ethos for success in the military and private sector as telling as the RN, BSN, CNS, NP alphabet soup that stands for the education, experience and expertise in the civilian world.

"You have to understand what the Army vision and the Army philosophy is," Harris said. A slogan sums it up, she said: "Every day in the Army, we do two things. We train soldiers and grow them into leaders."

To do that, the watchword is education, but education coupled with a military ethic.

Every Army nurse begins with Officers Basic Course, an immersion into military culture and standards. At the top level, senior nursing officers study leadership at the Army War College at Carlisle Barracks, Pa., where issues range from military strategy to national security.

Long before that, though, there are command schools and nursing management courses such as head nurse development and advanced nursing leadership.

"You're given the tools to succeed," Harris said. "Performance is always key to succeeding in the Army. You have to do a good job in whatever your role is in the organization. And the next thing is you have to be able to go through and do the different leadership courses so that you have the skills to succeed at a higher level."

A formula
Maj. Deborah Dickson, MSN, NP, RN, put the Army's penchant for education to work early, using an ROTC scholarship to earn her BSN from the University of Portland. She has used the learn-perform-and-lead formula over and over and, last summer, was appointed deputy director of the LPN course at Madigan Army Medical Center at Fort Lewis, Wash.

From her vantage point, Dickson has 15 years of perspective on the military and nursing, how the two are entwined and the Army model.

"I like the military culture, the professionalism it brings," she said. "Even when you're off-duty, you are scrutinized. You are an officer. People look up to you to uphold standards. As you come up within the Army, you sort of gain that respect and it never leaves you. You can really see it in the practice of nursing. You learn to treat everybody with respect, particularly your patients."

Then there is a commitment to education that is virtually unparalleled in the private sector. "I've gotten more education in the Army than I know I would have as a civilian," Dickson said.

Two years ago, she was assigned to the University of Nebraska to earn a master's degree. "They're really always kind of pushing you," she said. "Keep going, keep going. Refine this skill. Keep bettering yourself, keep learning. I think the military is starting to embrace the role of mentoring and guiding and teaching. We sort of bring up our own."

Maj. Risa Bator, MSN, FNP, RN, mentors nurses at Fort Carson, Colo., where she is a pediatric critical care specialist. "Military nurses are mentored to advance and continue education," Bator said, with firsthand knowledge that the Army rewards initiative and integrity by investing in promising nurses. It sent her to the Uniformed Services University of the Health Sciences in Bethesda, Md., to earn her master's degree.

"If we don't take care of our young officers, they're going to get out," Bator said, adding that she has a personal interest in the work ethic, proficiency and advancement of RNs such as 1st Lt. Nicole Roberson, RN. "If we go to war, she's going to be the one right beside me," Bator said.

Roberson, a graduate of the ROTC program at the University of Michigan, is three years into an Army career and, Bator said, given her performance, she is likely a candidate for Army-paid graduate school when she has more service and experience.

"I thought I was going to go in and be a nurse on the floor and that was my job," Roberson said.

Hardly. Although she is now assigned to family practice at Fort Carson's Evans Army Community Hospital, in October she cared for "war casualties" in exercises with the 101st Airborne Division and built on previous courses in basic life support, advanced cardiac life support, combat casualty care and basic field medicine at the Joint Readiness Training Center at Fort Polk, La.

"The Army teaches you such values about selfless service," Roberson said.

"You have to be the nurse, but you also have to be the military side. They work with you and you understand that you're part of a team. They hold you accountable. You have to do well. It's ingrained and you want to do well."