Strug­gles for ex-mil­i­tary

For­mer medics start­ing ca­reers face up­hill bat­tle

Modern Healthcare - - THE WEEK IN HEALTHCARE - Ashok Sel­vam

Ray­mond Fletcher re­turned from 2½ years of ser­vice in the Viet­nam War as a U.S. Army he­li­copter medic in 1974 and started his post­mil­i­tary ca­reer work­ing for Chase Man­hat­tan. But he quickly re­al­ized that nurs­ing of­fered the best chance to use his bat­tle­ground ex­pe­ri­ences.

Fletcher even­tu­ally earned a four-year de­gree to be­come a reg­is­tered nurse, and he’s now a nurs­ing in­for­mat­ics spe­cial­ist at the Man­hat­tan cam­pus of the Vet­er­ans Af­fairs New York Har­bor Health­care Sys­tem. But he says it should not have been so hard to get there.

“I think I should have got­ten more credit for my ser­vice,” Fletcher said. “I did more in Viet­nam than I have ever done as a nurse.”

Now, fed­eral and state agen­cies are work­ing to make it eas­ier for vet­er­ans to make that leap as the U.S. winds down its pres­ence in Iraq and Afghanistan and thou­sands of medics sep­a­rate from mil­i­tary ser­vice each year.

The credit awarded for mil­i­tary ex­pe­ri­ence varies de­pend­ing on lo­ca­tion. Eleven state nurs­ing boards al­low grad­u­a­tion from a mil­i­tary med­i­cal train­ing pro­gram as a sub­sti­tute for a nurs­ing de­gree when award­ing a nurs­ing li­cense, ac­cord­ing to the National Coun­cil of State Boards of Nurs­ing.

Many would-be nurses dis­charged from the mil­i­tary, though, hit a wall be­cause their ex­pe­ri­ence doesn’t qual­ify them to take the ex­am­i­na­tion for en­try-level nurses, the National Coun­cil exam for reg­is­tered nurs­ing, known as NCLEX-RN. State boards de­mand the pas­sage of that test for li­cens­ing.

The White House at­tempted to ad­dress this is­sue in April with a new pro­gram to pre­pare ex-mil­i­tary for the test. The ini­tia­tive, run by HHS’ Health Re­sources and Ser­vices Ad­min­is­tra­tion, along with the De­fense and Vet­er­ans Af­fairs de­part­ments, will award in­di­vid­ual grants of up to $350,000 to in­sti­tu­tions with ac­cred­ited nurs­ing pro­grams that build on mil­i­tary train­ing and get more vet­er­ans on track to earn bach­e­lor’s de­grees in the field.

There is dis­agree­ment, though, about the ap­pro­pri­ate credit that com­bat medics de­serve. Many schools see the ex­pe­ri­ence as equiv­a­lent to that of a ba­sic EMT, an en­trylevel cer­ti­fi­ca­tion that re­quires about 100 hours of train­ing.

Sandy Sum­mers, ex­ec­u­tive di­rec­tor of the Bal­ti­more-based nurse ad­vo­cacy group, The Truth About Nurs­ing, said ex­tra train­ing is needed. Nurs­ing, she said, in­volves more than treat­ing trau­matic in­juries. “It’s about help­ing peo­ple; nurs­ing is about help­ing peo­ple live life to it fullest, to be as well as pos­si­ble,” she said. “It’s just not about ty­ing a tourni­quet and call­ing it a day.”

But a job as an EMT or even a para­medic doesn’t bring the same in­come or pres­tige as nurs­ing. The 2010 me­dian pay for a para­medic was $30,360, ac­cord­ing to the Bureau of La­bor and Statis­tics, while an RN’s was $64,690.

The sub­ject drew national at­ten­tion on “The Daily Show” in Oc­to­ber. Host Jon Ste­wart in­ter­viewed two Army medics re­cently back from Afghanistan who told him they were strug­gling to find nurs­ing jobs in the civil­ian world. Ste­wart chal­lenged the govern­ment to make it eas­ier for vet­er­ans to find nurs­ing jobs.

The fed­eral govern­ment has tried. Start­ing in 2011, it paid more than $102 mil­lion to nurs­ing schools and other train­ing pro­grams so they could bet­ter align mil­i­tary medic train­ing with ac­cred­ited nurs­ing pro­grams. Th­ese pro­grams aim to train medics as nurses and physi­cian as­sis­tants.

Also, some states are de­vel­op­ing pro­grams that pro­vide vet­er­ans a bridge to nurs­ing. San An­to­nio Col­lege launched a pro­gram in Jan­uary that al­lows Army com­bat medics, Navy hos­pi­tal corps­men and Air Force medics to earn as­so­ciate’s de­grees in nurs­ing in one year and fast-track them to­ward four-year de­grees else­where. Most med­i­cal per­son­nel in the Army, Navy and Marines are now trained at the sprawl­ing Med­i­cal Ed­u­ca­tion and Train­ing Cam­pus at Fort Sam Hous­ton in San An­to­nio. The com­mu­nity col­lege pro­gram is part of the state’s Col­lege Credit for Heroes ini­tia­tive an­nounced in 2010.

But turn­ing mil­i­tary ex­pe­ri­ence into a civil­ian ca­reer is com­pli­cated, said Sadie Hughes-Young, a National Guard mem­ber, an RN at Cincinnati VA Med­i­cal Cen­ter and ex­ec­u­tive di­rec­tor of the Cincinnati chap­ter of National Nurses United. Com­bat medics, she said, need ad­di­tional train­ing to de­velop their crit­i­cal-think­ing skills, and the tran­si­tion to civil­ian life can be chal­leng­ing for vet­er­ans, who are some­times cop­ing with post-trau­matic stress dis­or­der.

“Many of them that come back and try to go back to school may have dif­fi­culty con­cen­trat­ing in the class­room,” Hughes-Young said.


In 2012, there were slightly more than 75,000 ac­tive duty, guard and re­serve mem­bers in health­care sup­port oc­cu­pa­tions. Last year, nearly 10,000 sep­a­rated from the mil­i­tary.

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