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Feature: VETERANS DAY TRIBUTE

Military nursing

A primer for new recruits

Cox, Catherine Wilson PhD, RN, CEN, CNE; Wiersma, Gretchen M. DNP, RN, CPN, CNE, CHSE; McNelis, Angela M. PhD, RN, CNE, FAAN, ANEF

Author Information
doi: 10.1097/01.NURSE.0000719216.45758.c8
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MILITARY NURSES are crucial to quality healthcare within the United States Armed Forces. The military trains and maintains a nurse workforce that is prepared to deliver care, lead teams, and deploy at any time. Nursing recruits are assigned to the Air Force, Army, and Navy through enlisted commissioning programs, Reserve Officer Training Corps (ROTC) opportunities, and direct commission and recruitment initiatives. The Air Force, Army, and Navy are the only US military branches with their own Nurse Corps. Currently, around 10,000 full-time nurses are on active duty (3,155 in the Air Force, 3,334 in the Army, and 3,537 in the Navy).1 Among the 8,000 part-time reserve nurses, 2,460 serve in the Air Force, 4,329 in the Army, and 1,316 in the Navy.1 The Navy supplies healthcare services to the Marines because the Marine Corps is part of the Navy, and the Coast Guard employs civilian nurses. Nurses who are interested in non-military public service can work as nurse officers in the Commissioned Corps of the US Public Health Service.2

Expectations for military nurses differ from those of their civilian counterparts because military nurses have the dual roles of RN and officer. Moreover, these nurses often deploy into volatile global environments and lead interprofessional teams of care providers, so they must be able to transition into both roles rapidly and competently. This article offers an overview of military nursing and provides three examples that illustrate how nurses can advance their careers within each service.

Benefits and challenges

The benefits of military nursing include being commissioned as an officer, practicing in collaborative environments, honing leadership skills via hands-on and professional development opportunities, learning cutting-edge technology, and traveling within the US and/or abroad.3 Additional benefits include generous compensation and benefits—for example, 30 paid vacation days annually, low-cost life insurance, a thrift savings plan, and paid sick and maternity leave. Military nurses also receive free on-base housing or tax-free off-base housing allowances, comprehensive medical and dental coverage for both nurses and their dependents, more autonomy in clinical practice than in most civilian jobs, opportunities to pursue a graduate degree at minimal or no cost, and retirement benefits and a military pension after serving for 20 years.

Challenges may include the prospect of deployment, possibly to austere environments, as well as separation from families and friends. Military nurses may also be challenged by the possibility of working long hours without overtime pay, biannual physical fitness tests, and the insecurity of not knowing where the next assignment will be until having “orders in hand.” Undeniably, the ultimate challenge is risking the loss of life in service to one's country. For example, 201 military nurses died in service during World War II, including 16 killed by enemy fire and 13 who died in weather-related flight crashes.4 Nine Army nurses have died since the start of the Iraq War in 2003.5

Who can join?

All three services have various age, physical, education, experience, and citizenship requirements. The maximum age requirements for all three branches are predicated on federal law, which allows for full retirement and receipt of benefits after at least 20 years of service. However, age waivers may be available depending on certain circumstances. For example, applicants may be exempt from retirement rules if they work in a specialty with a worker shortage.6

Physical requirements differ across the services, but in general, all applicants must pass a full physical and mental examination. Given their military role and the possibility of being deployed to an austere environment, nurses who need lifesaving medications such as insulin or nurses with a health disorder that requires constant monitoring would pose a risk. Most applicants are US citizens, but permanent residents may be eligible to serve.

All active duty and reserve military nurses complete a civilian BSN program before they join a Nurse Corps; additional training or experience requirements vary among the three branches. Nurses who join the Nurse Corps via Direct Commission in any of the three branches must also have at least 1 year of RN experience.

ROTC scholarships are competitive scholarships awarded to undergraduate nursing students, and scholarship benefits and requirements vary between the three branches. Students interested in joining as Army and Navy nurses can also apply for either's Nurse Candidate Program.

Other recruitment programs include the Enlisted Commissioning program, which is open to active duty or reserve members of all three services who wish to become officers. The Seaman to Admiral-21 Program is a competitive in-service commissioning program offered exclusively to Navy sailors; the Health Profession Scholarship Program is open to graduate nurses interested in joining the Nurse Corps in any of the three branches.

According to the assignment officers of the three Nurse Corps within the military—Lt. Col. Tracey Gosser (Air Force), Col. Susan Cloft (Army), and Capt. Carolyn McGee (Navy)—about 500 nurses who join each year are prelicensure graduates and another 300 are postlicensure RNs who join the military after working as civilians. Most of the prelicensure recruits come from ROTC programs, which are offered at over 1,700 colleges and universities in the US. These officer-training programs focus on leadership skills as well as communications and ethics.7 ROTC students reflect a variety of majors, not just nursing.

