Nursing Shortage

[afnurse65]

Fix the promotion of AF Nurses.
Nurses are finally getting smarter about "why" Nurse Corps (NC) promotion timing and percentages are so poor when compared to the rest of the AF and other services. The meager number of field grade NC positions are a product former gender-related policies that prohibited women from remaining in the military if they got married or pregnant. As a result, most women got out ot the military as CGOs. When the DOPMA policies were instituted, rather then builiding a typical rank structure, they froze the existing bottom-heavy structure and have refused to correct it. It takes a nurse nearly 18 yrs to become a Lt Col. That is nearly three years longer than their peers. It not only takes nurses longer, but their promotion opportunity is significantly less. This amounts to institutionalized gender discrimination. All nurses want is to be paid/promoted the same as their peers for their expertise. Equal pay for equal work does not seem like too much to ask. It's hard to believe that our AF leaders know this is happening but have chosen not to fix it.

[opionated1]

I never realized that the poor NC promotion rate is because of gender discrimination. Rather than rewarding nurses for paving the way for women in the military, they have become victims of their own success. People seem to think we need to lower nurse educational standards or RIF nurses at 10 years so they don't compete for field grade positions. Would any other group of officers put up with this? Why not just even-out the percentage of company grade and field grade positions within the medical service and then continue to level across the line of the AF? It seems like the right thing to do. No wonder the nurses are leaving the AF....

[FlightNurse]

Quit trying to fix the AF nurse shortage on the cheap. The only remedies I’ve heard is to lower the educational standards of our nurses or to fix the dismal promotion opportunity by RIFing them at 10 years. Please, just promote them and pay them and we won’t have a shortage.

[aligirl]

-Reward/promote the nurse who wants to remain at the bedside, who is the expert and loves what she/he went to nursing school to do..."be a nurse!"
-Let these clinical experts be our clinical mentors/role models and at least make it to Lt Col without having to run the leadership/administrative ladder to prove they are worthy.
-Offer that clincial tract a promotion potential up to 0-5 if still at the bedside.
-Encourage a clinical nurse specialist route that is more "clinical" vs "administrative".
-Reward shift/weekend differential as in the civilian community. This will help retain the junior nurses in the trenches who bail after their initial tour because they can make more on the outside.
-Farm out the majority of PCO, FHO whatever you want to call it or make it ,to civilian nurses as much as possible. That allows for more community continuity in care.
-Keep the nurses/medics at the training platforms, civilianize everything not related to keeping task competent in the deployed setting.

[Premie52]

There are multiple reasons for the nursing shortage in the AF, when I speak to junior nurses that are electing to separate their first term I hear comments like, the promotion rate is too slow, I want to remain clinical, why cann't I get promoted and stay clinical. Other comments are regarding clinic nursing, not a deployable skill and very demading with little return for the nurse. Another issue is the promotion system itself "DOPMA". This has hurt nursing for years, why are physicians not on this system, answer being you would not retain them! So why would you think nursing is any different. A physican can be promoted up to Lt Col without PME or the highly competative PRF system, promotion is automatic providing they do not harm to a patient. in additon all physician receive a nice healthy bonus every year just for sticking around. It is time the AF, DoD wakes up and view the NC as a medical profession and treat it as such. Fix the promotion system, give annual bonus for all not just the Lt through Capt, you need to retain Maj through Lt Cols as well. Eliminate DOPMA ASAP and shorten the promotion time to include pin on dates. Pay nurses what they are worth and promote them bottomline.

[Leaving ASAP]

Of course there is a nursing shortage in the AF. You will soon be another nurse short. You push clinically competent nurses into positions that will get them promoted leaving clinically unexperienced nurses at the bedside and to the battlefield! Shame on us for accepting these terms for promotion. At 27 years as an RN, I am earning what I earned the last year I worked as a civilian nurse, when I joined the AF 13 yrs ago. I want to get paid for my competence instead of being compensated for accepting a position which raises me closer to a level of incompetence.

[medic gal]

Recruitment and retention are both key. We will not attract new nurses if they look at stats and realize how long it will take to be eligible to promote nor can we retain if the prospect of promotion does not favorably compare with the civilian sector.
Re Recruitment: Experienced RNs are highly prized by health care institutions and schools of Nursing as evidenced by double-digit percentage salary increases yearly, yet vacancies exist because the existing RN pool is too small, the average age of practicing RNs is high, the work is stressful and physically demanding. The Nurse Enlisted Commisioning Program (NECP) will help the shortage. In addition, several universities offer civilian Clinical Nurse Leader programs or Masters' Entry Clinical Nurse for any non-nurse with a baccalaureate who, after taking 3-5 prerequisite courses, are eligible for (very competitive) admission to a 2-year Masters program. Upon completion, they may sit for RN licensure, though not Advanced Practice (Nurse Practitioner or Clinical Nurse Specialist) certification.
Re Retention: No magic bullet solution for retention but some suggestions:
-Create more upper FG billets for nurse leaders, then recognize and promote expertise within the field and within clinical and non-clinical specialities
-Throw out the concept of percentages and promote based on achievements, skills, merit, certification and the ability to lead others on that path
-Teach/Encourage development of skill sets germane to the military that may have civilan applications as well
-Encourage joint assignments among services, encourage niche specialization growth as well as general nursing
-Allow ability to move between the Reserve and AD, easing the transition to AD or reserve depending on military needs
-Heavily advertise/recruit within Nursing organizations, Schools of Nursing, conventions---use real faces to tell our story and convey the unique opportunities and rewards of AF Nursing

[Oldschool]

All of my thoughts have already been posted (and then some). I'll be retiring in less than a year for many of those reasons - - I appreciate that Leadership is finally attempting to pay and promote nurses according to their worth; but for an experienced nurse who filled all of the squares (certification, master's, etc... ) without hesitation; who although a DP, waited in perhaps the longest promotion queue in AF history; who received no sign-on bonus, student loan reimbursement, nor specialty pay - - I, like others with similar stories, 'feel that these attempts are too little, and definitely too late.

[pd0623]

Nurses are always the last to be promoted and have to struggle to get there. Those of us that want to stay at the bedside risk not being promotable if we do. Not every nurse is an administrator, clinical nurses/bedside nurses make good leaders and managers. We need to have the experience at the bedside and in deployed areas to help our new nurses learn the necessary skills and time management.

Give the nurses compensation for their knowledge like the providers receive. Nurses should receive some type of Professional Pay as the doctors do. Maybe not the same amount but something that shows the AF wants and values their nurses.

Promote them and pay them. Nurses make up HALF of the AF medical deployers. They are operational and phenomenal officers. Match civilian pay using on time promotion, accession bonuses, and special pay.

Quit trying to fix the AF nurse shortage on the cheap. The only remedies I’ve heard is to lower the educational standards of our nurses or to fix the dismal promotion opportunity by RIFing them at 10 years. Please, just promote them and pay them and we won’t have a shortage.

[CougRN]

For reasons already stated, promotion opportunities for AF nurses fall well short of those given to those serving in other career fields...I have heard plenty of excuses and rationales for why AF nurses have to wait 17 YEARS to meet a promotion board to Lt Col (and let's not forget to tag on the wait times to pin rank!). The reality is that when you or your loved one is admitted for medical procedures, you expect and deserve a team of nurses that have experience, expertise and advanced education delivering your care - and rank equals experience! Promote us...or better yet eliminate DOPMA constraints and we'll make it happen. We aren't asking for more than our peers, we're asking for equity across the board!

[CougRN]

For reasons already stated, promotion opportunities for AF nurses fall well short of those given to those serving in other career fields...I have heard plenty of excuses and rationales for why AF nurses have to wait 17 YEARS to meet a promotion board to Lt Col (and let's not forget to tag on the wait times to pin rank!). The reality is that when you or your loved one is admitted for medical procedures, you expect and deserve a team of nurses that have experience, expertise and advanced education delivering your care - and rank equals experience! Promote us...or better yet eliminate DOPMA constraints and we'll make it happen. We aren't asking for more than our peers, we're asking for equity across all career fields!

[LovinLifeasAF_RN]

Nurses are always the last to be promoted and have to struggle to get there. Those of us that want to stay at the bedside risk not being promotable if we do. Not every nurse is an administrator, clinical nurses/bedside nurses make good leaders and managers. We need to have the experience at the bedside and in deployed areas to help our new nurses learn the necessary skills and time management.

Give the nurses compensation for their knowledge like the providers receive. Nurses should receive some type of Professional Pay as the doctors do. Maybe not the same amount but something that shows the AF wants and values their nurses.

Promote them and pay them. Nurses make up HALF of the AF medical deployers. They are operational and phenomenal officers. Match civilian pay using on time promotion, accession bonuses, and special pay.

Quit trying to fix the AF nurse shortage on the cheap. The only remedies I’ve heard is to lower the educational standards of our nurses or to fix the dismal promotion opportunity by RIFing them at 10 years. Please, just promote them and pay them and we won’t have a shortage.

BRAVO! Counl not have said it better myself.

[AKNurse]

Remove DOPMA constraints--a physician can be promoted up to Lt Col without PME/leadership experience.
Maintain opportunities for nurses to remain at bedside and get promoted or seek leadership positions. Leadership opportunities should go to best candidate and shouldn't be based on what corps an individual is in. Maybe more diversity at the top will change the way nurses are treated/promoted.
On time promotion will address most pay issues. It will also let nurses know that their role is valued. If we are the ones who are deploying--we should be the ones getting promoted.
Do not quick fix this by lowering the standard. We need educated nurses at the bedside and the battlefield.
The Air Force offers nurses so many great opportunities--AFIT, force development, travel, serving our great country... if we could fix broken promotion rates/timelines I truly believe we would have no trouble recruiting and retaining the best nurses out there!

[retired2006]

The AF nursing shortage will only get worse as they are treated like second class citizens by the LAF and the Medics. They have destroyed the rank structure and promotions system for nurses by taking away the billets and giving them to the Line or other Medical Corps. Nurses should not have to wait 13 years to meet a majors board when others meet it at 9. They should not have to wait 19 years to be Lt Col when others are there at 15. Nurses should not have to give up clinical practice to get promoted. The Nurse Corps leaders have been trying to fix this for years and have gotten nowhere with the Line of the AF and Senior Medical leaders. That is what will fix the "shortage" and the sooner it happens the better.

[mainegirl]

As a nurse mentor it is difficult to see the number of young qualified nurses leaving the military because of the dismal promotion opportunties. As nurses struggle for promotion many of our outstanding experienced nurses leave the bedside. We as a county need this expereince at the bedside and as the mentors to the junior nurses. We NEED majors and Lt Cols mentoring Lts not Lts mentoring Lts.
It is difficult for me to rationalize for nurses why we have so many line officers that they see work half the number of hours and deployments but have almost a double chance at promotion. We can not keep up this pace of losing the qualified.

[CalculatorNurse]

The absolutely dismal promotion opportunity for nurses is a huge push out the door and a morale buster for those who stay in to serve and deploy (Nurses make up half of medic deployers). The line and other medics have deliberately kept the NC field grade spaces lower than would drive career progression and equitable promotion. There is NO equal opportunity for NC officers in the AF...in this day and age?!! Its not all about money either. Yes, NC officers lose thousands of dollars through out a career by being held down as an 0-3 or 0-4. But its also about being held down to lower housing standards based on advancedment in grade, prevented from sponsored education, and blocked from highly desirable job opportunities.

