What follows is our interview, edited for length and clarity.
How did you get interested in being a psychiatric NP, treating trauma and mental health? What drew you to it? How long have you been doing it?
I have been a psychiatric mental health nurse practitioner (PMHNP) since 2010.
Treating trauma and mental health was an accidental merge as I worked as a trauma nurse while completing my clinical rotations for mental health. Over time, I would see my patients recovering from head trauma and would start showing signs of mental health needs that were often untreated by the time of their discharge. I felt a sense of responsibility to my patients, with a conviction that the emergence of mental health symptoms was not coincidental. I thought pursuing research was the best way to help my patients in a strategic way.
Explain to me briefly what you do in general. What types of patients do you serve? What do you provide for them?
I am a board-certified psychiatric nurse practitioner who has worked in trauma and psychiatry. I work as the track coordinator for the Psychiatric Mental Health Nurse Practitioner Certificate program and maintain a clinical practice in Baltimore City serving families recovering from substance use. My research includes identifying biomarkers for PTSD in Veterans with a history of traumatic brain injury (TBI), which includes exploring the factors influencing seeking treatment for PTSD after a TBI.
You’re a Jonas Philanthropies Scholar. What does that mean? What do you do as one?
Jonas Philanthropies and its Jonas Scholars program support nurse scholars across the country who have transitioned into roles as faculty, clinical leaders, and researchers. The goal of the program is to improve health care by investing in doctoral nursing students, such as myself, who are pursuing PhD, EdD or DNP degrees, and whose research and clinical focus addresses the nation’s most pressing healthcare needs. As a Jonas Scholar, I’m given financial assistance, leadership development, and networking support for my work as a psychiatric nurse practitioner and my research on biomarkers for PTSD in Veterans.
What do you like most about your work? Why?
I love working with individuals and their families, and I feel really lucky that I get to explore multiple aspects related to mental health through research, my clinical practice, and teaching.
What are the biggest challenges in your work?
Waiting for science to catch up with reality. Research is often very slow and tedious to find supportive evidence to enact change. It is necessary, but so many people are in need of it, and it is often difficult to be patient with the process.
What are your greatest rewards?
Seeing a patient smile. It is a reminder that while many things can be wrong and recovery is a lifelong journey, small things like a momentary smile symbolize ongoing hope.
If you could fix/cure one thing in your line of work (could be with patients or whatever), what would it be and why?
Take away the stigma related to mental health – it hinders so much, and so many people who deserve help are often unwilling to seek it because they do not want to be labeled negatively.
Is there anything I haven’t asked you that is important for our readers to know?
Research for TBI and mental health has made incredible exposure and progress in the last few years, yet so much needs to be done to help individuals who desperately need it. It makes the difference between just existing and having an opportunity to live a fulfilling meaningful life, and that’s what we all deserve regardless of a diagnosis or injury.
How often – and how well – do nursing programs teach lessons about the impact that climate exerts on health? And as more of us are exposed to and sickened by toxins, polluted air, unsafe drinking water, and a lack of access to basic health care – not to mention the economic, geographic and social effects of rising tides, stronger storms and predictably unpredictable weather – should climate lessons be mandatory for clinicians?
Kirby began her professional life working in nonprofits before heading to nursing school in spring 2020, just as COVID struck. Two years later, Kirby – who on May 22 earns a master’s in nursing through the UVA’s Clinical Nurse Leader program – says it couldn’t have happened any other way. And the environmental causes she embraced since childhood continue to flavor her nursing and determination to do good for both the planet and its human residents.
“I thought entering health care would be the end [of my environmentalism], but it’s turned out to be quite the opposite,” Kirby said. “There are a lot of people in nursing and medicine who care really deeply about the planet, and they’re motivated to change things. It’s very buoying to see how many people are interested in this.”
A climate and health conference in early 2021 first brought Kirby into contact with UVA nursing professors Tracy Kelly, Emma Mitchell and Kathryn Reid, champions of the Nurses’ Climate Challenge, which offers tools, resources and support for faculty committed to teaching climate and health lessons in their courses.
As Kirby’s environmentally minded connections multiplied, so did her ideas and determination to act. Over the last year, she led in developing a Planetary Health Report Card tool for measuring nursing schools’ planetary awareness. The work has presented speaking opportunities at conferences, and landed a national award and other applause from national nursing and environmental groups.
