To mark the one-year anniversary of Joining Forces, national nursing leaders, Penn Nursing Science faculty, First Lady Michelle Obama, and Second Lady Dr. Jill Biden met on April 11 at the University of Pennsylvania in Philadelphia to announce an initiative to prepare nurses to care for veterans suffering from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, and other mental health issues.

With nursing students and members of the National Guard standing behind her and about 1,100 nurses, nursing students, nursing educators, and soldiers in the audience, Obama said, “Whether we’re in a hospital or a doctor’s office, or community health center, nurses are often the first people we see when we walk through that door. And we often spend much more time with nurses than just about any other health professional.” That contact and the sheer number of nurses in the U.S. made it clear to Obama and Biden that they needed to work with the nursing profession to help ensure military personnel, veterans and their families have access to the care they need.

A significant number of people need that help. “An estimated 1 in 6 troops—more than 300,000 Americans—are affected by PTSD or TBI,” said Karen Daley, president of the American Nurses Association, at a nursing leader summit held after the announcement. ANA coordinated the summit and led the nursing response as more than 500 nursing schools and 150 nursing organizations pledged their support for the initiative to educate every nurse about PTSD, TBI, and depression.

Obama highlighted her own positive experiences with nurses, particularly with her children, and added, “Every day, with your hard work, with your skill, your compassion, you determine the quality of care that we all receive.”

“Nurses are 3 million strong,” Afaf Meleis, dean of Nursing at the University Pennsylvania School of Nursing, told Obama and Biden. “We thank you for both turning to nursing to improve the care of our military veterans. You have the right partners for your initiative.”

“I’m a proud military mom,” said Biden. She noted that Joining Forces was started “so that every American can take action to honor and support our military families.” Obama and Biden created Joining Forces to champion wellness, education, and employment among military service members and their families.
Biden pointed out that since 9/11, military men and women—and their families—have stepped up to meet the challenges of more frequent and longer deployments. “It is our sacred obligation to show that we appreciate their sacrifices on our behalf.”

Biden highlighted her own connection with nurses, saying, “I have the great privilege over the years of teaching countless nursing students, and I have to tell you they’re always my A students.” She added that nurses are on the frontline of providing care in the community, a key role given that only half of veterans seek care in a VA facility.

More than 500 nursing schools and 160 nursing organizations have pledged their support for the initiative, and the American Nurses Association (ANA), which been in the forefront of the nursing response to the initiative, has created a special webpage for this work (http://www.anajoiningforces.org) where nurses and nursing organizations can sign a pledge and access valuable resources on PTSD and TBI. This month, ANA is highlighting two organizations’ practice guidelines for TBI: American Association of Neuroscience Nurses (“Nursing Management of Adults with Severe Traumatic Brain Injury”) and the Association of Rehabilitation Nurses (“Care of the Patient with Mild Traumatic Brain Injury”).

Obama ended her remarks with a call to action for nurses to serve as leaders in the initiative, not just in their practice settings, but also in the community. “We need you to work with your employers to better support our veterans as they transition to civilian life. We need you to work with teachers and coaches and youth group leaders to help them understand that our military kids are going through a lot as well.”

She added, “I look forward to working with all of you to ensure that our veterans and military families get the world-class care that they deserve.”

After the program, Sally Brosz Hardin, PhD, APRN, FAAN, dean, school of nursing and health science at the University of San Diego, commented, “I was very impressed with the First Lady’s insight into the importance of nursing in health care, not only of our military, veterans, and their families, but of all our citizens.”

Already on the job

At a summit held after the announcement, the nearly 100 nursing leaders present at the announcement met to identify steps nursing associations and schools of nursing can take to prepare nurses for their role in caring for military personnel, veterans and their families. Participants included the top leaders in many nursing organizations and schools of nursing, and leaders from the Department of Defense.

Amy Garcia, chief nursing officer for ANA, welcomed participants to the working session. Jennifer Lee, MD, White House fellow, greeted participants by affirming the importance of nursing to the initiative. “If there is any discipline that could do this, it’s nursing.”

Meleis; Catherine Rick, chief nursing officer for the Department of Veterans Affairs; and Daley, added their own welcome, each emphasizing the importance of nurses’ roles.

Meleis said, “We need to renew our commitment to research [in the area of PTSD, TBI, and depression].” University of Pennsylvania School of Nursing faculty has played a leading role in this area.

“We seek to educate and prepare every nurse to recognize symptoms, provide care, and refer those with both visible and invisible wounds of war to get treatment,” said Daley. She noted that returning service members who don’t have access to a VA facility or may be reluctant to seek treatment, as well as their families, need access to support. “With nurses in every community and health care setting, we can create the bridge to ensure that our warriors and their families get properly diagnosed and obtain care. With our expertise in holistic care, we are uniquely positioned to help our service men and women and their family members.

Daley also summarized the pledge for the initiative (see box below) and added, “Our mission now is to turn this broad-based pledge into action.”

To begin that process, Penny Kaye Jensen, president of the American Academy of Nurse Practitioners, gave the participants their assignments—to discuss what their organizations were doing now to prepare nurses to care for veterans with invisible wounds and their families, what they could do in the future, and ideas for moving the initiative forward, including collaborations and ideas for research and education.
University of Pennsylvania nursing students served as scribes as 12 tables of nursing leaders discussed and debated options. Laughter and earnest conversation could be heard as participants took just 40 minutes to create a list of ideas (see box below).

As representatives from each table presented their suggestions, it soon became clear there was consensus around two needs: raising awareness through education (both continuing education and inclusion in nursing school curricula) and conducting research to identify best practices.

As the nurses worked in the University of Pennsylvania School of Nursing, a wall of paintings depicting the history of nursing fittingly served as a silent witness to another significant event.

Daley summed up the meeting “Nurses can have a dramatic impact in improving the health [of veterans], strengthening their families, and in some cases, saving their lives. We must remember that these are strong people supported by strong families. With our support, they have important contributions to make beyond that of their military service. Now that’s something truly worthy of our commitment.”

What you can do

Every nurse can participate in this initiative by:

• Learning about PTSD and TBI
• Learning about free resources useful to you, patients, and families
• Sharing knowledge with other nurses, patients, families, and the community

Those interested in research can play a leading role in ensuring that interventions are evidence based.

Examples of resources

American Nurses Association website (www.anajoiningforces.org)

American Association of Colleges of Nursing (http://www.aacn.nche.edu/joining-force)—includes resources for schools and information about a free four-part Webinar series May 2, 7, 9, and 14

American Psychiatric Nurses Association (http://www.apna.org/i4a/pages/index.cfm?pageID=4403)—includes a military and PTSD resources

Veterans Crisis Line (www.VeteransCrisisLine.net)—this is a toll-free, confidential resource that connects veterans in crisis and their families and friends; you can download resources.

Cynthia Saver represented American Nurse Today at the announcement and summit. American Nurse Today was the only nursing news outlet present. Read more at “ANA ‘joins forces’ with first lady to help veterans.”