Although this article does not specifically address recruits to the reserves, it is important to recognize that the three Nurse Corps depend on reservists to meet the demands of a full range of military operations; for example, in military treatment facilities via aeromedical evacuations, on hospital ships, and/or in deployments for global activities. Furthermore, recruitment numbers may decline a few years down the line due to recent consolidation in military medical systems and efforts to cut healthcare provider positions, including those for active duty nurses.8 It is unknown if the positions will be completely cut, converted to contractor jobs, or shifted to the reserves; however, the demand for military nurses will persist regardless of downsizing and/or consolidation. It is important to recognize that active duty and reserve nurses are complemented by civilian nurses in order to meet health readiness mission requirements of the Armed Forces.1

Recruitment pathways

Prelicensure recruits in the Air Force attend a 10-week nurse transition program course in one of four US locations, and they complete a 1-year nurse residency program following graduation in one of eight locations in the US or two in Europe. In the Army, all prelicensure recruits attend a 6-month clinical nurse transition program at one of nine locations in the US or one in Europe. For their first tour of duty, new Navy nurse prelicensure graduates are sent to inpatient facilities, each with its own decentralized transition program.

Paths to service: Three examples

Example 1. Antonio∗ enlisted in the Air Force and became an aerospace medical technician. He was picked up for the Air Force's competitive Nurse Enlisted Commissioning Program (NECP), excelled in his baccalaureate program, earned his BSN, and passed the NCLEX-RN on his first attempt. After graduation, he attended Commissioned Officer Training (COT) in Montgomery, Ala. After COT, Antonio went to Scottsdale Healthcare in Arizona to complete a nurse transition program. Antonio's next assignment was to a nurse residency program at Travis Air Force Base in California, where he stayed for his follow-on tour. Today, Antonio is certified as a critical care RN and is awaiting orders to an overseas duty station.

Example 2. Michelle became an Army nurse via an ROTC scholarship. She decided to apply for the scholarship to pay for school as well as opportunities for travel and adventure. Upon graduation and after attending required Army medical training, she was commissioned as a second lieutenant, passed her nursing boards, and completed the Basic Officer Leader Course in San Antonio, Tex. She was then stationed at Landstuhl Regional Medical Center in Germany, where after completing the Clinical Nurse Transition Program she officially began her role as both a military officer and a professional nurse. Michelle transitioned into a career as a civilian nurse after 10 years in the Army.

Example 3. Elizabeth met a Navy recruiter during her senior year of nursing school. She became a Navy nurse via the Direct Commission pathway and attended Officer Development School in Newport, R.I. Her tours included Navy inpatient facilities in Bethesda, Md.; Cherry Point, N.C.; and Portsmouth, Va. Eventually Elizabeth transferred to the reserves and recently retired as a Navy captain. Her military education benefits paid for her master's and doctoral degrees.

Final thoughts

Military nursing is a unique experience that offers nurses the opportunity to be a part of something bigger than themselves. The shared perspective of Air Force, Army, and Navy nurses is that a military nurse uses a “one-team” mentality to care for military service members and their families. Understanding the pathways nurses take to join the military workforce is important for nurse educators and administrators to know in supporting their success.

REFERENCES

1. Office of the Assistant Secretary of Defense for Manpower & Reserve Affairs. Defense manpower requirements report: fiscal year 2020. US Department of Defense. 2019. https://prhome.defense.gov/Portals/52/Documents/MRA_Docs/TFM/Reports/Final FY18 DMRR 11Dec2017.pdf?ver=2018-02-03-141625-140.
2. Commissioned Corps of the US Public Health Service. www.usphs.gov.
3. Dreater P, De Jong M. Is military nursing for you. Nursing. 2003;33:22–23.
4. Tomblin B. G.I. Nightingales: The Army Nurse Corps in World War II. Lexington, KY: University Press of Kentucky; 1996.
5. Moore CJ. Fallen Army nurse corps warriors from Operation Iraqi Freedom and Operation Enduring Freedom. Army Nurse Corp Association. 2020. https://e-anca.org/History/Fallen-ANC-Warriors-OIF-OEF.
6. Rand Corporation. DOPMA/ROPMA policy reference tool: retirement for age and years of service. http://dopma-ropma.rand.org/retirement-for-years-of-service.html.
7. Today's Military. ROTC programs. www.todaysmilitary.com/education-training/rotc- programs#:~:text=The Reserve Officer Training Corps,officers in the U.S. Military..
8. Defense Health Agency Publications. Military Health System. www.health.mil/About-MHS/OASDHA/Defense-Health-Agency/Resources-and-Management/DHA-Publications.
Keywords:

Air Force; Army; military nursing; Navy; ROTC

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