SIXTEEN MILLION American men and women served in World War II, but, in 2015, fewer than 1 million of these veterans were still living. Each day, 362 World War II veterans die. Actuarial science predicts that the last veteran from the greatest generation will die in 2044.1
Admiral Alene Duerk passed away at age 98 on July 21, 2018. She was a nurse who was active not only in World War II, but also in the Korean War and the Vietnam War. She was the first female admiral in any navy in the world.2 Her contributions to patient safety, interdisciplinary teamwork, and trauma survival rates continue to influence contemporary nursing care.
At age 97, Admiral Duerk was living independently outside of Orlando, Fla. The authors interviewed her in 2017. Although our questions had probably been asked many times before, she shared her memories with graciousness, humor, and generosity. With minimal assistance, the Admiral got in and out of the car, went to dinner, and somehow managed to pay the bill without the authors' knowledge. We wrote this article to tell a piece of her story.
Born on March 29, 1920, Duerk grew up in a small rural town in northwest Ohio. Having fought in France during World War I and come home with severe chronic lung problems due to exposure to mustard gas, her father was never well. A public health nurse would visit to help care for her father, bringing a thermometer, tissues, and other supplies. The nurse's knowledge, resourcefulness, and black bag of supplies made an impact on the young Duerk. “She always knew what to do, whether it was bandaging a wound [using] scissors she retrieved from her black bag or giving advice on ways to ease my father's breathing,” she recalled. Duerk was only 4 when her father passed away, but her resolve to become a nurse had already started to form.
On to nursing school
During the first half of the 20th century, career choices for young women were limited. Nursing was one option that offered the certainty of employment. Duerk attended the Toledo Hospital School of Nursing, a 3-year diploma program, and became a “probie” or probationary nursing student in the fall of 1938.
Clinical assignments began that first semester, and she and her classmates worked in the Toledo Hospital. Typically, the hospital's staffing needs dictated the nursing student experience. During her psychiatric nursing clinical experience, Duerk was the night charge nurse of the women's ward and remembered large doses of insulin administered as treatments. Under today's standards, a nursing student would never be put in charge of a group of patients, but this was the norm in that era.3 She recalled being nervous during this clinical rotation, not only due to her responsibilities as a charge nurse, but also because the patients did all the cooking and used the large kitchen knives.
Duerk's community nursing experience with the visiting nurses was also memorable. She was assigned to a downtown free clinic, and every prostitute in Toledo had to come in for a vaginal exam one day each week. She recalled, “If they did not come in, we would report them to the police and the police would bring them in. They knew who the ladies were. We were looking for signs of venereal disease. Of course, we had no real treatment at that time and would treat them with potassium permanganate douches.”
She worked hard to earn her diploma, and hers was the first class at Toledo Hospital School of Nursing to earn college credits from Toledo University. She did not realize the value of these college credits until later, however, when she would go on to earn a bachelor's degree at the Frances Payne Bolton School of Nursing at Case Western Reserve University in 1948. She passed the licensure state board examination in the summer of 1941.
World War II
On December 7, 1941, Japan bombed Pearl Harbor and the US entered World War II. Duerk enlisted in the Navy. Sentiments were high to support the war effort, and nurses were particularly in demand because numbers had been low during peace time.
“I remember when I arrived in Virginia to receive my assignment and training,” she told us. “I came in the middle of the night and was dropped off at the bottom of a tall set of stairs leading to the hospital. So, I hauled up my suitcase and figured out where to go.”
By age 25, Duerk had earned the rank of Lieutenant and was assigned to serve aboard the USS Benevolence, one of the Navy's large hospital ships, in 1945 (see POWs remember the USS Benevolence). The ship departed from New York and sailed through the Panama Canal, stopping in Hawaii and the Marshall Islands before reaching Japan. During the voyage, President Truman ordered the atomic bombing of Hiroshima. By the time the USS Benevolence arrived, Japan had surrendered and the peace treaty was signed, so the ship's mission changed from battle support to rescue and care.
One of Duerk's most lasting memories was rescuing hundreds of released prisoners of war (POWs), some of whom started swimming to the ship while it was anchored in Tokyo Bay. These young men swimming toward her had been recently released from camps in Omori and Shinagawa. Neither she nor anyone else aboard had experienced anything like this rescue mission.
In the first 36 hours, 30 nurses triaged more than 1,500 patients and admitted approximately 750.4 Some were transported to other ships for the journey home. Duerk recalled, “These boys were in terrible shape, although they had nice clothes on because the marines had dropped clothes to them. But they were malnourished, infested with lice, and suffered from [tuberculosis], beriberi, and deeply infected wounds. Our orders were that they could eat whenever they wanted. Food was not to be restricted for them.”
Like many nurses, Duerk was discharged after World War II. The GI Bill paid for her bachelor's degree in nursing, and she moved to Detroit, Mich., to work as a nurse supervisor and instructor at Highland Park General Hospital. She and her colleagues developed a nursing education and service integrated curriculum model. She remained active in a military reserve unit and was called back to active duty when the Korean War broke out.
The Korean War
Lieutenant Commander Duerk stayed stateside during the Korean War, first working on a trauma unit in Portsmouth, Va., and then teaching medical corpsmen. Enlistees were assigned as corpsmen on their first day of active duty. Some were chosen as first responders on the battlefield—not necessarily by choice, but based on results of aptitude testing. She found her passion in training these soldiers.