The first Planetary Health Report Card tool was created in 2019 by a group of University of California, San Francisco medical students to assess across five metrics about the climate consciousness of medical programs.
Following a similar model, Kirby, fellow clinical nurse leader student Alyssa Dimatulac, and a team of nursing students from the University of Minnesota, the University of Brighton, the University of Lancaster, and Germany’s Esslinger Science and Health College compiled their own tool to assess nursing programs’ environmental mindedness across curricula (how well and how often nursing courses embed topics of climate’s impact on health), day-to-day sustainability practices, student support, community impacts and interdisciplinary research. She hopes the tool ultimately becomes a commonplace way for prospective students to assess programs that align with their personal values.
Leaving a lasting mark on the organization they serve is a dream for many, but for one nurse, through her career in the Army Reserve, she’s been able to do just that.
Lt. Col. Kelly Bell, MSN, RN, CEN, USAR, commander of the 7203rd Medical Support Unit in Hobart, Indiana, successfully advocated for accommodations of pregnant Soldiers and new parents, resulting in Army policy change at the highest level.
“Be the change. Advocate for your soldiers.”
Announced and released on April 21, 2022, Bell was an integral contributor and author of the new Parenthood, Pregnancy, and Postpartum Army Directive. The directive features 12 distinct policy changes that pertain to pregnant and postpartum Soldiers as well as new parents. Changes touch on areas ranging from deployment deferments, an extended timeline to take the Army Combat Fitness Test after giving birth, and attending professional military education while pregnant, to convalescent leave after pregnancy loss or miscarriage or stillbirth, and more.
“I just wanted to take care of my pregnant Soldiers the way I wanted to be taken care of,” she said of her collaboration on policy change.
“It’s a change I never thought I’d see in my career, and it’s been needed for many, many years,” said Capt. Jennifer DeMaio, a mobilization officer with Army Reserve Medical Command, who gave birth to her fourth child on April 20, 2022, the day before the directive was published.
DeMaio, who has had all four of her children while serving in the Army, said the attitude towards pregnancy is different now than it was 18 years ago when she had her first child. For example, she only received a four-month deployment deferment after having her first child.
DeMaio also praised the new one-year timeline to prepare and train for the Army Combat Fitness Test after childbirth, mentioning the level of athleticism and healing that is necessary.
“The events are completely different,” DeMaio said of the new test. “And they are harder. This one-year prep time for the ACFT is completely needed.”
DeMaio experienced a complicated pregnancy this time around and delivered a baby girl, Jessah, via C-section at 26 weeks after several weeks of bed rest. DeMaio said she is grateful for her command’s reaction to and support of her pregnancy—a hint that culture change towards the normalization of parenthood has already begun.
“This unit is the most accepting of any unit I’ve been in,” DeMaio said of her pregnancy. “I was scared to tell my leadership because I didn’t have the best reactions (to her pregnancies) in the past. But I can’t imagine it going any better—nothing but positivity.”
Maj. Quentin F. Stewart, a plans officer at Army Reserve Medical Command and father of a newborn, said he believes the policy changes align with the Chief of Staff of the Army’s “People First” initiative and will have an impact on retention.
“This is a really great change for the health and welfare of our Soldiers and Families,” Stewart, currently on paternity leave, said. “The foundation of everything we do in the Army begins with people and I believe the parent and postpartum changes bring the Army on par with the other services when it comes to supporting the important early years of new family additions.”
“I think culture shift takes a lot longer than just writing a directive, but we hope that the directive will give the tools to begin the normalization of parenthood that’s necessary.”
For Bell, advocating for new parents and helping foster change to Army policy isn’t new; she’s been fostering accommodations around this topic for a while.
Bell commissioned into the Army Reserve in 1999 through Marquette University’s Reserve Officer Training Corps program after earning a bachelor’s degree in nursing. Since then, she has worked as a nurse both in the Army, which included a deployment to Afghanistan and a stateside mobilization during the COVID-19 pandemic, and in her civilian career. In her civilian capacity, she now works at a Des Moines, Iowa Veterans Affairs primary care clinic.
With the bulk of her experience in emergency room nursing, Bell has loved taking care of others as a career. She explained that becoming pregnant with her first child while serving as a commander of a medical unit was eye-opening to the challenges faced by military mothers and new parents.
