Interview with Cpt Elisabeth Hoettels, US Air Force Nursing Corps, LRMC
Nurses, medics, medical technicians and other non-medical personnel provide valuable assistance to physicians and other medical officers in caring for patient soldiers at home as well as on deployment.
In the past, articles published in MCIF have rarely reflected this fact and this group of professional medical assistants seem to have been somewhat neglected. MCIF therefore very much appreciates the opportunity to publish several interviews we were able to hold at LANDSTUHL Regional Medical Center with experienced nurses. Nurses from different services of the US military provided us with a very interesting and quite impressing insight into their experience and the life in the Medical Service Corps. We are happy and proud to publish these interviews in the next two issues of MCIF (3/12 + 4/12). Apart from granting a valuable appreciation of their work, these interviews demonstrate the significance and the value of qualified assistance personnel for the military medical community. They also made clear to us the importance and the necessity to make this perception available to the readers of MCIF. Let us start then with Captain Elisabeth Hoettels, a nurse serving in the US Air Force Nursing Corpsat LANDSTUHL Regional Medical Center.
MCIF: Captain Hoettels. For many years the Nurse Corps are a very important part of the Military Medical Service in the US. …Can you tell us when this nurse corps was formed, how old is it?
Cpt Hoettels: It depends which service you’re looking at. For the Air Force, our birthday was in 1947.The Air Force Corps is very young – asthe Air Force in the United States is young, the Army Nurse Corps is much older (111 years) as well as the Navy Nurse Corps (104 years). Ours is the youngest - we didn’t have planes a hundred years ago, so we’ve only had our Nurse Corps in the Air Force for 65 years.
MCIF: Can you explain for what reason the Nurse Corps in the Service was formed?
Cpt Hoettels: I know that they understood that in a service you should have separate groups, so that physicians could be physicians and have someone to do the admin side...There are different medical occupations with different tasks: Veterinary Corps, Medical Corps, Nurse Corps, and Dental Corps. There also is a Specialist Corps that includes physical therapists, occupational therapists, physician assistants and dieticians. Then there is the Medical Service Corps responsible for the administrative side, making sure the hospital is running, your logistics.
MCIF: That means the Service Corps runs the hospitals, but the nurses are responsible for patients’ care?
Cpt Hoettels: Yes, they tend typically to be more clinically orientated, so we are either at the bedside or we also fulfil other roles such as education. For example I do ACLS, that’s cardiac life support, or basic life support, and everybody in the hospital has to have such courses, in our Nursing Corps this kind of education falls under the department of nursing.Nurses typically do not get to go outside their realm, although every once in a while we get selected to go work someplace else, but then the Nurse Corps brings us back. We kind of stay within our hospital, we do deploy, obviously...
MCIF: The Surgeon General of the US Army, LTG Patricia Horoho, is a nurse and the new Commanding Officer of the LRMC, Colonel Barbara Holcomb is a nurse too. These are good examples for the chance of career of members of the Nurse Corps in the US Military.
Cpt Hoettels: Correct, Colonel Holcomb is a nurse.
Before I took this post I was a commander as a nurse. I not only understand the medical side, but I can also do some of the admin side. Again, I was in charge of physicians who worked for me per se, but I could let them be physicians, I understood what they needed to do, but I could not do their job – they have a very specialized job which I cannot do, I can support them though.
MCIF: But they were subordinate to you?
Cpt Hoettels: I still signed their paperwork, but most of them were Majors and Colonels, so I still called them “Sir”. Rank wise it is a little odd, but if they wanted to take holidays I signed their paperwork, I was their commander.
MCIF: In military thinking you were their boss.