The training program was brief, only 10 to 13 weeks, and did not include infantry training. Although corpsmen were called to active battle sites, they were trained only in basic ground combat. Their skills included first aid, wound patching, and evacuation techniques. “There were a lot of Gold Stars in my classes,” Duerk noted, referring to the designation given to the family of a military service member killed in the line of duty.5
Duerk wrote the first formal curriculum for corpsmen, including pre- and posttesting as a novel concept between 1950 and 1953. Later, while assigned to a hospital clinic in Long Beach, Calif., she included clinical experience for the corpsmen, such as stabilizing hemorrhaging wounds and threatened airways, that was considered novel for this rank of enlisted personnel. “The corpsmen were tested and certified, not just trained to apply bandages,” she emphasized.
When asked about teaching an energetic but largely unskilled group, she expressed the comradery between nurses and corpsmen.6,7 There was a deep respect and dependence on each other to take care of patients. Duerk commented, “They not only respected my rank, but I was intimidating at six feet tall. And besides, I did not write everything and everyone up.”
Starting with Duerk's emphasis on adaptation and collaboration, the curriculum continued to grow and included skills development and clinical experience. Corpsmen were trained on techniques for endotracheal intubation, intraosseous infusion, and chest tube insertion. As corpsmen developed more expert clinical skills and became better at stabilizing the wounded, battlefield deaths decreased precipitously.8,9
After the Korean War, Duerk remained on active duty and worked many assignments. These included the eyes-nose-throat unit at Bethesda Naval Hospital, now known as Walter Reed National Military Medical Center, where she saw the first artificial eye implanted, and Subic Bay Station Hospital in the Philippines, which was a large base with military dependents, including children.10,11 She returned to Japan in 1962 as assistant chief nurse and commander. Later she worked as a nurse recruiter at the height of the Vietnam War and assumed the position of director of the Navy Nurse Corps at the Pentagon. She attained the rank of Captain on July 1, 1967.12
Legacy of a pioneering career
Duerk became the first female admiral in the US Navy after being promoted by President Nixon in 1972. She received the news of her promotion from the radio while driving across Ohio to visit her mother.13 Over the next 3 years, she worked to promote women and nurses until her retirement in 1975. (See Qualities for success in nursing.)
A firm believer in the value of a BSN for entry-level nurses interested in becoming Naval officers, Admiral Duerk advocated for the skills and potential of military women around the world. In her many speeches and appearances, she promoted the role of women and the fairness of the Navy. She recognized that women are an important part of the Navy, and her promotions showed that men knew it too. She later commented, “I receive exactly the same pay and privileges as men holding the same rank, which isn't always true in the civilian world.”4
The distinction of being the first woman to achieve the rank of admiral allowed for unique authority and responsibility. She made best practices relevant for an entire generation of military emergency personnel. As a pioneer, she allowed others to follow in her footsteps as more military branches opened to nurses and women. (See Medalsawarded to Admiral Duerk.)
As a nurse, Admiral Duerk modeled and expected key behaviors: mutual respect, collaboration, and critical thinking. Regarding her service to the country and to nursing, she said, “I had served for 32 and half years. I watched nursing change from a job to a career, from a vocation to a profession, from good patient care to potentially miraculous patient care. It was an amazing experience. I was very grateful to have been part of it.”14
Today, Admiral Duerk's uniform is part of the Smithsonian Institution's collection.15
POWs remember the USS Benevolence4
This hospital ship treated hundreds of American POWs released from Japanese internment camps. Here are some of their memories.
- “I was on the USS Benevolence for a short time. I was a B-29 pilot shot down over Tokyo on a fire raid. After three days, I was captured and taken to Kempi Tai cells. While there, I lost 100 pounds...I think it was August 29 when the Navy men came and picked us up. I was on the USS Benevolence, checked, and fed. It was a great comfort to be on that hospital ship and in the care of fellow Americans.”
- “That war was so long ago; I didn't think anyone would ever remember that beautiful ship. It was beautiful to us. I was shot down over Tokyo, during a B-29 bombing raid. I was held in a cell in downtown Tokyo then moved to Omori POW camp, which was on a little landfill in Tokyo Bay. That beautiful hospital ship came into the bay and all of a sudden we were free men.”
- “The nurses cheered us as we came aboard. Then all the ex-prisoners had to go through a lot of cleaning and showers. We were given new, clean clothes after finishing the detox shower and given a quick check of our medical condition. The [seriously ill] patients were given immediate treatment. The nurses were wonderful and made us all feel good.”
Qualities for success in nursing4
Below are the characteristics of successful nurses according to Admiral Duerk.
- Self-control and discipline: “You must set certain goals and objectives in your life. To accomplish these goals, there are times when you must pass something by in order to achieve your long-range goal.”
- Caring or loving: “You must care enough for your patients to understand the fears and concerns that they have. You give [all] of yourself to the patient and expect nothing in return. You are there to provide support and encouragement. A nurse holding the hand of her patient is caring.”
- Ideals: “You set goals that are realistic guideposts to your life. You set goals and ideals that are within your reach. New goals are set as others are achieved. Your ideals must be tempered with reality. The commitment to patients is the highest goal of all.”
- Courage: “Courage is needed to ensure your own honesty and wisdom. You must have the courage to know and understand yourself. It takes courage to admit a mistake. Courage guarantees honesty. You need courage to have faith in others, God, your country, and a life of self-discipline.”
Medals awarded to Admiral Duerk4
- American Theater Campaign Ribbon for her military service during World War II
- Asiatic-Pacific Campaign Medal, awarded for serving in Asiatic-Pacific during World War II; with a Bronze Star, which was awarded to those aboard the USS Benevolence who helped repatriate and return POWs
- Navy Occupation Ribbon for serving as part of occupying force that went into Japan at end of World War II
- Victory Ribbon for serving in World War II
- Navy Reserve for serving as part of Navy Reserve for 11 years
- National Defense Ribbon, awarded for serving in the Navy during the Korean War; with a Bronze Star, which was awarded for serving during the Vietnam War
- Legion of Merit, which was awarded upon her retirement for outstanding service to the Navy.
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