[Love AF Nursing]

I have been in the Air Force 25 years and have loved all of it. I have been able to do more in the Air Force than I would have ever done in the civilian sector. One thing I liked about the Air Force is that I would get paid the same as my Air Force counterparts who had my same rank and time in the service. This is true, but the part that is skewed is nursing is 2-3 years behind the promotion timeline as our counterparts and our promotion opportunity is dismal. I was promoted to a rank early and still had a line officer comment that I must have been passed over because I had been in so much longer than line officers of the same rank. Making our promotions equal with physicians and dentists (eliminating DOPMA constraints) would be one way to increase our promotion rate and hopefully result in decreasing the Air Force’s nursing shortage.

[Phdpsychnurse]

I am commenting as a psychiatric nurse who has observed the disenfranchisement of our field throughout the years. If there had not been a war, psych nursing would remain an enigma within the military, especially the air force which has relegated our field to that of mental health technician level. Aside from the obvious and often spoken of disparities with promotion both on the nurse corps level and air force level, the mentality of “a nurse is a nurse is a nurse” is very much alive and well among senior leadership as evidenced by the complete lack of acknowledgment of mental health nurses in the DOD mental health task force advisory report of 2007. This lack of knowledge has permeated through all of the mental health disciplines resulting in ignorance on the part of our professional counterparts as well as a decline in the viability of potential mental health assets that are extremely in need at this time. My recommendation: Nursing specialties need to be utilized and acknowledged and promotion opportunities need to reflect these types of expertise. Create two tracks as they have in the civilian communities which consist of administrative and clinical since both are very important but it is the rare individual who can excel at both.

[Live Positively]

The nurses in the USAF NC are the most intelligent and highest educated nurses, with our basic requirement a BSN. To make Maj one of the known requirements is PME and a national certification in a clinical area of nursing. For Lt Col the requirements are generally a Masters degree and more PME. Additionally, for Col another PME is required. We are experts in our fields of study and in the Air Force mission and polcies thus our promotion rates and our rank should reflect that expertise. If DOPMA was lifted, nurses would have opportunity for promotion and we would not have a storage of experience at the bedside. We deserve the promotion and the pay for our critical knowledge and skill sets. We just want to be recognized like other fellow Air Force professionals whose promotion rates are higher and quicker. Nurses want to be nurses so.....Promote Them, Pay Them, Retain Them!!

[Scruples]

I am commenting as a psychiatric nurse who has observed the disenfranchisement of our field throughout the years. If there had not been a war, psych nursing would remain an enigma within the military, especially the air force which has relegated our field to that of mental health technician level. Aside from the obvious and often spoken of disparities with promotion both on the nurse corps level and air force level, the mentality of “a nurse is a nurse is a nurse” is very much alive and well among senior leadership as evidenced by the complete lack of acknowledgment of mental health nurses in the DOD mental health task force advisory report of 2007. This lack of knowledge has permeated through all of the mental health disciplines resulting in ignorance on the part of our professional counterparts as well as a decline in the viability of potential mental health assets that are extremely in need at this time. My recommendation: Nursing specialties need to be utilized and acknowledged and promotion opportunities need to reflect these types of expertise. Create two tracks as they have in the civilian communities which consist of administrative and clinical since both are very important but it is the rare individual who can excel at both.

AMEN !!!

The Air Force leadership need to wake up. We are fighting wars and our service need to revamp and improve its mental health services by treating our Psychiatric and Mental Health (PMH) nurses with respect and giving them the responsibilities commensurate with their training and job description. DO NOT treat them like technicians. In addition, the Air Force has to establish education and training opportunities for advance nursing practice in PMH such as Clinical Specialist and Nurse Practitioner training programs to augment the ranks of Psychiatrists and Clinical Psychologists that are being swamp with mental health cases related to repeated deployments and overstretched manning as a result of the Force Shaping.

[LADYVIOLA]

Wow! We hear a lot about the nurse shortage in the United States. Any logical thinking person would draw the conclusion that the various US Military Services Nurse Corps would be experiencing the same relative shortage. I had thought, though, that the blatent discrimination that nurses had to put up with in WWII and the times between then and now would have been resolved. I'm a prospective nurse that wants to join the Air Force. I am a 46 yr old prior service Army Medic who also got her LPN in the Army and then realized that in order to really get my RN I had to get out. I am in my last year at the University of Delaware for my BSN. I am in discussions with an Air Force recruiter. I never expected that there was this kind of blatent dicrimination against Air Force CG Nurses. What about the senior leadership of medicine, or nurses, in the Air Force? They ought to be tuned in. What about the senior Air Force leadership in general? They ought to realize that everytime they come in to the clinic or hospital it is a nurse that will take care of them. If they bring their child or spouse in it is the same nurse taking care of them too. If they skip Air Force medicine and use TRICARE to seek help off base, the nurses there are LPN's and ADRN's at best, or foreign workers imported to fill the gaps, or travellers and agency nurses. AND there aren't enough of them. Why would it be the rule rather than the exception that the Clinical Nurse is not the epitome and model for what a nurse aspires to. In the MASH tent or medical bunker when all hell is breaking loose and there is noise and smell and pain and yelling and mistakes and machines, the wounded young person laying there bleeding, is looking up and into the eyes of the Clinical Nurse. When everybody else is thinking of medicine, bandages, gas, and golf, the Clinical Nurse is holding the hads of the patient. WE ARE THEIR GUARDIAN ANGEL. That is a lot of responsibility all of us had to go out of our way to seek.

There are some pretty generous signing bonuses and tuition pay off schems right now, why not some retention money to retain those CG and FG Clinical Nurses, the ones who pull the 12 hr shifts, nights, weekends, holidays, deployments, and excercises and then on top of that the discrimination and misuse by their own kind at the leadership level. I'll tell you one other thing, if EVER a junior person or enlisted person of ANY rank ever treated me or any nurse who was near me, with anything other than proper military courtesy I'd rip a new xxxhole in that person. Regardless of the pay and promotions, a military nurse is still a Commissioned Officer and there is a UCMJ that ensures good order and discipline.

I'm still going to seek a commission in the Air Force Nurse Corps. I will seek my Masters Degree in Clinical Nursing. I will be a board certified Med/Surge Nurse (BC-RN) before I enter the Air Force. I am a professional Med/Surge Nurse now and I'm damn proud of it. I work in a regional hospital as an RN now and I am the mentor for new nurses who hire on to the Med/Surge floor. I am a full time RN and a full time Nursing student. I hope this bad situation resolves its self. What is being done by Air Force Nurse Leadership to right the problem?

[ProudAFNurse]

RE: AF Nursing Shortage/Unequal Pay- WE NEED ACTION NOW

“This is a time for change “---stealing a slogan from our Presidential campaigns—these are serious times in our Nation for health care and Nurses are at the pivotal point of the health care crisis, and specific in our beloved AF. As a recent retiree of 25 of years in the AF NC, it saddens me that the LINE AF & Medical Service most senior leader has not moved forward and are actually "stuck" in the old ways of equal pay for all. Especially during a time of war, in which my nurse colleagues to include myself served in the "battle space" and sacrificed for our Country along- side the warriors on the ground and in the air. As I witness the severe nursing shortage in our country from a "civilian" perspective, it is very clear to me, there is another "war" on the home front that is serious and we are losing----lack of competent, sufficient nurses in our complex --struggling health care delivery system. And if the AF leaders wait... and don’t act now, the pool of nurses are diminishing, and we will have lost the competitive edge to retain and attract the brightness and best to serve our Country now and in the future.
Key lessons learned from highly recognized, national nurse leaders, especially from “Centers of Excellence”-- top quality institutions have learned ; 1) you must pay nurses for their education, and clinical experience (no short cuts when dealing with life and death) , 2) respect them with a career- forward thinking workforce promotion ladder, and 3) ensure you have the right mix of nurses educationally prepared (Baccalaureate Nurses make the difference between quality, and safe nursing practice thru clinical expertise and leadership decision making skills—minimal Associate Degree Nurses). In addition, the AF needs to recognize the “must have” of nurses with years of experience who have fine-tuned their astute clinical decision- making skills whether it is in war, homeland defense, or peacetime medicine, similar to the seasoned pilot with 10 years of flying who is valued and rewarded with an appropriate promotion rate.
Unfortunately, the AF is way behind (after 7 years of studying nursing promotion rates), why has the LINE and medical (doctor) senior decision makers/leaders repeatedly missed the opportunities to finally fix a long time problem when given the facts? Do they misunderstand the issue, or the key importance of “how to” recruit, (right scholarship funding), or is it just not important enough, or worse yet apathy? In the area of recruiting, for example, at a large university —AF nursing is ranked 3rd as a choice of service (due to historical poor promotion rates, lack of scholarship entry funding). THE LINE of the AF, needs to wake-up and show how our medical leaders can correct this issue, and make sound, equal policies when it comes to nurses promotional cycles, DOPMA, and scholarship funding. The time has come, the clock is ticking---before it is too late, the top leaders (CSAF/SG1) need to fix AF NC promotional rates/scholarship funding rates---it has been studied and discussed enough-- our Airmen and their families deserve better.

[Khapten]

I've been an AF nurse close to 12 years now and I must say that it has been a blast so far. However, within that timeframe, I have also seen an exodus of highly qualified, trained and disillusioned nurses. This is a sad fact considering that the majority of them entered with a patriotic and motivated zeal and yet the system failed them somehow along the way.
The time to act on this issue is right now. The military could not afford to wait any longer considering the state of affair the nursing shortage is in right now. Aside from rumping up our recruitment, retention, pay and promotion processes and incentives, I'd like to propose a possible remedy to the problem. As it stands now, there are a lot of licensed but foreign trained/graduates practicing nursing in the United States. Why not tap into this pool? There are a lot of them who are just as eager to join the military ranks but couldn't do so because of the hurdles they have to overcome to get in (the biggest one of them being the NLN rule). Ease some of the requirements, allow and grant waivers for certain restrictions. If their credentials are good enough to allow them to work in the civilian sector (coupled with the right skill sets, citizenship and length of experience) why couldn't the military take them in as such and offer them commissions? Something to think about... Thanks.

[Why?]

The AFMS has a very physician-centric culture. This has truly damaged the AFMS over many years. The AF and AFMS leadership have bent over backwards to accommodate physicians at a high cost to the rest of the AFMS career fields, primarily the NC. The providers are able to get away with things that a nurse, medical technician or other medical personnel would never get away with saying/doing. Equality needs to be across the board with promotions, treatment for verbal abuse/unprofessional behavior, distribution of work (MDs are exempt from so much...nurses are busy too!) and overall accountability. It really seems the AF and the AFMS have been in a tail-spin for many years. I don’t see recruiting and retention getting any better, especially for nursing. You can't recruit nurses for 3-6 years and maintain a core group. Also, many will pop smoke at 20 years. Why go beyond 20 years with such an unfair playing field. Take the retirement and run. Nurses are tired of being treated like second-class citizens. Brace for the mass exodus (CGOs and FGOs). There are tons of jobs we can do on the outside with better treatment, pay and benefits, let alone happiness. The AFMS has worn the NC CGOs and especially the FGOs ragged. Too little, too late!