Cpt Hoettels: Yes I was their boss. But the way I look at it, I signed their paperwork, but I still worked with them. I don’t like to say “Hello, I’m your boss.” If you’re not doing the right thing, I might say “Hello, I’m your boss.” But I’d much rather say “Sir, how can I help you, how can I make your life easier?” And if it means I’m the intermediary, if they’re trying to give you too many patients, I can go to the administrators and say “Look, stop, he already has a thousand patients assigned to him, he does not need twelve hundred.” I can defend them, because I understand what it takes to see a patient, how many medicines they need to issue, how it is important to be able to spend time and make sure that a patient is taken care of. For example, if someone calls and says “I just need a refill of this”, I understand what they need for a refill, and I can take care of that problem by entering a telephone consult so I am not taking time away from the physician and their appointments.. Many of the nurses have started taking over some of these positions because we understand; we are multi-taskers and many are very good at it. So we can do a little bit of everything as a nurse.
MCIF: The size of the Nurse Corps in Army, Navy and Air Force are similar?
Cpt Hoettels: The Army and Navy have more than the Air Force.I know that just in general the Army is largest, so they will have more nurses then the Navy and then the Air Force. The Marines have support from the Navy in the United States, they do not have their own medical assets, all the medical assets come from the Navy, The Coast Guard has a few medical assets but they do not typically leave our shores.
MCIF: Do you have a special command structure in the Nurse Corps? Compared to the other structures?
Cpt Hoettels: We still have a Chief Nurse, so in our hospital you will have the Chief Physician, and then you have the Chief Nurse, and you still have a Commander.----
MCIF: They are all on the same level?
Cpt Hoettels: Typically, the Commander is still in charge of the Hospital, but we do have a Chief Nurse, and our Chief Nurse does everything from making sure that the clinical matters on the in-patient side is taken care of and that the nurses in the out-patient setting are also being supported. My Chief Nurse for example is the Nursing Administrator in charge of the budget, the education and a couple of other things fort the department of nursing, but at the same time she also does counselling for the Air Force Nurses, „How do I get to be a Major“, „Where do I want to go for my next assignment“, Chief Nurses are very supportive of whatever aspects we want to do, and keep us progressing in our career. Colonel Jefts is our AF Chief Nurse here, but we also have an Army Chief Nurse because we are a joint facility.Our Head Chief Nurse at this facility is Army. In a joint environment our senior nurse is who the nurses belong to – in this case we have an Army Chief Nurse – but if it deals with where I’m going for my next assignment then I speak with the Air Force Chief Nurse.
MCIF: So who decides whether you have to go into a combat zone or not?
Cpt Hoettels: My Air Force Chief Nurse.
MCIF: She can say, tomorrow or next month you have to go to wherever? And probably she should have talked to the Army Chief Nurse at the hospital before?
Cpt Hoettels: Yes, she has to, because if I am deployed, who is filling my position? They are all in constant communication. I guess it is probably not any different as with the physicians. If one of them is sent into a combat zone, who is seeing his patients? They have always to think one step ahead. And that is what happened to me as Commander, I just got a new Internal Medicine physician and they sent her downrange, so I had to ask myself „Now what will I do, .I still have patients that need to be seen, how will we make this work?“
MCIF:The chief of the Air Force Nurse Corps is subordinated to the Surgeon General of the Air Force?
Cpt Hoettels: Yes, Major General Siniscalchi is the Assistant AF Surgeon General, Medical Force Development as well as the Air Force Chief Nurse.She works with Major General Green, the Air Force Surgeon General, a physician.
In the Air Force we only have one nurse general.She works at the Office of the Surgeon General for the Air Force Medical Service.AFMS is part of the USAF, which is part of the Department of Defence.
MCIF: During your training, being educated for a nurse, you are just in the Air Force? Does the Air Force have its own education and the Army and the Navy likewise, or is it something like a joint education?
Cpt Hoettels: Right now most of us are doing things separately. Each service has its own training system. Here we have a nurse transition program where they train new nurses not only for their job but also to be a leader. Back home in the civilian system a new nurse goes out on the floor and is expected to be doing nursing. Here we expect a nurse to also be in charge of a whole bunch of people. You are getting multitasked, so you are getting extra training learning how to do both.