Winning the battle to support lactating mothers in a modern army
Bell encountered vague guidance on the postpartum period for new Army mothers, including in the area of accommodating a time and place for pumping breastmilk for their new infants.
“It’s a huge mental stress on a lactating Soldier if they aren’t provided the services to pump and store breastmilk for their children,” she explained.
And her first foray into advocacy touched on this issue. In 2018, Bell wrote an email to the sergeant major of uniforms branch, asking for provisions be made for lactating Soldiers to wear an alternate nursing t-shirt that would make pumping breastmilk more easily accessible: her request was approved.
This led to a revision to AR 670-1 in 2021 which includes the undershirt authorization and notes that Soldiers are permitted to breastfeed their nursing child anywhere the Soldier and child are authorized to be. Additionally, the updated uniform regulation does not require breastfeeding Soldiers to cover themselves with additional items while doing so.
“This is a really great change for the health and welfare of our Soldiers and Families.”
“I think the most significant thing this time around is the time I’ll have to get back to the standards,” said Spc. Kellie N. Steele from Midland, Michigan, a dental specialist in the 7203rd Medical Support Unit. Steele, who is now pregnant with her fourth child (her second while serving in the Army Reserve), said she is grateful that the new Army directive will give her a year after having her child to take a record Army Combat Fitness Test.
Steele explained that after having her last child in December 2020, she experienced hip and pelvic pain, and it wasn’t safe for her to lift weights until she had fully recovered from childbirth.
“Every woman’s body is different,” Steele said. “The fact that they are extending and accommodating things means a lot.”
Steele said she is also grateful for the lactation accommodations in the new directive, as breastfeeding her children is important to her. The directive clarified and expanded Army Regulation 600-20, Army Command Policy, and now dictates where, how long, and under what conditions commanders will provide lactating Soldiers the opportunity to express breastmilk and discusses its storage.
Bell was instrumental in facilitating the passing of a waiver to Tri-Service Bulletin Medical 530, which discusses food codes. The waiver allows for storage and management of breastmilk in field food establishment refrigerators, making it an option to store breastmilk for nursing Soldiers.
Steele explained that she was able to use this waiver firsthand while on annual training at Fort McCoy, Wisconsin and away from her then eight-month-old daughter for two weeks: she successfully stored her breastmilk and was able to transport it home after her temporary duty, rather than throwing it away.
Bell did not stop her advocacy there, and became active in moderating two popular Facebook groups aimed at giving Army mothers an outlet for discussing pregnancy and childbirth topics.
Normalizing treatment of soldier parents
Bell found in the Facebook groups that Soldiers of all ranks and components pointed out further gaps in policy, education, and empathy on behalf of command teams. Concerns that continued to come up from new mothers included maternity and paternity leave, postpartum body composition testing, being excluded from attending professional military education while pregnant, and leadership education, among others.
Bell, along with 10 other authors, wrote a white paper published in 2021 that addressed these topics and stood as recommended revisions to the Army’s pregnancy and postpartum policies. Bell’s particular area of concentration for the paper was looking at the Army’s current operational and deployment deferment for new parents. Through research, the author group concluded that a one-year deployment deferment is necessary for both the development of the child and the child’s bond to its parent.
“We wanted to keep at least one parent at home with the infant during the child’s first 12 months,” Bell explained.
The white paper had the desired effect: senior leaders listened. Just a year after the white paper was published, the policy has been issued—a speed of action which suggests how seriously the recommendations were taken by Army leadership.
“The Sergeant Major of the Army was an integral part of reading this … and working with us to get the words right from a very early stage,” said Amy Kramer, lead action officer for the policy during a Pentagon press briefing.
Kramer noted that becoming a parent is a healthy, natural part of life, and the Army is committed to de-stigmatizing it.
“I think culture shift takes a lot longer than just writing a directive, but we hope that the directive will give the tools to begin the normalization of parenthood that’s necessary,” Kramer said.
For Bell, she’s leaving behind a legacy of perhaps enabling pregnant Soldiers and new parents to be both phenomenal troops and caregivers at the same time—to be able to better balance both worlds without having to choose to compromise one.