[SuperNurse]

1.PME – Why do we still accomplish PME when it hardly pertains to our practice? I only say this because the doctors don’t concern themselves with it. I consistently see my co-workers struggling over volume after volume and the line side has the luxury of going in residence, at a whim. I don’t understand why the Air Force nurse needs to finish PME via correspondence to be eligible to attended the course at Maxwell; seems like a waste of time and money to do it twice.

2.Rank-Why can’t the Nurse Corp promote automatically to the rank of LtCol or even Major? Perhaps not having to struggle to hold positions in management, setting up the squadron picnic, and whatever task that might get them noticed on their next OPR to get rank might keep more at the bedside.

3.Stress-Nurses still eat their own, I understand we are supposed to be a friendlier kinder Air Force but the culture has not changed. No more computer training on empowerment, team dynamics, or problem solving; it doesn’t work we must find out a new method to better management, clearly missing that in-residence PME is doing the nurse corp some harm.

4.Work hours -Air Force nurses that work with civilians feel this the most (training, mandatory appointments, flight meetings, commanders call, mass briefings, PT, recalls, exercises, ON-CALL NURSE, etc). No one likes to be called in and we recognize the above as our obligation or duty, but depending on what base you’re at management may give or not give comp time for something like PALS, or ACLS. To work 16 days in a month, + 2 days of training + 1 Staff meeting + 1 commanders Call/on-call nurse for 3, and the obligatory base training we have to accomplish our work hours vary greatly from or civilian co-workers. ****Of course many Jump ship to the civilian side, that pays less overall but I believe the possibility of family/personal time is becoming more appealing than cash.

5.Deployments-Frequency

[JKISSRN]

I have been really surprised that this has not been addressed before in AF Times at this extent. The nursing shortage has been going on for many years but nothing has happened in the USAF NC since I've been in. I see many incentives for enlisted personnel to get into nursing, huge bonuses for brand new nurses, AF members in many other areas are getting huge bonuses as well to stay in but there is nothing for the seasoned, deployed, experienced nurse at the bedside. This makes me very sad because I see many great nurses leave in dismay of this situation. I am wondering why we don't get any retention bonuses if we are so badly needed. CRNAs are not the only nurses who deserve the bonus yet they are the ones currently getting it. I am not saying that they don't deserve it but the rest of us taking care of patients at the bedside, deploying, and doing everything else that the doctors and technicians don't want to do, we deserve a bonus as well. We are also the ones who train the brand new nurses who just came into the Air Force and nursing with their huge assession bonus. Besides the discrimination in promotion as was expressed in previous e mails, this is all very disturbing to me and I know to many of the other nurses I have worked with. I am not surprised at all if CGOs and FGOs are leaving the Air Force in droves. We are treated so poorly, why would anyone who wants to live a happy life would put up with this. And I have not even mentioned our physician collegues. We are belittled, yelled at, put down, made feel stupid on a daily basis. Why?? Why do we have to put up with stuff like this from our highly educated collegues?? Nurses are also educated just as well. We have very high standards, in fact I think higher than in the civilian world, as was noted in previous messeges. Why then it is allowed to be treated in this manner by people who consider themselves very intelligent. Anyways, I think it is time that all these disparities come to an end. It is time that we, who despite of all this, stick around, do something and don;t let this fester any longer. I beg to our AF leaders to please, please, hear our voices and don't just look at the numbers on a board. Behind every number, there is a human being with needs, aspirations, dreams, and a great sense of pride to be in this great Air Force of ours. We want to make a difference, we want to take care of our war wounded but we also want to be treated as humans. Thank you for reading.

[CountryFirstNurse]

Well it's Labor Day and I'm hearing the echoed voices of Chavez, Che and a host of other luminaries singing the chorus of the... "equal pay for equal work" theme song. Bravo, my fellow Nurses, BRAVO!!! Maybe we can get Sally Field to play the part of a longsuffering but end-of-their-rope corps chief rallying the troops to storm the DOPMA or whoever else we need to storm to get this important message out! But alas we digress from perhaps the most changeable, and therefore the most important of our dilemmas and I say to this patient, "NC, heal thyself!" Let's be honest on a few accounts. First, I heard about this thread from an email sent directly from the senior nurse in my chain of command who forwarded the email directly from another nurse who let's just say is “kind of a big deal”. In the email (which was originally sent to a short list of star-studded nurse corps leaders) we are not only given the exact instructions for posting on this thread and several soft talking points but also gently admonished to "change the answers somewhat so they don't all sound the same" -direct quote. Dear Oh Dear do the top-tier oligarchs in the NC really think us that simple-minded? Does the NC leadership really believe that we can be manipulated so easily! Where are you Che? Do they think I just stepped off the short bus? The answer... so far, YES. Integrity First. Next, how come it's always someone else's house that's not in order? Is that even possible? In the talking points we were obliged to mention wrongdoing... even bordering on institutionalized discrimination (a criminal offense) on behalf of the AF, the Line and so on but not a single comment directed towards the corps. Seriously, how many of us AF nurses have low-GCS links in our chain? The email I saw was filled with a who's who of AF resource sapping, never-been-deploying, officer club going, on-line Masters degree waving, staff-position squatting, well over 20 year serving, AARP eligible, immovable objects who as a collective are a perfectly irresistible force. No my fellow bondservants we must discard the tyranny of this upper class who goad us to action with scintillating stories of fancy. It’s not all someone else’s fault. We do not accept this continual abnegation of responsibility! We want wholesale change. 1) We are clinical experts, let us practice, reward us, promote us and then let us retire. If we do not want to retire at 20 then make us meet a clinical and physical board yearly to prove we are capable of deploying and preserving life (which by the way is why we exist in the first place). 2) Compensate clinical excellence more than longevity. Seeing how many O-5 or O-6 assignments you can get even though you are already topped out should not be seen as admirable, clever or proof of one’s patriotism. It's a disgrace, everyone see's it but nobody says it. It's an embarrassment to the NC and our country that we let it happen! 3) UP or OUT!!! Make room for the rest of us, I know we have earned it. We make SGN or CC? Great but it's a one-shot deal no double-dipping and no "Oh but that was only a small squadron". Those of us that say we love the AF and really want to serve will proudly serve an assignment as CC or SGN and move on happily when it's over ready to give someone else a chance. Service Before Self... haven't I heard that somewhere before? No, folks you have to clean out your own house before you go poking around in everyone else’s. We have daunting tasks ahead of us fraught with risk since many of the folks directly responsible for our careers fit the descriptions above. Nevertheless, at every level we must fight this fight with Excellence in All We Do, excellence in our clinical practice that outstrips the past (this we are doing already) and Excellence in how we fight! Push these leaders, let them know we want change, write to your congressmen as I have, speak up in any forum you have be it NSM, SOS, ACSC or otherwise. Let your voice be heard that we are tired of being the AF's weakened whining corps, we want change and we want it to start now! WE ARE EXCELLENT, we are proud, and we are sick of our corps blaming everything on everyone else. Do we suffer these discriminations of rank, sex and traditional substandard representation? I am sure we do. However, there are ways to go about it and an email sent from the high places of plenty to the starving serfs in the field below requesting they mount an unarmed attack on a neighboring castle to get their food is actually quite sad. Shame on us and shame on the AF Nurse Corps.

[70gto]

1. Elimate all clinic/FPC slots. It is pointless to pay a BSN prepared nurse to answer T-cons and Triage. A contracted LPN could do the job at a fraction of the cost. Furthermore, there are hundreds of clinic nurses who are not in a deployable billet. I was recently at Tinker AFB where NONE of the nurses deployed during my 2 year tour. It simply don't make sense for some nurses to deploy 3 to 4 times when others have yet to deploy.

2. As a highly skilled RN, I did not join the AF to learn to write OPRs, EPRs, or awards packages. Allow me to do what I do best. All this nonsense about base and wing level activities to prove I am a great nurse has got to go.

3. Model the AF NC off of the United States Public Health Service.

4. Increase promotion rate to 0-4!

[LADYVIOLA]

To each of you Nurses, wanna-be Nurses, lovers of Nurses, and anybody else with whom this thread of conversation strikes a chord; try these suggestions and see if we can generate some added interest and attention.

Go to at least 5 other current threads on the first page of this forum (if you go beyond the 1st page the exposure to those who brouse for conversations is lost). Tie those conversations to some aspect of nursing in the Air Force. Taking care of them, deploying with them, being there for their families, being there for our country, etc. Help them see that Air Force Nursing is ubiquitous to everything and everywhere the Air Force is. Tell each audience in every thread to come to this one and read the subject matter. You get significant cross-talk from many folks who wont come hear unless their curiosity is piqued. Challenge their thinking, engage their intellect.

Go to other forums and start the discussions. Refer them all back to this one.

E-mail this thread to all the Air Force Nurses you can and encourage them to speak up in this particular thread and many others that are read here.

E-mail this thread and subject to senior leadeership in the Air Force and ask them for answers to the questions raised here.

If each of us do some of what I suggest above then maybe the message will get further out.

Retention of good nurses is a positive step in the direction of solving the nurse shortage in the Air Force.

Long range (look beyond 2 years) recruiting at colleges that produce nurses is another step. Nurses on recruiting is a step.

Add nursing to ROTC units.

Address the nursing shortage straight on and advertise for new accesions.

Pay retention bonuses.

Promote through Major at a set rate.

Reward those who deploy.

Reward the Clinical, bed-side nurse.

What else, let's hear some added suggestions for action. It isn't an answer to just complain. How do we let many others outside of nursing hear the problems?

If each of us does these simple things a groundswell of interest can be generated.

[sparrow56]

I think it’s a crying shame that as nurses we are even having this discussion. Why are promotion rates for NC officers lower than line officers, why is the bedside nurse forced be certified to be eligible for promotion but not paid a monthly bonus for their years of expertise, and when will we realize the solution to the nursing shortage is not lowering our entrance standards into the nursing profession? This problem is bigger than the Air Force-it resides in a culture which values youth over age, power over nurturing and technology over touch. The Air Force must lead the way in changing the perception of nurses as “the handmaiden” and align us as professional military officers.

[LADYVIOLA]

Who out there is reading this? What is your position, what is your view? What have you done about being heard and ensuring others are encouraged to speak up? Take a moment and figure out how to work this forum. Reach out to other thread topics and tie their topic to Air Force nursing somehow. Invite those readers/writers to read this thread and make their comments.

Recruiting/retention of Air Force Nurses is a chronic problem that has become alarming.

Recruiting bonus/retention bonus/promotion/respect/advanced education/acknowledment of the clinical med-surge nurse (BC-RN)/reduction of entrance level qualification for nurses/seeming abandonment by senior nurses as they become managers and administrators. All of these issues and many more are hot-buttons worthy of long discussion. What is DOPMA? Where did it come from? Why is it what it is? What needs to be done to change it? How?

Air Force Nurses, along with Army and Navy Nurses, puts her/his hands and heart in places that no other person even thnks of. We are there for birth and we hold your hands as you pass on. We give physicals, nurture hurts, give advice, provide a second confessional, keep secrets. We deploy with you, and repair you. When you look up from your bed or gurney its our eyes that look into yours, it's our hands that hold yours, it's our voice that sooths your fear. We fly to Landstuhl with you and on to Andrews or Dover with you. We gently change your bandages, wipe your butt, cry over your wounds and we do it 24/7x365.

