Second Lt. Nina Hoskins, 81st Surgical Operations Squadron operating room nurse, briefs Col. Debra Lovette, 81st Training Wing commander, and other base leadership on robotics surgery capabilities inside the robotics surgery clinic at the Keesler Medical Center June 16, 2017. (Photo: Kemberly Groue, U.S. Air Force) ()
The ongoing COVID-19 pandemic has fast-tracked many changes to the Military Health System and forced all providers – especially nurses – to innovate at near-quantum speed with agility and flexibility.
Nurses are the backbone of daily health care operations. In the future, nurses will continue to play a vital role in the evolution of modern health care.
"Nursing will take on more leadership and strategic roles to transform the health care system, better advocate for nursing personnel, and integrate across care to enhance the multi-disciplinary team," said Defense Health Agency Chief Nursing Officer Air Force Brig. Gen. Anita Fligge.
As the DHA observes Nurses' Week for 2022, Fligge and other top Defense Health Agency nursing officers talked about changes on the horizon for military nursing and the details of how the career field will evolve in the coming years.
They said the pandemic has underscored the connection between health and readiness. Virtual health care options will continue to expand. Robotics may play a prominent role in standardized care in the future. And continued education for nurses will be essential to maintaining a ready medical force.
Working in a joint environment within the integrated DHA workforce will improve efficiencies for nurses, allowing them to spend more time on patient care by having standardized policies, procedures and tools across the services, Fligge said.
She pointed to the collaboration already underway in the local health care markets. For example, she said, Navy nurses in the Puget Sound market help backfill at the Madigan Army Medical Center and vice-versa. The same collaboration is ongoing in the Colorado Market, she said. Air Force nurses are assisting at the Army's Ft. Carson Evans Army Community Hospital.
The pandemic "has opened the doors for nursing to see what could change as to how we care for patients in the future, using technology in a new way, and using data to assist in bed expansion or use of resources more effectively," said Army Col. Jenifer Meno, DHA's deputy chief nurse officer.
The pandemic has "required more precision and flexibility, including virtual health care, remote patient monitoring, and touchless medication refills to optimize care delivery," Fligge said.
Virtual Health
The future will mean more virtual health care and telehealth services for certain specialties such as dermatology, behavioral health, primary care, urgent care, and obstetrics while maintaining the focus on high-quality patient care and increased access to care, Fligge said.
The expansion of virtual care will help save lives on the battlefield and also improve care during humanitarian crises and future pandemics.
Additionally, at home, virtual health will continue to provide MHS beneficiaries with more access and flexibility to get assistance and appointments.
The COVID-19 pandemic has taxed nursing staffs beyond anything in recent memory as they cared for both COVID-19 patients and maintained routine health care operations.
The pandemic has "prompted the need for us to re-look at staffing models and ratios to optimize utilization of the workforce, while ensuring safe, high-quality care delivery and positive outcomes." Fligge said.
The past two-plus years also have seen a "greater awareness and need to address burnout and retention," Fligge said.
Better Health, Better Outcomes
Keeping nurses themselves healthy is a key priority for the entire health system, Meno said.
"The more healthy you are makes you more resilient in multiple ways, from being physically healthy, having mental well-being, and spiritual well-being," she said. These three are all part of Total Force Fitness, the DOD's framework for improving holistic health and performance aligned to one's mission, culture and identity.
She pointed to the increasing use of mobile digital applications as one way to monitor heath across the military community.
These apps are available to help decrease stress, monitor exercise habits, and support healthy diets. "Nurses can use that data to assist in educating and teaching patients how to care for themselves as well as recognize triggers that may be a risk to their care," Meno said.
"If we maintain a healthier mindset, it prepares the body to fight off disease and illness. If we use it to help our patients to be healthier and do preventive activities, that would change potential outcomes for the future."
More Robotics and AI
Nurses have been integrally involved in newer surgical techniques such as robotic surgery since the 2000's.
"Some things never change," Meno said. "Nurses in the operating room will continue to be the eyes and ears for the patient. They will continue to ensure that the patient is receiving the best care with high quality and safety."
Nurses on robotic surgical teams must demonstrate "a very high level of professional knowledge, and be experts in robotic technology. This is demonstrated by playing a key role in data collection, analyzing trends and outcomes, and identifying safety issues," Fligge said.
The nursing team will need to continue to maintain sterile techniques and ensure the integrity of the surgical field, Meno said. The team will need to communicate more in the operating room as technologies evolve. And nurses will use evidence-based teamwork tools from TeamSTEPPS to support a highly-reliable organization, Meno added. She is referring to an approach called Team Strategies and Tools to Enhance Performance and Patient Safety, an evidence-based teamwork system designed to enhance patient outcomes by improving communication and other teamwork skills among healthcare professionals.
Artificial intelligence is already a technology that nurses use in everyday care via mobile health and alerts in joint tele-critical care network (JTCCN) units. These are an important force multiplier, leveraging virtual health resources to extend critical care expertise and treatment at a distance.
And without a doubt, there are more changes to come. AI and machine learning will assist nurses by using data to help improve the efficiencies of systems and processes, but those technologies are still in their infancy.
More Nursing Expertise
The pandemic also has meant an "increased capability and use of our nursing workforce by ensuring that personnel are equipped with the education and training to perform at the highest level and scope of practice and license," Fligge said.
Meno sees more nurses getting certifications to be the subject matter experts in their field.
The increased number of nurses obtaining their Doctorate of Nurse Practice will also grow now that the American Association of Colleges of Nursing has endorsed the movement of advanced nursing practice from a master's degree to the doctorate level, Meno predicted.
"This doctorate develops nurses to look at process improvement and holistically at improving systems and processes that include other disciplines in patient care."
Meno said that discussing hybrid nursing roles had already taken place.
"We see nurses now that are doing hybrid nursing roles due to their versatility and agility. Nurses are not only at the bed side, but they are also clinical nurse specialists, research scientists, advance practice providers, educators, and health system leaders."
