Military nurses answering the call to serve

Konrad, Sandra

HIGHLIGHTING THE DIVERSE ROLES OF REGISTERED NURSES

October 3, 2003. Two Canadian soldiers were killed and three others injured in Afghanistan less than 24 hours ago. Maj. Theresa Norsworthy, Capt. Joanne Kane and Lieut. Brian Carriere, registered nurses in the Canadian Forces meet with me at 1 Field Ambulance at Garrison Edmonton. The mood is sombre.

“We have a nurse from Garrison Edmonton over there, ‘one of ours.’ We received an e-mail from her this morning; she was looking after the three wounded. It was a good feeling but it’s sad. It doesn’t seem like a stable situation; you don’t have the same sense of security. We do the best we can with our training as nurses and as military officers but I don’t think anything prepares you for this,” muses Norsworthy, officer in charge of Maintenance Clinical Skills Company.

Wherever Canadian troops are stationed, at home or overseas, so too are registered nurses (RNs), members of the medical team clinically prepared to care for casualties. Their mission is health care for Canadian Forces personnel anywhere, any time. Regardless of their uniform – army, navy or air force – they are prepared to go where the need is greatest.

The military needs RNs with intensive care, operating room and mental health specialties in addition to general duty nurses. However, RNs certified in a specialty keep up general knowledge because versatility is crucial. In Canada, RNs may supervise the garrison walk-in clinic, provide community health services on base, serve as senior medical personnel in cadet camp, give hands-on bedside care in Canada’s remaining military hospital in Halifax or teach at the Canadian Forces Health Services Academy in Ottawa. Nurses are officers, prepared to lead and rise in the levels of command.

Prior to the 1991 Gulf War, the Canadian Forces had not been deployed for decades. Having answered the call to serve, nurses view overseas deployment as an opportunity. Whether she, or increasingly he, has a spouse and children or is single, deployment means being psychologically ready to leave on short notice. Maj. Theresa Norsworthy, deployed to the recent British Columbia fires just after she transferred to Edmonton, missed her children’s first day in a new school. Her husband is the stay-at-home parent, an arrangement they made years ago. Though policies and programs are increasingly available to support families, nurses adjust primarily by living within the military culture that understands long separations, frequent moves and the inherent stresses.

Today’s nurses on overseas deployment are not on the front lines, though some would like to be, they’re in the rear in field hospitals and command headquarters.

Soldiers first, nurses possess an astonishing range of skills. Nurses search for weapons when patients first arrive at the field treatment centre, deactivating a loaded rocket propelled launcher and taking it outside if need be. ICU nurses, escorting patients to larger hospitals in a Bison armoured ambulance must also navigate, reading maps to determine if the route is clear of mines. They must be able to identify all aircraft and armoured vehicles along the way. If the field medical centre were attacked, the nurse would remove patients to a shell-proof container protected by sandbags and metal plates. Strenuous physical tests-a 13-km march carrying 55 pounds completed in two hours 20 minutes and a fireman’s carry lifting and carrying a person of equivalent weight – are performed annually.

Maintaining pistol and rifle competencies, nurses must be able to protect their patients and themselves, and are armed with a 9-mm pistol to do so. If the hospital were ever attacked, they would pick up a rifle to defend it. “I’ve never heard of anybody having to do that,” says Norsworthy who has 18 years in the military. “It would be more probable in a war situation when patients are under attack.” “I’ve never done it,” adds Cape. Joanne Kane, an OR nurse deployed five times in 25 years of military service. “If we had to, we could.”

RNs, when deployed, operate under an expanded scope of practice much like nurses in trauma units in Canada, placing IV lines, ECGs and catheters. “You’re quite independent when you’re on deployment; you have to be able to think on your feet,” says Kane who has served in three different theatres – the Gulf War, Bosnia, and Afghanistan.