Where is everyone when we need a little help?

[evac-nurse]

I also would like to echo the comments on the board here. I am a prior enlisted nurse who came from the line, and let me tell you the view from the line is that we are all second class citizens! I hear it all the time: They don't deserve SOS slots, they are not real officers! I have heard all sorts of anecdotal stories of how incompetent nurses are at being officers, and seen no evidence to back it up. I was 9 years enlisted and an ROTC graduate, and I have been told by other officer that nurses are commissioned right off the street, and that all they have to do is take a short class on how to wear the uniform. The sad thing about it is that these attitudes did not come from the ether, they were taught.

My brother is an F-15 pilot....no masters degree, no deployment experience. He will be promoted to Major next year (we have roughly the same date of rank). I have a masters degree, have been deployed 4 times, have nearly 300 combat hours at a flight nurse, and I will wait patiently until a time around 3-4 years in the future that has not yet been determined. Whats wrong with this picture? Pilots are important, but nurse professionals are important too! My brother agrees by the way...

I had a recent discussion with a nursing professor from Idaho state who was doing a study on men in nursing. She had found an interesting relationship in her studies: Men had more of a tendency to refer to nursing as a profession, and women had more of a tendency to refer to it as a calling. Why is this relevant? We need to get out of the "calling" mindset, which sets us up to be door mats, and start thinking of ourselves as highly educated professionals! We need to advocate for and PROMOTE OUR NURSES!

[Scruples]

It is sad to see the disparity of promotions between the Nurse Corps and the Line of the Air Force.

A friend of mine was a Captain in the Nurse Corps and worked with a 2nd Lieutenant about 10 years ago. The Lieutenant cross-flowed into the Line of the Air Force about 8 years ago.

She recently deployed to Iraq as a Major and by chance met this same 2LT at the Dining Facility wearing a Major's rank insignia. The former 2LT was actually embarassed by the weird situation because my friend served as one of his mentors in the Air Force Nurse Corps.

It is about time to change the UNJUST situation of Nurses in our Air Force !!!

I wish they allow unions in our military like they do in some European countries.

Nurses of the world unite! You have nothing to lose but your chains!

Let's go on STRIKE!

[LovinLifeasAF_RN]

I have read all the messages in the thread of Nursing Shortage and am dumbfounded of all the fantastic thoughts, ideas, and needs. What I don't understand is who is speaking up where it needs to be heard. It is obvious that there are concerns by all the responses.

1. Promote like the doctors get promoted. Up to Major. They do not get looked at for their certifications, PME, degrees.
2. When young Capt's hear that the lazy civilian (sorry...to those who are offended) is getting paid an astronomical amount for doing nothing, why stay in? In San Antonio, the civilians at 2 bases just got an increase of $7K to $20K in allowance (not base pay) annually. Why not give bonuses to the active duty nurses for staying longer? After doing research for my MSN, I have found that the young Lt's and Capt's base their decisions on where the money is. They are not looking at the added bonus of a retirement system or the travel, etc. I myself would stay til I was kicked out (made to retire) if the pay was right. I am leaving the military after 20 plus years (prior enlisted) because I have been recruited by a few hospitals for my skills and they are going to pay me for those skills. I have not met the Majors board yet and it looks like I won't for another 1.5 years, when my line side breathern with the same time in service have met the board 2 years ago.
3. Bonus those who deploy more than once. I have been 4 times in the past 5 years when many nurses I know have not even been once. I know that it is our mission and I am fine with it, but when others have not even deployed, we have a problem. There have been LtCols deployed who have not worked a floor in 17 years, yet are put in positions of leadership and guidance of nurses who work L&D, peds, etc and are expected to jump right into adult medicine. It is not working.

If I were to be able to change things I would have the promotions better, start bonuses ASAP, and leave the Majors and Lt Cols on the floor more often. Better mentorship ranther than a new 1Lt or Capt precepting and guiding. AF nursing is the best out there, but it is going downhill fast.

[Premie52]

After reviewing all the posting regarding the poor promotion rate, poor opportunities for nurses and how far behind the NC is compaired to the line side, it makes me sad to think that our culture/AF leadership both AFMC and line side still do not fully appreciate what the NC has to offer to this great country. Tossing money at the problem in the short run may retain a few nurses but history has proven that money alone will not fix the problem. To fix the current issues that have faced and continue to face the NC requires awareness from all corp leaders to include congress. We must have a fair playing field regarding PME/promotions and professional bonus like the physicians and CRNAs. The other huge issue I have noticed in my 26 years of military service is that there has never been a male NC 2-star....why? When I talk to senior male NC leaders the same comments are voiced....we are the wrong gender" This is very wrong, these comments tell me there is as much segregation among the nurse corps as there is with other corps towards the NC in general. There is much to be done by our leaders to correct the past promotion/pay opportunities however this is much that the NC needs to consider within its own ranks.

[AFRN]

I am an AF nurse that has only been in for 4 years. I question my decision to stay in the military. I was stationed at Lackland and deployed every 15 months (twice once to Iraq and once to Iraq and Afghanistan) when some never deployed or got to deploy or shall I say go TDY to Germany and more than once!! I PCS'd at the first chance--doesn't matter where--to get out of there. The critical care nurses are being deployed often when other bases deploy infrequently. I realize that the decision has to do with staffing but come on--we had to close beds at Wilford Hall to deploy our people. A break every now and then wouldn't hurt and I am talking a PCA to a clinic or some other area such as PACU or Same Day Surgery--just to get a break so we won't burn ourselves out!! Critical Care is stressful enough and especially in the desert where we work 12 hour shift 6 days a week. Mistakes happen when you work a person that much!! We had to watch each other. I myself caught (and thank God averted) 3 people that almost made life threating mistakes!! I myself caught and averted myself making a critcal error with medication. We as nurses would never make some of the mistakes we did in the states as we did in the desert. We were so mentally and physically exhausted! I have been thinking about crossing over to the Uniformed Public Health Service (Navy) just to get away from the deployments--as have others and that have followed through. I realize that is not my calling. The other issue I have is the promotion situation. The NC is hard on their people!! We have more boxes to check for promotion and sometimes a longer wait to make rank--not fair!!

[evac-nurse]

Premiere52 has an excellent point: Whay are males so grossly under-represented in senior NC positions? I did some number crunching on the last promotion board and found an interesting statistic:

Roughly 35% of the Majors promoted were men
When you get to LtCol, the number drops to near 10% for men

Does anyone on this board have a plausible explanation for this? I have not rushed to judgement on it yet, but I am very interested in hearing what others on this board think about why this is happening.

From what I am getting from some very senior nurses on this board is that the NC is used as a doormat because of its majority female status.....Why isnt diversity embraced to mitigate that effect? This is the year 2008 and more and more men continue to join our ranks, and I still see a gross under-representation of male O-6s. Does the Air Force use the nurse corps to ramp up its stats on female promotion similiar to the way DOPMA uses the nurse corps in other ways? I am not naiive enough to believe there is a sinister plot, however I would like someone to offer insight if they have any.

The one beneficial thing about the shortage we are experiencing is that something will have to be done about it soon, or the Air Force will no longer have a mission ready nurse corps. Sooner or later it will get the attention it needs and we will see the results we are looking for (I can be hopeful right?). The Air Force will have to compete with te civilian sector and the only way they will be able to do this is by promoting us fairly, offering cert bonuses, and making life as a nurse corps officer generally better. Fortunately, or unfortunately, depending upon how you look at it, the time is now if they want to fix this problem. More empty and distant promises (i.e. "we'll have cert bonuses next year," "we'll have more promotion boards soon,") won't cut it anymore.

I have 2 more years until retirement eligibility, and plan on working somewhere my education and experience are valued as soon as that day arrives. It will take a fundamental change within our corps to convince me otherwise. I love serving, and certainly love caring for our wounded troops, but I feel insulted and let down by the AIr Force and its lack of progress on this issue. Air Force leadership: There are hospitals lined up right now waiting to hire me......Not a threat, simply a reality.

[Phdpsychnurse]

Evac Nurse: As you were talking about the air force finally having to face this nursing shortage it suddenly dawned on me that for many years they (AF nurse corps) were quite successful at having nurses believe they were not in demand on the outside and this has actually served to keep nurses from exploring their options. If you have only worked in the military setting, it would be very difficult to know just what opportunities are open to you and of course you might be very hesitant to take a risk for the unknown.
Again, the solutions for the air force nursing shortage involve a paradigm shift and cultural change among senior leadership, an economic change, and a professional identity change which are all things that require time and a willingness to devote attention to the issues..

[Scruples]

Electronic access: http://bosun.nps.edu/uhtbin/hyperion-image.exe/07Mar%5FMessmer.pdf (746 KB)

Personal author: Messmer, Scott J.

Title: Analysis of the retention and affiliation factors affecting the active and reserve Naval Nurse Corps [electronic resource] / Scott J. Messmer, Kimberly A Pizanti.

Publication info: Monterey, Calif. : Naval Postgraduate School, 2007.

Physical description: xvi, 97 p. : ill. ; 28 cm.
General note: Thesis Advisor(s): Yu-Chu Shen, Cary Simon.
General note: "March 2007."
Dissertation note: Thesis (Master of Business Administration)--Naval Postgraduate School, March 2007.
Bibliography note: Includes bibliographical references (p. 91-95).

Abstract: This thesis assesses the factors affecting retention rates in the active Naval Nurse Corps and afilliation rates with the reserves among those who left active duty services. The thesis is composed of two parts: (1) an organizational analysis of the Navy Nurse Corps utilizing the Organizational System Framework and the Organizational Configurations model; (2) an empirical analysis to analyze charactreristics of those who are retained in the active Naval Nurse Corps and those who affiliate with the reserve Naval Nurse Corps using multivariate logit regressions. Cohort data files were compiled from the Defense Manpower Data Center and the Bureau of Medical Information Systems. We analyzed three groups of factors: demographics, professional characteristics, and military experience. Factors associated with positive retention rates include being a male, a minority, having dependents, being prior enlisted, having a subspecialty beyond general nursing, and having a postgraduate degree. The best accession sources were the Medical Enlisted Commissioning Program and Direct accession. Factors associated with positive reserve affiliation rates include being prior enlisted and having a subspecialty beyond general nursing. Our major recommendations for the Navy include shifting focus from accession bonuses to retention bonuses and increasing the Medical Enlisted Commissiong Program accessions.

Technical details: Mode of access: World Wide Web.
Technical details: System requirements: Adobe Acrobat reader.
Local note: US Navy (USN) author.
Personal author: Pizanti, Kimberly A.
Corporate author: Naval Postgraduate School (U.S.)
Other forms: Also available in print.

[sparrow56]

As a fellow psych nurse I agree 100% with your view of the AF mental health nurse. I too believe we need to place value on specialization and having career tracks to grow the expertise we need.

[Scruples]

Slowdown's Side Effect: More Nurses
Economy's Woes Prod Many
Who Left Field to Return;
Brushing Up on Anatomy
By CONOR DOUGHERTY
May 7, 2008

The ailing economy is helping to ease the nursing shortage.

