Nurses stay ready during COVID-19 pandemic

Readiness for the Military Health System has two faces: a medically ready force must be prepared to defend the nation, and the readily trained medical force keeps those service members healthy. Military nurses are instrumental to both sides of that coin. During National Nurses’ Week 2020, the MHS recognizes the many ways that nurses improve and sustain readiness for the military.

Nurses continue to serve vital roles in each of the Defense Department’s three main priorities for health care during the COVID-19 pandemic: protecting troops and personnel; helping safeguard the nation’s security missions; and, supporting interagency government efforts to address the pandemic. Nurses serve vital roles in each of these areas, ranging from the front lines of military treatment facilities to data analysis and policy behind the scenes.

If anyone asks Navy Rear Adm. Mary Riggs about military medical readiness, she will say that MHS nurses consider it an everyday activity. Riggs is the interim assistant director for health care administration and interim chief nursing officer at the Defense Health Agency.

As a link between health care providers and their patients, nurses bring medical knowledge and bedside manner that puts both groups at ease.

“They adjusted to what the requirements of the pandemic were in a fearless manner, and quickly adapted to make sure that our patients got the best care possible,” Riggs said. “I think this is a real tribute to how our nurses embrace their profession.”

Riggs attributed this success to a learning culture that has helped nurses expand their skill sets throughout the MHS. With nursing now recognized as a functional area that drives success in the DHA, Riggs and her team are developing ways to measure and influence how nurses ensure readiness and patient safety. The creation of a tri-service advisory board and tri-service nursing working groups help the team reap the best practices from all three military services.

“No matter what service you're coming from, or what MTF you work at, there's a real emphasis on knowledge growth and development,” Riggs said. “That lifelong learning model within nursing has created a community that has guarded itself from stagnation.”

Army Col. Jenifer Meno supports the development of nurse skills for readiness as the deputy assistant director of strategy, planning, and functional integration at DHA. Meno’s team uses data from products such as patient surveys to demonstrate the quality care nurses are providing. Meno, a nurse herself, was quick to emphasize the data as something beyond numbers.

“Our numbers represent people,” Meno said. “They also represent outcomes we're trying to improve in our Military Health System, like readiness for our service members and care for our own beneficiaries.”

Meno uses data to validate the work nurses do and examines it to allow patient feedback to help shape next steps for improvement. The numbers directly address both sides of readiness for the MHS.

“We hear their voices and their needs so we can make sure we're doing the right thing for our patients and staff,” she said. “Nursing has become that ability to look at problems from how we continue care across both areas and try to align training policies to ensure that we maintain high standards of practice and care delivery.”

The MHS has taken advantage of pre-existing channels like the MHS Nurse Advice Line and telehealth engagement to help guarantee that these standards are met during the COVID-19 pandemic. At DHA headquarters, nurses have continued to leverage their field experience to refine and enhance the solutions developed in response to the outbreak. Nurses on the front lines are also stepping up to ensure quality care.

Army Maj. Alex Tatone, chief of Evans Army Community Hospital’s Department of Inpatient Services at Fort Carson, Colorado, used modeling to predict that the small hospital did not have enough critical-care beds to support the potential influx of COVID-19 patients. As a result, the Baylor University graduate created a bed expansion plan that nearly quadrupled the number of critical-care beds at Evans, and included training nurses that do not normally work in intensive care units to support those beds. Once they complete the short but comprehensive training program, the newly trained nurses are paired with experienced ICU nurses on the floor as guides.

“Our nurses are being asked to do something that we normally wouldn't ask them to do and work a little bit outside of their comfort zone,” Tatone said, “but we wanted to make sure that we provided the training and support in order for them to be able to do that.”

The strategy of expanding staff functions through appropriate training and education has provided facilities the manpower to address a potential surge in patients, and also demonstrated the dynamic nature of nursing in times of critical need. Nursing students at the Uniformed Services University of the Health Services graduated early to begin immediate support of their colleagues in the MHS amid the global coronavirus pandemic. A March Defense News article praised the “cadre of competent health care professionals who can augment current resources” and “have matriculated a curriculum that has a specific focus on threats like emerging infectious diseases and disasters.”

From expanding nursing functions inside of MTFs to meeting screening needs in tents outside, all three nursing professionals praised the adaptability of nurses throughout the COVID-19 pandemic. Riggs is confident that nurses will continue to deliver, from the fast pace of the emergency room to the regular drumbeat of floor nursing. She hopes to leverage the training nurses have received to look at more opportunities in readiness and operability.

“Our MHS nurses, whether civilian, contractor, or military, embody the DoD core values of a real performance culture,” Riggs said. “That requires leadership, professionalism, and dedication to duty. The future right now seems uncertain with our current health care crisis, but I have every confidence that our nurses are up for the challenge.”