MCIF: But basically, you get the same education like the civil nurses?
Cpt Hoettels: The military gives us more opportunity. The friends I graduated with had six weeks and then they said “go”, as civilians, I had a four months training. It was not only didactics; it was hands on in critical care and also in class. The nurses we have now are doing evidence based practice, they are doing the research projects, learning very young how to improve something. For example,if we have a high infection control rate, how do we set up a process to come up with how to improve - and then report on it: So within those four months we’re not only getting education on just how to be a nurse, how to be in the military. It is almost like a fellowship where you are doing case studies. You have a broader experience. I talked to my friends and they were very stressed, had lots of anxiety, they said “I’ve had six weeks and they expect me to do XYZ…
I cannot say one system is better than the other, but it was very nice to ease that way into nursing rather than being pushed out the airplane door going “Here, jump!” Maybe it’s similar to residencies where you become a physician and then you get time learning how to do your job. You get time being a physician and then you go to a specialized fellowship specializing in emergency medicine or in intensive care. Same thing for nursing, we go through an initial period, and then we specialize .I went through an ICU fellowship, I did one year at Bethesda Naval Hospital where I
Trained in intensive care with the Navy... We are in fact starting to get a new service, I was one of the first people to go whereNavy and Air Force worked together – also with the Army. We trained the soldiers and we got a better concept. Army, Navy and Air Force all working at Bethesda just learning how to work as a team.There are additional fellowships to be able to train us in whatever specific area we might want to go into. We have ER/Trauma fellowships, and then before we go down range, before we go to Afghanistan for instance, they send us to civilian fellowships. I went to Shock/Trauma at the University of Maryland, and we spent three weeks there working side by side with the nurses and doctors who do Trauma every single day. So, rather than send that a new nurse to Afghanistan where her first exposure to Trauma is there, we get to go to Baltimore Shock/Trauma for some weeks, we learn from the civilian physicians and nurses who are doing amazing things.
MCIF:Can you choose the hospital where you want to go, or are you sent to wherever your Corps wants you to go?
Cpt Hoettels: They have specific training platforms for the Air Force. If you are a medical surgical nurse - just regular ward nursing - you go to the University of St. Louis and you train there. For the ER, ICU and OR nurses we all go to Shock/Trauma to do more of trauma training, long hours but fantastic trainings, the trainings set up so that we do a lot of Friday nights. Unfortunately, Baltimore and that whole area have a lot of crime, so we get to see at least some sort of trauma. We saw car wrecks, a lot of shootings, stabbings but it gives us a
chance toworkwith civilian nurses.The Army has similar programs. Fortunately America has a lot of great places and then not so great places, and they tend to send us to those not so great places because they have such things happening. So we do go through civilian training and then we finally go and deploy down range.
MCIF: The term medic is used in different countries in a different way.
In your service medics are medically trained soldiers or medical professionals?
Cpt Hoettels: Qualified Medics. We use the term “medic” loosely, referring to doctors, physicians, nurses - because we all take care of people. Our Medics have gone through basic emergency medical technician programs. Many of them have gone on to Paramedics, so they do more training. Of course we have specialized Medics in Special Commands of Army, Air Force and Navy. They have much more training. Most Medics have at least Emergency Medical Basic, but our Medics get to do a little bit more, if you go to the ICU when you are a Medic we start training you how to do some of the things like how to give blood. In the United States civilian system no medic would ever give blood. But at a certain point the physicians and nurses have their hands full, so we train the ICU Medics. We still have oversight, they never do anything on their own, but we train them. I work with them and I teach them so I know if I say, “Let’s hang this blood”, I know they know how to do it.
MCIF: As a nurse, are you legally allowed to give blood or injections?
Cpt Hoettels: Yes, physicians still need to write the order, because I cannot decide to give blood, but as long as the physician says ”we need a unit” I can handle blood and I am allowed to give injections.