With house prices falling and the cost of gasoline and food rising, many nurses are going back to work, in some cases to make up for the income of a spouse who has lost a job. Hospitals say part-time nurses are taking on extra shifts. And nursing schools are seeing an increase in people applying for refresher courses on the ins and outs of modern hospitals. Some older nurses are putting off a planned retirement.


"We are seeing a temporary lessening of the nursing shortage," says Jane Llewellyn, vice president of clinical nursing affairs at Rush University Medical Center in Chicago. But, she says, "as soon as the economy turns up we'll see them staying home again."

It's a familiar pattern during economic slowdowns. For years, the high demand for nurses has allowed them to design work schedules that suit their financial and family needs. Many start off working full time on difficult shifts and then reduce their hours when they have a family -- the profession is more than 90% female -- or as they approach retirement. But when the economy goes sour, many nurses go back to work full time.

Dana Goodin, a nurse at Chicago's Rush University, worked three evening shifts a week for nearly two decades, giving her time to raise her four children. But after her husband, a carpenter, was laid off late last year, Ms. Goodin began working four days a week to boost the family's income and to qualify for cheaper health benefits. Although her husband has since found a new job at a retail warehouse, he makes just half of his former salary, and Ms. Goodin is looking for another shift to push her above full time.

The nursing profession also is attracting greater interest among new recruits, drawn by expanding job opportunities and rising wages in some places. Nursing school enrollment surged in the wake of the Sept. 11, 2001, terrorist attacks and the economic slowdown that followed. Enrollment continues to grow apace, though at a reduced rate, and schools are turning away thousands of qualified applicants for lack of faculty. Even so, nursing experts predict shortages will grow in future years as demand for nursing services outpaces the number of professionals entering the field.

For hospitals, the renewed interest in nursing is a relief. Shawn Tyrrell, chief nursing officer at Rush-Copley Medical Center in Aurora, Ill., says that until last year the hospital used outside employment agencies when it didn't have enough nurses to cover the shifts. Now, despite an increase in patient volume, the hospital's own nurses want extra hours, so it doesn't need the agencies. "We've been able to handle that volume increase through our own staff members," she says.

The nursing shortage began in the 1990s as older nurses started retiring and there were fewer newcomers to take their place. The crunch got worse as baby boomers got older and demand for health care increased. By 2001, there were 126,000 vacant nursing positions in the U.S., according to the American Hospital Association. That means about 13% of all nursing jobs were unfilled.

Beefing Up Recruiting

ON THE JOB


The economic slowdown is one factor helping temporarily to ease the nursing shortage.
• Many nurses are returning to the profession, or seeking more hours, after a spouse loses a job.
• Nurses who have been out of the profession often require refresher courses before returning to work.
• With more nurses available, some hospitals are finding it easier to schedule shifts.
RELATED ARTICLE


• Would-Be Caregivers, Beware To attract nurses, hospitals have increased wages and beefed up recruiting, including from overseas, and have offered potential hires signing bonuses of cash or even new cars. Hospitals have also taken steps to keep older nurses in the work force by making their jobs easier, including replacing hand cranks used to lift beds with automated lift devices, bringing in lift teams so nurses don't strain themselves picking up patients, or putting supplies closer to patients' rooms to cut down on walking. By the end of 2006, the nurse vacancy rate had fallen to 8.1%.

Of course, nurses who haven't been working for some time can't just jump back into the job. Nurse-education requirements vary from state to state, but in general the longer the nurse has been out of the work force the more likely it is he or she will have to complete a refresher course to be relicensed. The Mount Carmel College of Nursing in Columbus, Ohio, for instance, offers a refresher program for $700 plus the cost of textbooks that includes 230 hours of online courses, covering such topics as anatomy, new medications and privacy regulations. Students also log 100 hours working in a clinical setting such as a nursing home or a hospital.

Economic Indicator

For the past few decades, nursing has been a kind of reverse economic indicator. In periods of economic weakness or recession -- including in the early 1980s, the early 1990s and earlier this decade following the technology-company bust and the Sept. 11 attacks -- the number of full-time nurses grew at an average annual rate of 3.5%. By contrast, in times of healthy economic expansion, the increase has averaged just 2.4%, according to an analysis of government data in "The Future of the Nursing Workforce in the U.S.," a book by Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, Douglas Staiger, a Dartmouth College economics professor, and David Auerbach, a principal analyst in the Health and Human Resources Division of the Congressional Budget Office.

Last year, there was a net increase of about 113,000 nurses in the work force, the largest increase since 2002, and most of the added nurses were over 50 years old, according to the Census Bureau. The pattern has continued this year. Although the U.S. economy lost 20,000 jobs in April, the fourth monthly decline in a row, health-care employment rose by 37,000 and is up 365,000 jobs over the past 12 months, according to Labor Department data released last week.

"In bust periods, unemployment is rising, which means there is a lot of pressure on married RNs to be working," says Mr. Buerhaus.

Jennifer Schlesser, a 57-year-old Ellicott City, Md., resident, says she worked as a nurse for 27 years before leaving the profession a decade ago, feeling overworked and underpaid. She went to work in the mortgage-lending industry, but the housing slowdown has forced her to change employers and has cut into her commissions.

Refresher Courses

Ms. Schlesser is currently enrolled in an online refresher course for nursing and she expects to be relicensed by next month. She plans to work part time in both nursing and mortgage lending. "Whatever works out best," she says.

But over the long term the nursing shortage is expected to continue and eventually worsen, as retiring baby boomers ramp up demand for care. In their book, Messrs. Buerhaus, Staiger and Auerbach use Census data to project that the nursing work force will plateau in 2015. By 2025, they estimate there will be a shortage of almost 500,000 nurses, representing a vacancy rate of 40% or higher.

Write to Conor Dougherty at conor.dougherty@wsj.com

Source: The Wall Street Journal, see link http://online.wsj.com/article/SB121011475341071811.html?mod=pj_main_hs_coll

[majorrn]

Throwing money at a burning building will not put out the fire! Money (rank) is part of the problem but not the only problem. 1) Nursing schools are suffering without enough educators to accommodate those signing up hence waiting list. AF can pay for the schools, but what are they doing to work in the community to help educate the nurses? 2) Being told to shut and color as a professional and having minimal say in where you live (I have spoken to the nurses who have gotten out and this seems to be the #1 problem with them) Maybe having more control over your assignments would help 3) Making deployments as part of promotion, yet deploying same people over and over again. I know of many nurses who volunteer to be deployed and never get picked up, so look at deployment history and share the wealth 4) Nurses take on a lot of the work and responsibility to make rank. This is especially difficult for those nurses in provider positions. Units are not going to decrease access by letting a nurse providervolunteer for something that will take them away from patient care. Maybe place nurse providers in same pool with physicians in making rank. (you have to kill someone not to make rank) 5) Some nurses want to sit behind a desk, while others would like to stay at bedside. reward those who are willing to work the shift work and stay at the bedside. Nurses are getting out because they feel they have done their time at bedside, okay let them sit at the desk This one assignment bedside and then another clinic does not work. There are too many clinics and not enough in patient places to pcs to. Consider partnering with VA's and of course joint force facilities. I would love to work in San Diego with the navy. Look at those communities no one wants to go to and see how civilian medical care is in that area. That way we could reduce the needs in that area. Then of course the whole staying in Capt position for long period of time. The AF also puts a good amount of money in new recruits knowing you may only get 4 years out of them, what about those people who have stayed behind? Put a cap on the amt of time someone can stay in. If we are top heavy in rank what is an incentive to get these people moved out?

[Scruples]

Electronic access: http://bosun.nps.edu/uhtbin/hyperion-image.exe/07Mar%5FMessmer.pdf (746 KB)

Personal author: Messmer, Scott J.

Title: Analysis of the retention and affiliation factors affecting the active and reserve Naval Nurse Corps [electronic resource] / Scott J. Messmer, Kimberly A Pizanti.

Our major recommendations ...include shifting focus from accession bonuses to retention bonuses and increasing the Medical Enlisted Commissiong Program accessions.

The USAF can learn from this Navy study by adding retention bonuses for NC officers. A financial reward in addition to the Conditional Reserve Status (CRS) makes a lot of sense.

[melmonica]

Get the nurses out from under DOPMA and we won’t have a shortage of experience clinicians. Struggling for promotion pushes our seasoned nurses away from patient care....and sometimes pushes them right on out of the AF out of frustration with a system that is broken.

When DOPMA was instated, the composition of the USAF Nurse Corps was already negatively skewed based on the real and perpetual history of gender discrimination. This is confirmable FACT. Its because of ancient gender caps on field grades that have since driven a bottom heavy grade structure. Nurses are waiting 13 years to hit the Major promotion board, everyone else only waits 9 years. Quit treating nurse like third class citizens (officers)!

Promote them and pay them. Nurses make up HALF of the AF medical deployers. They are operational and phenomenal officers. When something has to get done, is the doctor the one doing it? Is the Administrator? The Dentist? Heck no....it's the nurse that does it!


Treat us fairly and with equality. If this type of discrimination was happening to the Doctors, the Administrators, and the Line Officers, there would be an outcry to FIX IT NOW and stop this discrimination and belittling. Are we, as nurses less valuable?

If it weren't for nurses, you wouldn't be able to FLY FIGHT or WIN. Right the wrongs and take Nurses OUT from under DOPMA constraints. Let us promote EQUAL in proportion to all the other officers in the AF!

[evac-nurse]

Majorrn: All of your points are great, and I totally agree with you on the deployment issue. The AEF cycle was supposed to make things "fair" and "predictable." It has not. It is a tool that serves those who employ it (not the warfighter as intended). If you are "in the bucket" you are ripe for the picking......if you are not, then at the stroke of a computer key, you are now "in the bucket" and ripe for deployment. The problems don't end there; I remember going to NSM a few years ago, and quite literally half the class was on some ort of code "C" limitation for deployment. The job requires deployability folks! Many of the nurses who are carrying their end of the bargain are also carrying at least one other person's end as well! The deployment process for nurses should not be AEF driven, but based simply upon when you last deployed. It is the only way to keep things fair. And if they are going to do that then there should be more dispersal of taskings accross the Air Force instead of places like Lackland that live in a "constant deployer" model, and places like Tinker that barely deploy. It is not beneficial to our total force to over task one MTF and undertask others. I am sure there is some high level reasoning for the way we are deploying that many in the trenches dont understand, but regardless of the reason, from a business point of view, it makes no sense for sustainability of skills across the corps.

[LADYVIOLA]

Is there a forum, open door, line of communication, et al to the senior leadership of Air Force Medical or the Air Force Nurse Corps? (Sorry I don't know all the right nomenclature, and lingo yet.) Nurses are a well educated (everyone of you are at least a Bachelors of Science Degree holder), compassionate (for most Nursing is a calling NOT a profession), driven (quite a few of us got our education while working and we have advanced that education while on the job) group of people. We are professional and persistant.

Who is bitching to whom about the organization and employment of Air Force Nurses? If Senior Leadership is hearing and not doing anything, who has taken this to their Congressman/Senator? When was the last expose' provided to Ai8r Force Times?

I'm a Nurse. I will soon be an Air Force Nurse (God willing). I don't relish stepping in to a self made hell. If you know about it, and do nothing other than whine then you've made yourself part of the problem.

