Isolated, alone, and out of place

It wasn’t long after I left the military that I realized the transition into the civilian community was not going to be an easy one. I had just finished 10 years of service as a corpsman in the United States Navy, and on my first day at a community college, I looked across the room and noticed I was the oldest person in the room, including the professor. I was 28 years old and already regretting my decision to leave the service. The professor started class with introductions. She said, “Please tell everyone your name and something about yourself.” There I was, sitting in a class full of people 10 years younger, and as student after student introduced themselves, I quickly realized I was not only the oldest in the room but had absolutely nothing in common with any of them. 

That would not be the last time I felt isolated, alone, and out of place, and this scenario repeated itself on many occasions. Professors would start each semester with the same icebreaker question, and—not having anything else to share and a need to explain why I’m the oldest student in the room—I would divulge my military service as my X factor, which would soon be followed by the professor’s comment, “Thank you for your service!” To be completely truthful, I never know what to do with that or how to respond back. My response is usually an awkward smile!

Over the years, I occasionally ran into other veterans in my classes, each just trying to get through our days, weeks, and months until we got our degrees and joined the professional workforce. And then you realize you’re the oldest new grad working in a hospital among dozens of new grads. Then you’re one among hundreds of nurses in what seems to be a never-ending struggle to assimilate to the civilian community, aware of your behavior, language, mannerisms, and all while trying to navigate the social and professional norms of your colleagues. You experience your first Veterans Day at work, where the institution that has labeled itself as “veteran friendly” gives you a label to wear in the form of a veteran pin, veteran lanyard, veteran ID buddy badge, veteran everything.

It wasn’t until 2014 when I entered my PhD program that I started to look at the military institution, the US Department of Veterans Affairs (VA) health system, transitions into the civilian community, and my own experiences through a new lens. What I came to realize through research is that even though veterans are greatly appreciated and our service to the country is viewed in a much more positive light than that of veterans of only 50 years ago, the practices of helping us transition from military to civilian life remain incredibly disjointed and superficial at best. For some of us, this struggle to transition into the civilian community is a lifelong endeavor. And although institutions that brand themselves as military-friendly do a great job recruiting veterans, they do little to retain us. Healthcare is also concerning. Our care is often thought of as a VA responsibility; however, more veterans receive their care outside of the VA.

Whether we realize it or not, with nearly 20 million veterans in the United States, we have all taken care of a veteran and not even realized it. Why? Because as a nursing profession, I think we have failed to recognize the unique needs of this subculture within our communities and health systems. This translates to the academic setting, too—less than 10% of nursing programs have incorporated any veteran content and our unique health needs into their curriculum. As a nursing profession and the largest workforce in healthcare, how can we be so unaware of the veteran culture, specific physical and mental health needs, and unique environmental exposures that have led to various acute and chronic health conditions? Without this information, we are unable to care for this community holistically and adequately, often defaulting to the VA for answers to ALL veteran-related issues.

With that said, what do I think nursing needs to do? Simply asking, “Have you ever served in the military?” is not enough. To get a more correct answer, ask, “Have you ever served in the military, National Guard, or the military reserves?” Your next question should be, “Have you ever applied for VA healthcare or other VA benefits?” Asking these questions opens the door for a more accurate ability to take a comprehensive history and provide the appropriate care. 

The knowledge to care for the millions of veterans in our communities must become a priority for the nursing profession and nursing professionals, and I am incredibly excited to see a new nursing textbook focused on the care and the unique needs and culture of the veteran community called Caring for Veterans and Their Families: A Guide for Nurses and Healthcare Professionals. I was privileged to have contributed to this book and interviewed the editors and contributing authors on my podcast in November 2021 when the book launched. The book advocates for a renewed commitment to incorporate veteran health-specific content into the nursing curriculum, continuing education, and professional development forums to better care for and serve our veteran community. Other resources such as the “Have you ever served in the military?” campaign pocket cards and the “I Serve 2” pocket cards for healthcare providers caring for military children are a good starting point, too.