“None of these policies are now going to help me personally, but they will give me the tools needed to be a better leader,” Bell explained, and said she won’t be having any more children herself, but wanted to help usher change to help future generations of Soldiers.
“Be the change,” she said. “Advocate for your Soldiers.”
And Bell has done just that.
To access the full directive, visit: https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=1024798
The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.
Power is defined as the capacity to knowingly participate in change for wellbecoming (Barrett, 2015). Barrett (1986) assumes that everybody has power, but at times people may experience powerlessness depending on life circumstances. Mentoring is a modality that can help students overcome barriers that hinder their power to excel in their programs and as professionals in the field.
Mentoring has been used in nursing to help both nurses and nursing students grow and advance in their careers. It has been depicted as important to the growth of nursing (Navarra et al., 2017) and as a catalyzer for increasing diversity and the inclusion of minorities in nursing (Talley et al., 2016). It is not surprising that mentoring was cited as a modality that can help nurses excel. Excel is one of the components of the American Nurses Association (ANA) 2020-2021 Year of the Nurse theme: “Excel, Lead, Innovate” (Indiana State Nursing Association, 2021). In addition, mentoring fits into the mission of the CUNY School of Professional Studies (CUNY SPS), which is to offer customized programs that are responsive to its students’ needs, and its vision to enable students to grow and excel (CUNY School of Professional Studies, n.d.). Mentoring also aligns with the CUNY SPS nursing program’s mission to guide students in attaining the necessary tools (knowledge, skills, values, and ability to make sound judgment) to excel in the profession of nursing (CUNY SPS Nursing Department, n.d.).
The nursing program at CUNY SPS is a fully online program that offers many opportunities for nurses to further their education and climb higher in the profession. It includes a BS in nursing and four BS dual joint programs that ensure a seamless transition from Borough of Manhattan Community, Bronx Community, La Guardia, and Queensborough Community College. It also offers several MS degrees in nursing informatics, nursing organizational leadership, and nursing education, as well as an accelerated RN to BS-MS in nursing informatics.
The CUNY SPS nursing program uses two unique mentoring initiatives that target new students in the BSN program. The Black Male Initiative (BMI) is a CUNY-wide initiative that facilitates retention and degree completion success for Black and Hispanic men in higher education. The BMI program, which was designed to level the playing field of inequity and inequality in higher education, uses “a peer-to-peer mentoring model”. At CUNY SPS, the BMI program is used to enhance its Career Ladders scholarship program and to implement the BMI mentoring model (CUNY School of Professional Studies, 2021). It takes into account cultural differences and trains experienced high-performing students to serve as culturally competent peer mentors for new and struggling nursing students. Peer facilitation has been shown to boost both peer facilitators’ and students’ confidence (Davis and Richardson, 2017).
At the beginning of the fall semester, the CUNY SPS nursing department launched its first mentoring program. The aim of the program is to support nursing students in their journey to professional nursing. This decision was spearheaded by the need to provide support to adult students who very often are juggling school with full-time work and family, in addition to other life responsibilities. These realities were worsened by the COVID pandemic. The nursing department’s mentoring program is voluntary for both the mentor and the mentee. It targets new students entering the BSN programs. In contrast to the BMI peer mentoring program, the mentors are professional nurses who are active in the profession. Although all the mentors are currently CUNY SPS nursing faculty who volunteered to participate, mentors can also be professional nurses outside of the program. Careful measures are taken so as not to pair students to faculty who teach them. The hope is for students to use this resource for career guidance, confidence building, and collegial support. As we continue to evolve in an ever-changing world, it is our hope that these two mentoring opportunities can support our students’ aspirations, facilitate their ascent to higher grounds, and increase their power. As they knowingly ‘participate in change for their wellbecoming’, so too will those they serve. “Power is being aware of what one is choosing to do, feeling free to do it, and doing it intentionally” (Barrett, 2015, p 498).
Barrett, E. A. M. (1986). Investigation of the principle of helicy: the relationship of human field motion and power. Explorations on Martha Roger’s Science of Unitary Human Beings, 173-184.
Barrett, E. A. M. (2015). Barrett’s theory of power as knowing participation in change. In M. C. Smith and M. E. Parker (Eds.), Nursing theories and Nursing Practice (4th ed. pp. 495-508). F. A. Davis Company.
