When we imagine the professionals caring for aging Veterans, we often immediately think of doctors, nurses, and pharmacists. Still, one avenue of care you may not consider is geriatric mental health.
While older Veterans have vast experience coping with challenges, some face longstanding or emerging mental health conditions as they grow older. As our Veteran population ages, those who have served our country will need mental health professionals to help them continue to live their best lives.
A Unique Expertise
When it comes to providing for our aging veterans’ mental health, geriatric psychiatrists bring unique expertise to our team. They focus on the prevention, evaluation, diagnosis, and treatment of mental and emotional disorders in the elderly. However, the critical difference for geriatric professionals is their experience with older adults who have multiple medical issues and take multiple medications.
Aging Veterans may experience depression, anxiety, distressing memories from their military service, or stress related to health concerns—including pain, sleep troubles, or memory problems. Even something as basic as increased difficulty getting around isn’t limited to just the physical—there can be a mental component attached to the possible loss of independence.
“Having access to a specialist who not only understands psychiatric medicine but the pharmacological goals of the elderly we care for has made a tremendous difference in our ability to keep our Veterans stabilized and safe in our memory care unit,” explained Edith Emerson, who works in the memory care unit at the Togus Maine VA.
A Critical Need
VA has many programs to support older Veterans and their families and caregivers, both online and in-person at our facilities. We also provide specialized geriatric services for Veterans and families to help them cope with complex mental health conditions in later life.
However, the need for geriatrics professionals throughout the country is growing. There are more than 11 million people aged 60 and older alive today who have served in the military, representing the largest population of Veterans in the nation. As these Veterans find their way to VA, we must to be ready to meet their needs.
“Nationwide, there’s a shortage of geriatric services, in particular geriatric psychiatry,” said Dr. Isis Burgos-Chapman, a geriatric psychiatrist who provides community living center and outpatient consultation services through one of VA’s Clinical Resource Hubs.
A Career of Caring for Veterans
Between our ever-expanding telehealth services, inpatient care positions, and outpatient care support opportunities, there are plenty of ways a mental health professional with a focus on geriatrics can reach out to aging Veterans and demonstrate our core values—integrity, commitment, advocacy, respect, and excellence
These core values define who we are as VA employees and how we will fulfill our mission to care for Veterans in all their times of need. In addition, these five ideals describe our culture and serve as the foundation for how we interact with our Veterans and fellow employees.
Integrity: We act with the highest professional standards and maintain the trust of all we engage.
Commitment: We work diligently to serve Veterans and are driven by an earnest belief in VA’s mission.
Advocacy: We are truly Veteran-centric as we work to identify, consider and advance the interests of Veterans.
Respect: We treat all those we serve and with whom we work with dignity and respect because we believe you must show respect to earn it.
Excellence: We strive for the highest quality and value continuous improvement.
Work at VA
If you have an interest in working with older Veterans, whether in one of the VA facilities or in their own homes, VA has an opportunity for you.
Dr. Holly Martin, a doctor of nursing practice and family nurse practitioner, recently retired from a 22-year career with the Department of Veterans Affairs.Daily Nurse salutes her accomplishments as a changemaker, advocacy for equitable compensation for nurses, and devotion to serving Veterans by naming Dr. Martin our Nurse of the Week.
Dr. Martin’s journey as a healthcare professional took several turns before she found a home at VA.
“I had dropped out of high school and was floating around the university and not really doing much with my life, and I eventually applied for nursing school at age 26,” she says. “I ended up graduating at the top of my class all through the bachelor’s and master’s degrees and getting a doctorate in nursing.”
Dr. Martin stumbled upon VA through a nursing convention in the fall of 2000, where she met enthusiastic VA nurses eager to find peers skilled with computer charting. She began working with VA and realized she had a strong connection to the organization and to the people she served.
