The challenges faced by military nurses who return home after serving in war zones are examined in a new book by a Rutgers University-Camden professor who has chronicled the experiences of combat nurses in Iraq and Afghanistan.Nurses After War: The Reintegration Experience of Nurses Returning from Iraq and Afghanistan is a sequel of sorts for co-authors Elizabeth Scannell-Desch, associate dean of baccalaureate programs at the Rutgers School of Nursing-Camden, and her fellow academic, nurse, and twin sister, Mary Ellen Doherty.
The book, which was released in July by Springer Publishing Company, chronicles the stories of 35 nurses adjusting to and reflecting upon reintegrating into civilian life after serving in the Iraq and Afghanistan wars between 2003 and 2014.
Scannell-Desch, a retired colonel in the U.S. Air Force Nurse Corps, joined the Rutgers-Camden faculty in January 2016 after a 25-year military career and 15 years teaching at other universities. A former flight nurse, Scannell-Desch served on active duty all over the world from 1972 to 1997. During that time, she held a number of key leadership positions, including command nurse executive at U.S. Air Force headquarters at the Pentagon, where she directed nursing policy and practice for Air Force Reserve nursing personnel worldwide and served as senior nursing advisor to the Air Force Reserve commanding general.
For the nurses first deployed during the early days of the wars in Iraq and Afghanistan, living conditions were especially austere, Scannell-Desch says. While larger bases today have such creature comforts as fast-food restaurants and Wi-Fi, the nurses first arriving in war zones had to rely on mostly pre-packaged, dehydrated meals – “maybe they had one hot meal a day,” she says – and sporadic delivery of U.S. mail. The nurses could not be in regular contact with their families through cell phones, email or Skype, as some bases offer now.
More than the austerity of the infrastructure, the early nurses faced a brutal introduction to combat that they had not anticipated. “There were not a lot of seasoned war-hardened nurses to train the military nurses in the beginning,” Scannell-Desch says. Most of the trainers had not seen combat and could not realistically prepare the nurses for the casualties they would face. “There’s a big difference between handling trauma cases and handling combat.”
Many of the nurses suddenly found themselves in harm’s way, which they had not anticipated. Some were assigned to “Fast-Forward Surgical Teams,” which performed “meatball surgery,” the terminology used for patching up trauma patients quickly to stabilize them before sending them to larger hospitals for more specialized care. At times, some nurses were expected to collect the bodies of fallen soldiers in the field because there was no one else to do so.
“Even seasoned trauma nurses,” Scannell-Desch writes, “from large urban medical centers expressed horror at what they saw and had to do to save lives, ameliorate suffering, and allow death with dignity.”
While Scannell-Desch stresses that “you can’t totally prepare anyone for war,” the training these nurses undergo before they are deployed needs to be “as realistic as possible.” Now, as much of the training is handled by military nurses who have returned from recent tours, that training is more of an introduction to what the deployed will actually face, from sleeping arrangements to matters of life and death, such as weapon training so the nurses can defend themselves and their patients, if necessary.
In 2012, Scannell-Desch and Doherty, a professor of nursing at Western Connecticut State University, co-authored the book Nurses in War: Voices from Iraq and Afghanistan (Springer Publishing), which describes the experiences of 37 military nurses who cared for soldiers in mobile surgical field hospitals, detainee care centers, base and city hospitals, medevac aircrafts and aeromedical staging units.
The new book follows a different group of nurses who have been back an average of four years after serving in Iraq and Afghanistan. “We wanted people to have perspective on their wartime experience,” Scannell-Desch explains. “Everyone who goes to war comes back changed.”
For many returning nurses, whose names and identifying characteristics were altered to protect their confidentiality, a “new normal” meant readjusting to changing family dynamics resulting from their time away from home or a substantial alteration in the direction of their nursing careers. “Some people decided to get out of the military or pursue a different area of nursing that they had never contemplated before,” says the Rutgers University-Camden scholar.
Following the horrors of war, some nurses found they could not return to jobs as trauma nurses and opted to work with babies or older adults. Others – especially young nurses, Scannell-Desch notes – found that they thrived in situations of great stress and made new career choices that echoed their wartime experiences. While many military nurses wanted to stay on active duty, some did transition to civilian nursing careers.
In spite of the challenges of reintegration, Scannell-Desch says most nurse veterans successfully readjust with time. “It is important for them and their families to take advantage of the wealth of resources available to them,” she says. “Accurate information, coping strategies, and social support will positively influence their reintegration journey.”
The book recounts the variety of the homecomings returning nurses saw, from televised celebrations with happy families and military bands, to desolate arrivals where those who served hardly received a thank-you for their time overseas. For some, readjusting to life at home proved challenging because the nurses did not receive support from their families or co-workers, who seemed to think the time of deployment had been a vacation for the combat nurses. But Scannell-Desch stresses that every nurse had a different experience, which they shared through mostly face-to-face interviews with the authors.
As Scannell-Desch and Doherty write in the book’s final chapter, “We will never forget the 35 nurses who were willingly interviewed for the research study, which led to this book. They believed in our work and wanted the world to have a lens into the reintegration period. They hoped that others would benefit by reading their narratives and understanding the meaning and feelings behind their words. The nurses wanted to debunk the myth that implies that nurses have any kind of immunity from PTSD, compassion fatigue, or burnout. Nurses are susceptible; it is just that they embrace a healing mission.”
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