More nurses will not only sit at the table; they will also be gripping the national policy podium in 2021. As President Biden’s Acting Surgeon General, Nurse of the Week Rear Admiral (RADM) Susan Orsega, MSN, FNP-BC, FAANP, FAAN is going to be one of the key US health officials—and Orsega is ready for duty. She’s spent much of her career handling health emergencies and disasters ranging from AIDS to 9/11 to the 2015 Ebola outbreak. The Rear Admiral and infectious disease specialist has been Director of Commissioned Corps Headquarters (CCHQ) at the Office of the Surgeon General (OSG) since 2019.
RADM Orsega’s areas of expertise seem almost to be designed for the tumults of the Covid era. After receiving a BSN at Towson University, she began her career at the US Public Health Service (USPHS) in 1989, while the world was coming to grips with the AIDS pandemic. Orsega plunged into HIV/AIDS nursing practice, international operations, health diplomacy, epidemics, and disaster response, while fitting in an MSN in 2001 at the Uniformed Services University (USU) Graduate School of Nursing Nurse Practitioner program. She has been deployed on 15 national and international disaster/humanitarian deployments, including the elite USPHS medical team after 9/11.
In 2016, when she was named Chief Nurse of the US Public Health Service, Orsega addressed nursing students at her alma mater. According to the Towson news post, she told students to “think about how their passions, interests and strengths and their work experiences intersect to find their career focus, an area she called ‘the sweet spot.’ She also challenged them to think beyond direct patient care to what their vision is for their career, how they can grow into leaders on the local, state, national and international levels…”
Prior to joining the Surgeon General’s office, she worked at the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH). At the height of the devastating 2015 Ebola epidemic, Orsega was appointed to the NIH/NIAID Ebola trial operations team and helped lead the first human vaccine and treatment Ebola trials in Liberia and Sierra Leone.
Orsega served as the Chief Nurse Officer of the USPHS from May 2016 to March 2019. As CNO, she advised the Office of the Surgeon General and the U.S. Department of Health and Human Services (HHS) on everything from recruitment and assignment to retention and career development of nurse professionals and 4,500 Commissioned Corps and civilian nurses. Orsega has been a Fellow in the American Association of Nurse Practitioners since 2013, and in 2016, she was inducted into the American Academy of Nursing.
Previous nurse Surgeon Generals have included Rear Admiral Sylvia Trent-Adams, PhD, RN (appointed in 2017), and Richard Henry Carmona (appointed 2002). The White House is expected to announce Orsega’s appointment next week.
The United States is facing a critical shortage in all health care professions. With the nation’s baby boomer population approaching retirement age, the issue is twofold: the aging population requires more care, and the nation’s physicians, nurses, and other health professionals are retiring.
Too Many Students, Not Enough Options
The solution to filling this gap is replacing the departing health care professionals with nursing graduates of all academic levels. However, many higher education institutions are turning away suitable candidates in droves. In 2016, nursing degree programs in the U.S. rejected 64,067 qualified applicants from baccalaureate and graduate nursing programs alike citing a lack of budget, faculty, clinical sites and preceptors, and classroom space.
Currently, there is a serious shortage of physicians, which continues to grow. By 2025, there will be a projected deficit of nearly 35,600 primary care doctors alone. Nursing schools are facing the struggle and strain to increase the capacity of existing nursing programs, and explore other avenues like online courses and accreditation.
Higher Education Means Higher Pay
Enrollment is increasing in nursing masters and doctoral programs across the country, and it’s no wonder that nurses are applying to graduate schools en masse. RNs realize there are significant perks to training and becoming an advanced practice registered nurse. Evidence shows that the quality of care by an advanced practice nurse is comparable to physicians, while often more affordable.
The full-time annual salary for a Nurse Practitioner (NP) averages $105,546. The high pay range of the NP may be partly to blame for the faculty shortage—higher compensation in the clinical setting is luring potential educators away from teaching.
Most vacant faculty positions require a terminal nursing degree. If more nurses pursue a doctoral degree, the faculty shortage will be alleviated. What will the outcomes of the nursing shortage be? Only time will tell.
Caitlin Goodwin MSN, RN, CNM is a Board Certified Nurse-Midwife and freelance writer. She has ten years of nursing experience and graduated with a MSN from Frontier Nursing University.