A national committee has developed standards, minimum requirements for nurses’ deployment which stipulate the following:

* two years in service so nursing and military skills are consolidated

* a course that teaches the field environment

* weapons qualifications

* fitness training

* first-aid, CPR and advanced cardiac life support qualifications

Fortunately, times of peace outweigh times of overseas peacekeeping duties. Nursing skills could languish if it were not for innovative agreements between the Canadian Forces and civilian health care authorities where military bases are located. For instance, several of the 12 RNs posted at Edmonton Garrison work up to 32 hours a week in trauma units and emergency, intensive care and operating rooms in Capital Health’s hospitals to maintain their clinical skills.

The friendly fire incident of 2002 in Afghanistan that killed four Canadian soldiers and wounded eight others resulted in injuries that demand clinical skills nurses have scant opportunity to train for in a civilian practice setting. The injuries and deaths of Oct. 2 drive home the need for RNs to develop skills in caring for blast-type injuries.

Soldiers on patrol aren’t the only ones affected by land mines. When Capt. Mary Ann Barber came home from Bosnia, it was weeks before she felt comfortable standing on the grass in her backyard. “It’s ingrained in your skull; do not leave the ‘hardstand,” military jargon for a paved or stabilized area. Fortunately, casualties among soldiers returning from a mission aren’t common, making time in camp generally uneventful. Confined to a small enclave with a minimum of personnel and surrounded by razor wire and observation posts, Barber designed a health promotion program for the command and support staff during her deployment at Canadian military headquarters in northern Bosnia.

Focusing on cardiovascular health awareness, she implemented ECG and blood pressure clinics and cholesterol checks, detecting high levels of cholesterol among many of the soldiers. Some required medication. After educating personnel about altering their diet arid lifestyle, she re-tested them. The results showed marked improvement. She also ran weight wellness and women’s wellness clinics.

Robin Michaud, retired after 12 years of service, now teaches at Norquest College in Edmonton. Like all nurses on deployment, she worked six and a half days a week and otherwise was on call. An ICU nurse, she assessed patients as they came in, prepped them for the OR, attended to them in recovery and cared for them on the ward at Canada’s military Advance Surgical Centre in Bosnia.

“We also took care of Czech patients,” she says. “At first we had no dictionary to translate medical terms from Czech to English, so we used sign language. One fellow who had his appendix out appeared to be in pain. I attempted to ask him if he would like some medication. Instead I told him, Tm on the birth control pill.'” She admits ruefully that his laughter aggravated his pain and prompted swift interpretation of common terms.

Lieut. Brian Carriere practised at the Role 3 Multi-International Medical Unit alongside British, Dutch and Icelandic nurses during his recent deployment to Bosnia. Prepared for military patients, although there were few, the staff provided routine surgeries and treated emergency patients for the local medical community which was strained and devastated by war.

The Canadian and United States governments agree to train selected military personnel cooperatively. Routinely, Canadian nurses take the latest advanced air evacuation and combat casualty courses in the United States teaching their colleagues when they return.

Canadian nurses also work in American military medical installations. During the Gulf War, Capt. Joanne Kane, OR nurse on a Canadian medical team, worked on the USS Mercy, the hospital ship at sea in the Persian Gulf. Large by any standards, it features 16 operating rooms and 60 intensive care beds. There is always a Canadian nurse on a two-year posting with the American air evacuation team.

The Canadian Forces respond to civil emergencies such as eastern Canada’s ice storm and this summer’s forest fires in British Columbia. In BC, two nurses were part of the 160-member medical contingent providing back-up to the troops in a brigade medical station that primarily treated reactive airway disease. In preparation for the 2002 G8 Summit in Kananaskis, Barber trained to serve on the medical decontamination team to care for patients exposed to nuclear, chemical and biological agents.

Today’s military nurses honour the nurse veterans of World War II, inspired by their work. “They took care of a large number of casualties under horrendous circumstances,” says Michaud. “They took general care principles and applied them,” Barber adds. Every year on Remembrance Day, a military RN posted at Edmonton Garrison will parade with veteran nurses, proud of the bonds they share and honouring the nurses called to serve.

Laminates could victims of their own popularity

Spirituality in Nursing Standing on Holy Ground