A lot of our Medics on the battlefield can inject narcotics. We are making sure that our Medics can give certain medications - in the ICU if I need an antibiotic and my hands are full, as long as I am watching making sure everything is going right – I still double check to make sure it’s the right medication – but we’re making sure our technicians can do more. Up to what they are legally allowed to do they have a scope of practice.
MCIF: Let’s come back to a nurse-career. Which way do you have to go for Colonel?
Cpt Hoettels:: To become a Colonel or Captain in the Navy, the things that you need to complete as a nurse is have done very well as a bedside nurse but you also need professional military education. So for Captain in the Navy you have to go to Naval War College and a Colonel has to go to Air War College.
MCIF: So if you go to Naval War College or Air Force War College, you have the same courses like the line officers?
Cpt Hoettels: That is correct. Right now I am enrolled the Air University masters program. My current course is Warfare Studies, so we’re writing on the same things like the line-officers. My professor is a Special Forces 06 Colonel, and all of my classmates are pilots... It is fortunate my first degree is in International Relations, I understand a lot of the strategic stuff, we are talking more on a strategic level. I luck out, some of my peers have only done nursing school and these are very foreign concepts for them. We go in residence to squadron officers’ school for the Air Force; the Army calls it the Captains Course. We’re expected to do the same things as the line officers.
MCIF: The Nurse Corps consists in male and female officers. Outside the military nursing is a typically female world.
Cpt Hoettels: We have both, plenty of males. Of course it’s typically a female world, nursing, but we have lots of males.
My father was an Army Nurse in the 70ies. We have many males; some of them are prior Medics and want to expand their abilities. The other nice thing is as nurses we can go earn our Master’s Degree and become a nurse practitioner, I know there are nurse practitioners in Germany, but we can become certified nurse or registered nurse anaesthetists, nurses can be anaesthetists. So there are many opportunities, once you get into nursing to keep expanding as you go on.
MCIF: Perhaps we can come back to recruiting. Do you have a figure, how many personnel you need to recruit annually for the nurse corps?
Cpt Hoettels I don’t have an exact figure, I am sure it fluctuates a bit, but the Nurse Corps does keep track. And they will talk to the Chief Nurses - another good reason why we have them - and they will monitor who is leaving the service and who needs to be replaced. And they start forecasting for the year, it kind of waxes and wanes. Initially, in the war, everybody was very excited, we had way too many applicants, and then people started getting out, so it kind of levelled out.There are two ways to come into the Nurse Corps, either go through ROTC, Reserve Officer Training Corps, I signed up with the ROTC at University, they paid for my school, and I knew when I was out, I would be a commissioned officer serving in the military.The other option is a direct commission, you have a degree, you’re a nurse, and you join as an officer. We give people constructive credit, same thing for physicians; depending on your experience you get your rank.
MCIF: You said you are here “because you love it”. Can you tell us which part of being a nurse you love most?
Cpt Hoettels: I love taking care of other people and I love taking care of soldiers. There is sort of a family, I grew up that way, both my parents were in the military. I probably don’t know any other way, but I have friends all over the world, that I’ve known since I was little, and they are all my sisters and my brothers, and if one of them was hurt and I know I have a special skill or talent that they could use, why not go? Not everyone can be in the military, some can’t do it physically and some can’t do it emotionally, and there is nothing wrong with that. But for all the horrible days, there are many other days I know I can think back on and say: I know I made the right decision, because I’m here for somebody who needs me.
MCIF: Captain Hoettels, thank you very much for this frank and informative interview.
We wish you all the best for your further career.
Source: MCIF 3/12
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The 3rd Annual Operational Medicine Symposium will focus on DoD initiatives to enhance military medicine in an era of great power competition. This symposium will bring together highly regarded medical professionals from all services to discuss the practice of medicine in expeditionary environments.