Some thoughtfully put together facts organized in an easy to read/use package, with some overarching suggestions for fixes could be passed around in a quick way and momentum for change will soon be in the air.

I read here in this thread, the problems, the sources of the problems, and the proposedfixes. Not everything is highly polished or perfectly pertinant, or of the highest priority, but there's a lot here.

Recruiting is done by folks who don't know the Nursing profession, folks are discussing a potential reduction of education/experience standards (if the Air Force acceps LPN's, ADRN's, and foreign Nurses where does that leave the BSN/MSN?), recruiting $$$$$$ not just for accession bonuses and tuition payoff's but for travel, events, more and better qualified recruiters, ROTC in Nursing schools, shorten the TIG/TIS regarding promotions, Nurse/Doctor interaction and respect, Nurse (Officer)/Med Aid (Enlisted) interaction and respect, advanced education/experience to qualify for promotion, acknowledgment of the good old Bedside Nurse (the Med/Surg Nurse is the backbone of Nursing) as a specialty (BC-RN) rather than the place from which to advance, run away from, look down upon, leave for the junior amongst us, etc..

The Air Force Nurse shortage and mismanagement issue impacts EVERY NURSE IN THE AIR FORCE!!!!!!!!!!!!! If it impacts every Nurse, then Air Force Senior Leadership ought to understand that EVERY AIRMAN (from General Schwartz to the newest Airman) AND ALL OF THEIR FAMILY MEMBERS IN THE AIR FORCE IS IMPACTED. Nurses are ubiquitious to the Air Force.

If low recruiting persists, if low retention persists, if disrespect persists, if promotions continue to be slow, and all the other things we are talking about here continue, then this is what I suggest to you my sisters and brothers in Air Force Nursing: Speak up in a meaningful and constructive way and be part of the solution, or shut up and hang back and suffer or benefit from the efforts of others, or get out and fill the vacancies that exist in the civilian hospitals and medical facilities throughout the US. If you get out, you will get more benefits, better working conditions, higher pay, and more oportunities for advancement. In a world of LPN's and ADRN's the BSN rules.

I love this thread. It is enlightening. With all the horse sh*t piled up around us there must be a pony near by. Always look on the bright side of life.

[LADYVIOLA]

Why has everyone ceased speaking up?

[BRUWIN]

I'm a Nurse. I will soon be an Air Force Nurse (God willing). I don't relish stepping in to a self made hell. If you know about it, and do nothing other than whine then you've made yourself part of the problem.




You mean your not a AF nurse already? You're already complaining and you have yet to put a foot through the door? C'mon lady...please wait until you prescribe your first dose of motrin before you start.

[Hero]

What is the current retention rules in the Nurse Corps related to those who had three times been passed over promotions to Major?

Do they allow you to stay in and serve until you reach the 20 year mark.? Or do they force you out like the Line of the Air Force officers?

[Elwardo]

I've been an AF nurse close to 12 years now and I must say that it has been a blast so far. However, within that timeframe, I have also seen an exodus of highly qualified, trained and disillusioned nurses. This is a sad fact considering that the majority of them entered with a patriotic and motivated zeal and yet the system failed them somehow along the way.The time to act on this issue is right now. The military could not afford to wait any longer considering the state of affair the nursing shortage is in right now. Aside from rumping up our recruitment, retention, pay and promotion processes and incentives, I'd like to propose a possible remedy to the problem. As it stands now, there are a lot of licensed but foreign trained/graduates practicing nursing in the United States. Why not tap into this pool? There are a lot of them who are just as eager to join the military ranks but couldn't do so because of the hurdles they have to overcome to get in (the biggest one of them being the NLN rule). Ease some of the requirements, allow and grant waivers for certain restrictions. If their credentials are good enough to allow them to work in the civilian sector (coupled with the right skill sets, citizenship and length of experience) why couldn't the military take them in as such and offer them commissions? Something to think about... Thanks.As a retired AF nurse with a total of 25 years of AD service (8 years enlisted and 17 years as a NC officer), the suggestion that we should tap into the pool of foreign nursing trained/graduates to help fill the shortage of AF nurses and ignore having them meet the requirements of the NLN should never ever happen!* I am at an age now that allows me to choose whether to seek medical care at a military hospital or in the civilian community.* I recently chose to have an elective back surgery at a civilian hospital.* The nursing care I received was almost totally from foreign trained/educated nurses.* Some of the problems I* observed were (1) a severe language barrier; (2) lack of knowledge pertaining to the medications I was receiving [I questioned them about the medications and their use]; (3) a lack of genuine concern and caring - they were almost robot-like in giving care; (4) They commicated with their co-workers in their own language in front of me; and, I felt truly uneasy with the care I was receiving.* As a nurse recruiter while on active duty, Puerto Rico was one of my areas of responsibility.* I discovered the same basic areas of concerns in my visits there, although I do know some very outstanding AF nurses who came from Pureto Rico.* Further, in the educational universities that I visited I discovered that the schools used English text books, but the classes were taught in their native language - not very conducive to giving the students any desire or need to learn English.Your suggestion does have some merit, but bypassing meeting the NLN requirements should not be an option.

[Elwardo]

LadyViola - YOU ROCK GIRL!! You're hitting all the nails squarely on the head!!

[Scruples]

The requirements for admission as a Nurse Corps officer in the Air Force and the other services not only include a BSN earned from a National League of Nursing (NLN) recognized nursing school, but also American citizenship.

Many foreign graduates are not American citizens and that by itself will preclude them from serving as commissioned officers.

There are foreign graduates who have several years of experience in American hospitals and later on received their advance degree's (Masters &/or PhD) from NLN recognized nursing schools in the United States. In these cases, the Air Force may benefit by considering the waiver for the American citizenship requirement.

[Elwardo]

You're absolutely correct in what you say Scruples, however, becoming a military officer and nurse implies loyalty to our country, i.e. the oath of commission. Could we be sure that a non-citizen of the US of A could maintain that loyalty to two countries? Perhaps if a caveat was added that US citizenship would be obtained within a reasonable time frame after commission, your suggesstion would be acceptable. I guess I'm just old school enough to believe that if you're going to serve our country you need to be a citizen of our country.

[Scruples]

I do not see any problem with the citizenship issue because most of these foreign grads are probably legal immigrants in the first place. And immigrants are allowed to serve in the military and they do take an oath of allegiance when they enlist in the armed forces.

In addition, President Bush issued the executive order to facilitate the naturalization of immigrants serving in the military during wartime.

Source: http://www.ptsdsupport.net/becoming_american.html

In fiscal 2004, 7,627 alien soldiers, sailors, airmen and Marines took the oath of allegiance. That's nearly 15 times as many as the 518 who became citizens in 2000, according to U.S. Citizenship and Immigration Services. In the first three-quarters of the current fiscal year, 3,397 servicemembers have been naturalized.

President Bush issued an executive order in 2002 making it easier for foreign-born U.S. troops to naturalize. Congress further modified immigration laws late last year [2004].

As a result, any legal resident who enlists in the military can immediately petition for citizenship rather than wait the five years required for civilians to start the process. Those in the military previously had to wait three years to become citizens. And $390 in petition and fingerprinting fees are waived for servicemembers.

Citizenship applications from servicemembers more than doubled in one year to almost 10,000 after Bush's executive order in 2002. In the first three quarters of the current fiscal year, the Immigration Service has received more than 11,000 naturalization petitions from soldiers, sailors, Marines and airmen.

[Elwardo]

Scruples,
I respect you and your very well presented argument for the foreign nurse issue. I hope you can do the same for me. However, I think the two of us are at a stalemate and probably should just agree to disagree on this subject.

What do you think about the e-mail that's floating around from MJ Rank pertaining to the AF nurse shortage aSpellnd recruitment goals? I personally don't see how flooding the AF Times with messages about how to solve the problem is an appropriate way to solve the problem. There are many great ideas - specifically taking nursing out of DOPMA - bonuses - increased pay - equal opportunity deployments - promotions etc., etc. However, I do not think that we as a group have the power to make any of those changes. Isn't that why we now have two major generals in the SG's office? I'd be interested to hear your take on the subject.

[Scruples]

I have not seen the e-mail from MJ Rank.

Just from my sixth sense, the likely current problem is recruiting the worker bees (CGO) into the Nurse Corps. There may also be a retention issue with junior O-4s, but I do not have any statistical data.

It may be a good idea to do a manpower study of the Air Force Nurse Corps to identify the areas we are short of staff and also get a gauge on the reasons why people leave the Air Force after their 1st or 2nd term.

Once you have the data, then the "powers that be" can tailor the retention tools (bonus mainly). Who has the "belly button" on the DOPMA rules? Frankly, I do not know.

I posted a research study (thesis) of the U.S. Navy Nurse Corps retention problems and some recommended solutions. I do not think everything in this study applies to the USAF.

As far as the foreign graduates with experience and advance degrees from NLN-recognized schools, most of them are probably in mid-level positions in the civilian world and will not likely join the USAF for a Second Lieutenant or even a Captain's pay for that matter. Many have established roots in the civilian sector and not likely to be amenable to a life of PCS moving every 2 to 3 years.

I know some prior service people who did not mind taking a pay cut by joining as Second Lieutenants when they already have the equivalent of a Captain's pay in the civilian world. These individuals had 8 to 10 years of prior-enlisted service and usually have O-1E pay. There is an incentive to stay for these individuals because they only have to do 10 to 12 years to complete the 20 years and retire early. This may also explain the good retention of prior-enlisted nurses in the Navy study.

[THELADYKT]

Depends..... While he is not foreign..... My husband had 9 years enlisted service and almost 10 on the outside as an RN and came into the Air Force as a Capt. So long as they are naturalized citizens, I'm sure if they had enough civilian experience, they could come in as more than an O1

[Scruples]

Yes, the AF Nurse Corps recruiter gives 50% constructive credit for civilian experience. In the case of someone with 10 years civilian RN experience, that is the equivalent of 5 years in the Nurse Corps.

If 4 years in the Nurse Corps is what it takes to make Captain, that means this individual comes in at Captain plus 1 year time-in-grade (TIG).

Similarly, a civilian nurse with 4 years RN experience comes in as a 1st Lieutenant.

And a civilian with 2 years RN experience comes in as a 2nd Lieutenant with 1 year TIG.

[Scruples]

Nurse Enlisted Commissioning Program
By Rod Powers, About.com

Source link: http://usmilitary.about.com/od/airforcetrng/a/necp.htm

May 5 2007

The Air Force has established a new commissioning program for enlisted members who desire to obtain a bachelor of science degree in nursing and become a commissioned officer nurse in the United States Air Force. The program is called the Nurse Enlisted Commissioning Program, or NECP. Those selected for the program will attend college full-time at an accredited university, while remaining on active duty.

Selection boards for the program will be conducted periodically. The first selection board is scheduled to be conducted at the Air Force Personnel Center at Randolph Air Force Base, Texas, in July. Applications must be received no later than June 25. The nurse corps hopes to select 50 students for the upcoming fall semester.

"We are very excited to offer this accelerated nursing scholarship to our enlisted Airmen," Maj. Gen. Melissa A. Rank, assistant Air Force surgeon general of the Medical Force Development and Nursing Services, told the Air Force News Service..

"They are the backbone of our Air Force and a proven, reliable and highly respected force multiplier," the general said.