Nurse of the Week Dr. Holly Martin
Family in Every American War
“It didn’t dawn on me how much VA meant to me until I’d been here a while because my whole family was in the military,” she says. “My father was killed in Vietnam, my grandfather was in the Army Air Forces, and we’ve had a soldier fight in every American war since coming to this continent.”
As both a nurse practitioner and an educator, Dr. Martin sought opportunities to foster growth in the workforce and the services VA provided. She wrote a grant to open a telemedicine clinic in Elko, Nevada. After winning the grant, she went on to teach students who would become future VA leaders while at the same time developing telemedicine as a tool to deliver primary care.
She earned her doctoral degree as a member of the first cohort to graduate from the University of Utah’s Doctor of Nursing program. She then promoted further growth for VA telehealth care by working with Clinical Resource Hubs as a telehealth provider.
Challenged Standards for Nurse Practitioner Pay
“People didn’t understand nurse practitioners very well, and that understanding has grown significantly over the years,” she adds. Dr. Martin challenged standards for locality pay and helped to demonstrate the value of nurse practitioners and their licensures as independent practitioners to increase compensation to more equitable standards.
As she ended her career with VA after 22 incredible years, Dr. Martin says she gained many opportunities by simply saying “Yes.”
“Any time somebody asked me to do something, I said ‘Yes.’ Any time I can help other nurses get more time or more space for more students, I do it. It’s only a minute in your life to be nice and help other people out. If you can help another nurse, you should get your feet wet and help them out!” she says.
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
In honor of Veteran’s Day, Daily Nurse chatted with Richard Ramos, RN, MS, CNS, PNP, CPON, a pediatric oncology nurse at Stanford Medicine Children’s Health and veteran of the U.S. Army Infantry, about applying his military skills to his role as a nurse leader and devoting his career to pediatric oncology nursing.
Why did you pursue a career in nursing?
When I was younger, the mother of a family whose children I taught swim lessons was a nurse. The seeds were planted by her. While I was looking forward to the adventures my time in the U.S. Army Infantry would bring, when I left the military, I was also left with an abiding desire to continue to do service. In retrospect, it was conversations with this woman about nursing, what nurses do every day, and their important role in healing. It resonated with me.
Before becoming a nurse you served in the Army for four years, leaving as a 1st Lieutenant. Why did you decide to leave the military as an officer and become a nurse?
I was mostly inspired by my dad, an Army officer, and some of my scout leaders who were likewise in the military. They inspired a sense of service and taught me many leadership and outdoor adventure skills that followed me into the Army (e.g., orienteering, rappelling, backpacking, and basic survival). Nursing was a “seed” planted by the mother whose children I taught in Red Cross swimming lessons while I was in college. Some of her stories regarding service and caring for patients “stuck” with me over the years. When I resigned from my commission and reflected on our discussions, it seemed a natural “next step.” Something about it fits nicely.
Was there any experience that made you think, “I want to devote my career to pediatric oncology nursing?”
As I was re-educating and reinventing myself as a nurse, I did one of my clinical rotations at Lucile Packard Children’s Hospital Stanford in 1990. The experience granted me clarity on so many levels. For one thing, I found that the patients, families, and staff were at their best when life had thrown the worst at them. That moved me. Further, it was an easy “banner” under which to fight—caring for kids facing a life-threatening illness.
Do you see similarities (or differences) between serving as a platoon leader and being a nurse leader?
Undoubtedly. You must motivate and inspire the team to achieve a common goal/objective. In many respects, the team dynamics demanded by the military are similar to that of nursing. The most significant difference is communication and how to talk to people, unlike the infantry in the 1980s. What I thought was kind or reasonable in my speech while I was in the military was considered off-putting in different settings. Respect is key. The nursing process is a bit more intricate in its workings. It involves far more cooperation, collaboration, and a far kinder tone of voice than I had grown accustomed to when I served in the military. Even throughout my years as a nurse, I am still learning.
What skills have you seen translate from the military into your line of work as a pediatric oncology nurse?