"We see this endeavor as a win-win all around; the nurse corps gains vital military-tested and proven nursing assets, the Air Force retain these invaluable members of our family, and the individual gains exceptional knowledge and skills to further their academic and professional careers," she said.

Eligibility Requirements

Applicants must:


- Be active duty, E-4 and above
- Be a citizen of the United States (a certified copy of birth certificate, passport or certificate of citizenship/naturalization is required)
- Be commissioned by age 42
- Be worldwide qualified
- Meet all the requirements for commissioning
- Meet all prerequisites to complete an academic review
- Have completed 59 semester hours of graded college coursework from a regionally accredited college or university

- Have completed the following courses as part of the required 59 hours:


· general psychology
· anatomy and physiology I and II (labs required)
· microbiology (lab required)
· chemistry I and II (labs required)
· nutrition
· statistics

(College Level Examination Program coursework will be accepted, with the exception of labs)

[THELADYKT]

Nurse Enlisted Commissioning Program
By Rod Powers, About.com

Source link: http://usmilitary.about.com/od/airforcetrng/a/necp.htm

May 5 2007

The Air Force has established a new commissioning program for enlisted members who desire to obtain a bachelor of science degree in nursing and become a commissioned officer nurse in the United States Air Force. The program is called the Nurse Enlisted Commissioning Program, or NECP. Those selected for the program will attend college full-time at an accredited university, while remaining on active duty.

Selection boards for the program will be conducted periodically. The first selection board is scheduled to be conducted at the Air Force Personnel Center at Randolph Air Force Base, Texas, in July. Applications must be received no later than June 25. The nurse corps hopes to select 50 students for the upcoming fall semester.

"We are very excited to offer this accelerated nursing scholarship to our enlisted Airmen," Maj. Gen. Melissa A. Rank, assistant Air Force surgeon general of the Medical Force Development and Nursing Services, told the Air Force News Service..

"They are the backbone of our Air Force and a proven, reliable and highly respected force multiplier," the general said.

"We see this endeavor as a win-win all around; the nurse corps gains vital military-tested and proven nursing assets, the Air Force retain these invaluable members of our family, and the individual gains exceptional knowledge and skills to further their academic and professional careers," she said.

Eligibility Requirements

Applicants must:


- Be active duty, E-4 and above
- Be a citizen of the United States (a certified copy of birth certificate, passport or certificate of citizenship/naturalization is required)
- Be commissioned by age 42
- Be worldwide qualified
- Meet all the requirements for commissioning
- Meet all prerequisites to complete an academic review
- Have completed 59 semester hours of graded college coursework from a regionally accredited college or university

- Have completed the following courses as part of the required 59 hours:


· general psychology
· anatomy and physiology I and II (labs required)
· microbiology (lab required)
· chemistry I and II (labs required)
· nutrition
· statistics

(College Level Examination Program coursework will be accepted, with the exception of labs)


Looks pretty similar to the requirements for applying to the PA program too.

[FMARRUFFO]

When will it become apparent that military nurses are leaving military service rapidily? I have spoken to many new Lts and seasoned nurses who all say the same thing? "It is not fun anymore". So many want to spend time with family but are unable to because of job demands and overall low staffing. When will it get back to "taking care of yourself" first instead of the bottom dollar. Lest not forget the current promotion rates for nurses....I know of peers who are Line Officers that are now eligible for 05 and here I remain a 03, what is wrong with this picture? What is going on? I really don't understand it myself but it is becoming quite discouraging to see that nurses are still considered "second class citizens". I hope for better promotion opportunities or else the AF will have a major nursing shortage within the Nurse Corps.

[Concerned Nurse]

It is unbelievable that senior AF leaders have allowed the Nurse Corps to remain "status quo." With the downsized Air Force and demands that haven't accompanied the decreased population...and continuous deployments to support the warfighters, nurses are key to the survival of the warriors. Yet, based on the poor promotion opportunities and promotion boards that lag behind the Line and other AFMS Corps, nurses are greatly undervalued. It is a tragedy. Something must be done...a starting point is to remove the DOPMA constraints and keep the promotion boards in line with the Line Officer timelines.

[Concerned Nurse]

It is unbelievable that senior AF leaders have allowed the Nurse Corps to remain "status quo." With the downsized Air Force and demands that haven't accompanied the decreased population...and continuous deployments to support the warfighters, nurses are key to the survival of the warriors. Yet, based on the poor promotion opportunities and promotion boards that lag behind the Line and other AFMS Corps, nurses are greatly undervalued. It is a tragedy. Something must be done...a starting point is to remove the DOPMA constraints and keep the promotion boards in line with the Line Officer timelines. When nurses feel valued retention may be positively affected.

[Scruples]

Join the PUBLIC HEALTH SERVICE (PHS) uniformed Nurse Corps and continue with your same benefits and retirement:

http://phs-nurse.org/AssociateRecruiterProgram.htm


Do it now! There are no PHS deployments to Iraq or Afghanistan!

Get more respect and fair treatment with your promotions. There are no Line Officers in the Public Health Service.

[LADYVIOLA]

You mean your not a AF nurse already? You're already complaining and you have yet to put a foot through the door? C'mon lady...please wait until you prescribe your first dose of motrin before you start.

I'm not quite a virgin any more. I am a prior service Army Combat Field Medic (CFMB) and Desert Storm Vet. I got out of the Army as an LPN to get my BSN-RN. While going to school, I got the RN, worked in a Hospice for Vets, and work now as a Med-Surg Nurse. I'll be with you as soon as I finish my BSN in a few months.

I'm "bitching" because I want to help create a better professional arena for all Nurses. I want a better deal as a new but mature Air Force Nurse. I might have to serve you a Motrin, but I'll also hold your hand as you pass gently into the beyond in a forward deployed hospital, on the flight to Lanstuhl/Andrews/or Dover; I've done it before and I'll do it again.

I fit the category of the older, prior service, experienced nurse, empty-nester, second/third careerist who wants the adventure and career to go along with my service to you and the rest of the Air Force. I'm experienced, educated, trained, "blooded", physically fit, military oriented, and dedicated. I hear the calling of nursing, and see that I can pursue the profession of nursing in the Air Force. I can go stright to work from COT to the Med/Surge as an experienced military clinical nurse in either combat or in a large hospital setting.

I want the hard job, the deployments, the dirty work. I don't shirk or shy from it now nor in the past. I don't take shit from anybody but I respect the Service, the chain of command, and those senior to me. However, I expect the same.

I'm not bitching, per se, I'm making observations from my perspective. There are several threads here that address this subject from many angles. There are problems in both the civilian world of nursing AND the military. Education, training, recruiting, proper utilization, retention, promotion, assignments, leadership, and expectation managment to name a few.

Do I hear more from you and others, or do you qualify to speak here? What say you?

[Scruples]

Have you heard of an Operations guy who left the Air Force to become a civilian nurse?

This is a sad story:

http://www.aboutmyjob.com/main.php3?action=displayarticle&artid=2323

"Nursing is the worst career in the world.....air force to male nurse"

"Before I was a nurse I was in the Air Force. I did it for 20 years. After I left my Air FOrce career I felt like I wanted to help people.I was a highly trained Air Force Operations guy. I figured I was in wars, had done alot of stressful shit in my day. A real mans man. Now I feel like I am a beat down old used up worthless human.

Let me tell you my story and if you cant see my point then you are surely blind or are not a nurse. Well, one day I was in the Air Force. Wearing a flight suite. Getting laid. taveling the world. Basically, getting treated like royalty because I was an aviator. Well, I retire and go to the VA to apply for educational benefits. I have no formal training that can be transferred to civilian life. I have a wife to support. So I go talk to the VA guy. He makes me take this battery of tests. The next thing I know he says. Have you ever thought about nursing? I think to myself. HMMMM. Is this guy serious? So i take some pamphlets for the local college. I apply and get accepted. I have the GI bill it pays for nearly all my classes. THings are pretty good. I like the University classes and the atmosphere of a big campus. I struggled through the science classes I have to get tutors and study sometimes 16 hoursa day but i get through.

Finally, clinicals come. Im happier than a clam. FInally I see the light at the end of the tunnel. I do great in most of my clinicals. I love my instructors and they love me. Then its time for peds. I here the other students talking. You know, "WHatever you do, dont take proffesor so and so because she is harsh or doesnt understand....." I am like, heck. Im a hard worker and can handle it. SO I pick this rotation with this proffesor with a bad reputation. She is known to send home students for showing up late for clinicals. Also, she is known for being a bra burning man hater. But I have had her in lecture and she seems easy to get along with. SO i decide that I can handle it.

ANyway, clinical goes good for the first week. Then she overhears me talking to some of my female classmates. We are all good buddies. I am joking in the Student Union with some female clssmates. We did get a little "off color". But we were buds. Anyway, things go shitty. She pulls me aside and tells me thatshe doesnt like the way I was talking to the female students. I was receptive and told her that I would watch it in the future. I was given the most difficult patients in the fricking hospital. I was beaten down and scrutinized way beyond what the other female students were. So i dropped the class and retook. The warning signs should have gone up then but they didnt.

I figured this was just a bad experience. ANyway, I have no further trouble making it through. The rest of the instructors were kool. But I look back now to the sights and sounds of the floors during my clinicals. THey were all short on staff. Most of the nurses were the walking dead. They were working 12s or more. SOme with no weekends off. "Mandatory overtime" I saw this one nurse go ballistic on the floor and just stand up and scream and then just break down and cry. She had her head in her hands. "I cant take this anymore." She was prostrate. Crying sobbing. My instructor was standing with all of our little student nurses. I said, "Why dont you go over and talk to her." She said, "THat nurse is a discipline problem. Im going to make sure she is gone by the end of the day."

She went to the nearest phone and called the Nurse Administrator. THe nurse admin came down and sternly said, "go to your locker and get your stuff. Ill get your time card. I want you out of this building now." No one acknowledged her, No one put a hand on this poor womens shoulder. She couldnt have been over 35 but she looked like she was 100. Where was the compassion for our own here? Anyway, this should have awoken me to this hell. BUt is didnt. So I graduate and think hmmmmmm. I will try circulating. Those ORs are like assembly lines. Backstabbing, backbiting. Hate. No compassion to the staff. No understanding that we are not robots. I get burned out and try another line of nursing. Still, they hate eachother. I tried several times to get the nuses together for a beer or to shoot pool. But we are so damned tired. I mean BONE NUMBInG EMOTIONALY DEAD TIRED. No one wants to. BEsides, Ive seen the females set there and backstabeach other. whispering to each other at the charting station. "That Bitch. She thinks she is so damned hot...etc etc etc. Then the next minute they are with the "bitch" and talking about their husbands and giggling. I pissed off my supervisor one day for losing my tempor.

I quit. Now I am just fed up. I have no idea what the future holds for me. I was a nurse for 4 years. I dont want anything to do with it anymore. What is all this crap about it being a proffesion. Heck, we get trated like meat. I worked in a hospital that wouldnt give staff nurses raises unless they took classes, or did some other "self improvement" BS. We couldnt because we were so damned tired and we had families who needed us. They wouldnt give us a raise. Nurses were quitting left and right because of this but they would pay all of these travelors nearly double our saleries plus room and board. I never understood this. On some days there were 50% travelors. Hell, Id rather suck shit through a straw then be a nurse."
-----------------------------------------------------------------------------------------------------------------------

I apologize for the language of the quoted article above. But this is to give a perspective of the Nursing work environment that you may encounter in the civilian world. It could be one of the reasons for the nursing shortage outside.

[evac-nurse]

I have actually known 2 ops guys who went to nursing, and neither liked it very much. I think for the same reasons that were stated in the blog post above. Lets face it, any job is what you make of it. There are some bad organizations, and some good. If you work for a bad organization, then do your homework and go work for a hospital that is known for treating its nurses well. What nobody seems to realize for some reason, is that we have so much labor power! If we organized effectively, led effectively, and conducted ourselves in the same "protect your own" fashion the physicians do, we could really set the ground rules for what we will tolerate/ accept.

I have worked both civilian (recently via moonlighting) and military nursing, and would be foolish to assert that one is better than the other. Too many factors go into making a hospital "bad" to work for. If there exists a backbiting, uncooperative culture, it is usually indicative of leadership that either takes part in, or sanctions that type of behavior. One thing I find particularly bad about the Air Force is that positions are filled via our promotion (socialist) system, and not individual merit. I have seen a number of utterly incompetent nurses rise through the ranks due in part to our "up or out", paper tiger based promotion system. Likewise, I have met junior Captains (armed with advanced degrees) that should be in upper level leadership positions, but have to wait nearly 10 years before they can. Basically, if you have your squares filled and are willing to wait out the ridiculous promotion time frames, then you will probably make it to LtCol. Now whether or not you are competent enough to lead is another story...Now of course there are truly competent and effective leaders out there but IMHO, they are few and far between.

Now it certainly does no good for me to sit here and rant/complain about our current state of affairs. I can honestly say that every day I go to work, I make it my mission to change what I can and develop plans on how I will change things in the future. I do see light at the end of the tunnel, not everything is gloom and doom. Every one of us has the power to affect our own desitiny. We can quit when we want, or we can choose to continue. I like my job, so I choose to continue.

[LADYVIOLA]

Evac-
I think we each need to reflect on what brought us to nursing and service in the Air Force. For me it is/was a calling. I was called by a higher power to be at the bed-side of patients who needed my help, dedication and care. I was an Army medic and felt I could do more. I had to get out of the Army in order to get my RN degree, which spured me on toward my BSN. I am drawn to the Air Force for many reasons. I will always feel my calling and now I want to perform my nursing service in a professional setting. Today I know I want to be, and remain a Clinical, bed side nurse where I can put my mind, hands, and heart to work on that patient who needs me so badly. That is my personal calling. My profession is nursing. Soon it will be practicing nursing in the Air Force as an Air Force commissioned oficer. With proper exposure and training I will be a good Air Force officer and professional. The various settings and relationships will change many times over the span of my career. I will deal with that. However, like you, I will not be detered because I choose to continue toward my personal nursing goals.

Maybe that concept of calling vs. profession is what is both fulfilling and frutrating. Most, but certainly not all, jobs in the Air Force are composed of those efforts that make up a profession. But certainly those professions, such as medicine and the pulpit, require one to answer to a higher vioce calling them to service. I dont claim exclusivity of dedication or higher skill and I can't always put my finger squarely on the issue. I welcome more dialog as we move this thread of conversation forward.

I don't want those of us in Air Force Nursing (I will soon be there) to be treated different or better. I want Air Force Nurses to be treated EQUALLY when compared to the rest of the Air Force Officer corps. There is a normal standard for accession, pay, promotion, etc. for commissioned officers in US Military service. There is a norm for Air Force Officers that sometimes corelates and sometimes does not. We all know that there are reasons for exceptional deviations from those norms. In every case I see those exceptions as higher rank upon accession, faster promotion, retention bonuses, incentive pay, or rewards for exceptional duty. All of these are positives. Why then do we see that Air Force Nurses, who are all commissioned officers with Bachelor of Science degrees and licenses to practice in ordere to just enter the Air Force, who are then required to attain advanced degrees such as Masters and PHd's in their professional/technical field in order to be promoted further beyond company grade? Why do we see that Air Force Nurses are promoted slower than the standard norm for other military wide and service wide commissioned officers? Why is the standard for an Air Force Nurse lower than the norm? Who is in charge? Who is answerable for this? If they are a sister/brother nurse have they abandoned those who they are charged to lead and look after?

Todays Air Force Nurse accession bonus, tuition reimbursement, specifice short occupation field incentive pay does not compensate for the acid that is slow promotions and poor leadership.

What a wonderfully clear opportunity for someone in a position of Air Force Nurse leadership! The goal is clear. The result of their good actions will be tangible and immediatly measureable. Success will be almost immediate. They can show immediate cost savings through higher recruiting results, higher retention results, higher morale, happier nurses and their families, a sure common knowledge that ALL nurses are shareing the tough duties of long hours, remote assignments, deployments, etc. What a great challenge with a clear goal, and brightly illuminated path. It's like being given the opportunity to hit a home run off of a T-Ball tee.

Why has this remained a problem? Discussion?????????

[LADYVIOLA]

Any comments from Nurses, people who know one, or wanna be one?

[Scruples]

What is the current condition of manning in your base hospital or clinics?

Do you have the right mix of RNs and med techs (enlisted)?

Are you burdened by a heavy load of patients that require bedside patient care that it overwhelms your other RN duties, e.g., passing meds, blood transfusion, etc.?

There were cases when RNs had taken so much heavy load (including the charge nurse duties) and had ended up with errors in medication adminstration or hanging the wrong solution (not Normal Saline) with the blood transfusion.

What is the actual nursing shortage effects you have seen in your "neck of the woods"?

[LADYVIOLA]

1/23/2008 - BALAD AIR BASE, Iraq (AFPN) -- Editor's note: This is the first installment of a six part series by Tech. Sgt. D. Clare titled "Combat Nurses." In the series Sergeant Clare takes an in-depth and personal look at how nurses from different specialties are caring for the war wounded at one of the busiest trauma centers in the world.

It's 4 a.m. and Capt. Shelly Garceau, an emergency room nurse, is finally taking a breather.

Moments earlier, she'd dropped two Marines off in the intensive care unit of the Air Force Theater Hospital here. They'd suffered partial thickness burns over their faces and hands as a result of an explosion.

Captain Garceau consoles herself knowing she did everything she could for the men.

"That guy couldn't even see me. He wouldn't be able to show you who I am if he saw me," she said. "But he'd recognize my voice. And when he said thank you to me, it was like nothing else."

The hospital here is one of the busiest trauma hospitals in the world and is the only facility that provides a full spectrum of medical services in Iraq, said hospital officials.

The emergency room takes in 23 patients a day on average, 11 of which are trauma cases. In that same 24-hour cycle, the facility's operating room typically handles more than a dozen cases, performing more than 60 procedures. In the past year, nurses were behind the treatment of more than 10,000 injuries.

In a four month period, the facility's statistics match or exceed activities at stateside trauma centers, said Col. Norman Forbes, the 332nd Expeditionary Medical Group chief nurse.

Behind every case and helping every patient are the nurses of the 332nd EMDG. From the moment a wounded troop lands at the hospital to the time he or she lands in Germany or is medically evacuated to the U.S., a combat nurse is there to assist physicians, administer medication and care for the wounded.

The hospital boasts a 98 percent survivability rate for the wounded who arrive here. The success of the medical team here is known among the servicemembers who fight in Iraq, Captain Garceau said.

On a past deployment to Landstuhl Regional Medical Center, Germany, she received patients who had been treated at the hospital.

"The troops would tell us that they were really scared until they got to Balad Air Base because they knew if they made it this far, they'd be alright. That's the reason why I came here. I wanted to be a part of that," she says.

Beyond the prolific number of patients treated at the facility, nurses say combat trauma creates challenges for care providers who may be treating several different types of injuries simultaneously.

"We're dealing with high-ballistic, penetrating trauma. It's not the same sort of thing that you see on the streets of Detroit or Chicago or Baltimore. It's in a league of its own," Colonel Forbes said. "Most of the trauma you see in the states is blunt trauma from steering wheels and auto accidents. You get gang shootings and occasional single point entry gunshot wounds. You don't tend to see the multi-systems trauma that you see during wartime with the blast injuries."

Despite the hospital's location in the center of the war zone, nurses say they are able to offer care that meets and often exceeds the level of trauma treatment available elsewhere throughout the world. The nurses aren't encumbered by health insurance limitations or concerned with co-pays. Their sole focus is on saving lives.

"Our patients get the top notch care here. It doesn't matter how many supplies you use on a patient or how many times they come back to surgery. The cost is nothing," says Lt. Col. Jan With, the flight commander of operating room nurses.

"Military medicine is further ahead than civilian medicine. I've even heard my counterparts in my civilian life say that," the colonel said, a member of the Air Force Reserve Command who is deployed from Offutt Air Force Base, Neb. In her civilian life, she is a coordinator for more than 20 specialty clinics in Norfolk, Neb.

"The military is able to get the technology quicker," she said.

Beyond technology, the nurses learn to work fast and make critical decisions. Every day, lives are on the line, and they provide the critical link to the care patients need. They work seamlessly with doctors and technicians and quickly develop the synergy needed to keep war's wounded alive.

[Scruples]

Just want to revisit the issue of the Nurse Corps manning and the conditions that you live in. How is the new PT program being applied to the nurses and hospital staff schedule lately?

Do you feel that the deployment cycle is reasonable? Are you given enough time to recuperate from all the stresses of being exposed to all manners of injuries and troop casualties?

Hang in there...my best wishes to our nurses and other hospital staff.

[maverickemt]

Hi - I am not in the military by any means yet. I am applying to the US Air Force nurse corp with about 16 months experience as an acute care stepdown ICU nurse in San Antonio. My questions about the Air Force are the following:

1. Does the Air Force favor people who have had prior service experience?

2. Does the Air Force look at gender when selecting for the Nurse Corp? Does it like to have an equal number of men and women who are nurses?

3. Does anyone know, or is anyone allowed to tell me how many applications have been submitted to the Jan 26th boards already?

4. For anyone interested in the ARMY nursing boards - I checked today, and apparently the ARMY has met all its numbers for recruitment - so much so - that the med/surg nursing boards have been shut down and reopen hopefully in October. So this only leaves 2 services - Navy and Air Force. I am strongly thinking about switching and applying to the NAVY nursing if I don't get selected to the AIr Force?

5. Why is the military so slow in recruiting fresh talent? You would think the military has some sort of speed to it because we are given orders to fight wars almost overnight!

Thanks a lot - maverickemt

[maverickemt]

Hi - My name is maverickemt. I will reveal my real name if and after I get selected to the AF NC. Can I ask how many applications have been submitted to the AF nurse boards for the Jan 26, 2010 boards? Are the nurses selected at Randolph AFB in Texas?

Please reply as soon as possible because I am spending my whole christmas holiday thinking about my chances and getting really worried because I might be too late!

Thanks - maverickemt.

[bcoco14]

5. Why is the military so slow in recruiting fresh talent? You would think the military has some sort of speed to it because we are given orders to fight wars almost overnight!

Easy. The econmey blows and there's 10% unemployment. The military has people beating down thier door just to get a job, so they get to be very selective about who they let in.