The military provided me with a profound sense of service. Additionally, the experience showed me how to perform thoughtfully under extreme circumstances. Organization, leadership, critical thinking, responding to situations clearly with a sense of urgency, and risk management are a few examples that the military instilled in me. These skills generalized well in my career as a nurse.
How can bedside nurses use their experiences with hands-on patient care to help effect change on a larger scale than individual health outcomes?
Most nurses have always brought about positive change, specifically in health outcomes—changes that result in healing or extension of life qualitatively, certainly where pediatric oncology is concerned. And that is the change they have been eliciting all the years I have been a nurse.
This is especially evident for nurses who become involved in advanced practice and holistic care (e.g., nurse practitioners, clinical nurse specialists/educators) and/or administrators (e.g., managers, directors, quality improvement/assurance). In my experience, nurses who started at the bedside and learned the intricacies of care at that level develop a 360-degree view regarding clinical practice and how to improve it when stepping into a position that brings about change on a community level (when they move into advanced practice and administrative roles). In that sense, the adage “the hand that rocks the cradle rules the world” applies.
Working with children suffering from pain, discomfort, and fear–and their families–sounds even more demanding than palliative care. (Yet palliative care nurses tend to find their work deeply fulfilling). What is the hardest part of being a pediatric oncology nurse? And what makes it so rewarding?
Disillusionment. I think that’s the hardest part for all involved in caring for a child with cancer, especially when they are a “new diagnosis.” Examples of disillusionment are as follows.
The child. They are uncomfortable in a manner that won’t go away and from which their parents cannot protect them (a scary thing for a kid, I think). For adolescents, it goes a step further in that just when they’ve reached a station in life in which they were supposed to be “bulletproof,” they’re confronted with their mortality.
Parents. They likely had hopes and dreams for their child’s life—it certainly did not involve cancer.
Clinicians, especially young nurses, it’s the disillusionment caring for these kids is much more challenging emotionally, physically, and intellectually than they ever imagined.
The rewards come in inches, bridging the gaps mentioned above by making the patient comfortable. Listening to a parent just long enough to relieve their fears and reflecting that cancer is not always a death sentence. It’s a long fight but one worth the effort. Occasionally, the children who have obtained cures visit the unit. Even the end-of-life aspect of care has its rewards when the family and patient have been adequately prepared. It is peaceful and consoling.
If a nurse is considering specializing in pediatric oncology, what should their first or primary considerations be (for example, are personality or character traits beneficial in your field)?
While resilience is a term that has been a little overused recently, it is appropriate for pediatric oncology. The nurse new to the specialty will see things wonderful and horrible, sometimes during the same shift. They must find an emotionally adaptive way to process the experiences and return to the next shift to do the work skillfully and professionally.
Coupled with the emotional aspects, the budding pediatric oncology nurse should embrace the science of nursing in general and oncology in particular. Where medicine dedicates itself to saving lives, nursing is concerned with keeping people alive. To put it another way, medicine heals, while nursing sustains.
Nursing is the science of creating a therapeutic environment that allows medicine to work. It is sophisticated stuff. It involves surveillance and knowing when to call for help when a patient is in trouble. Nurses should administer the therapies as ordered by medicine and understand what they are and how to administer them safely in concert with the myriad therapies already being administered. In more extreme circumstances, they have to know how to support the patient that has arrested until help arrives. These are all the things I mean by keeping the patient alive.
How are you supporting Spanish-speaking parents in your role as a Group Facilitator at the Latino Parents of Children with Cancer? How are you making a difference in their lives?
I co-facilitate the Latino Parents of Children with Cancer group in partnership with Latinas Contra Cancer and the Leukemia and Lymphoma Society. Once a month, we meet and discuss the challenges and successes of caring for a child with cancer. The parents do most of the work in providing solutions for one another. For instance, the more experienced members will offer suggestions to new ones on navigating hospital systems and what’s in store as treatment unfolds. If clinical questions arise, my colleagues and I are there to explain the process.
On occasion, we advocate on their behalf if clinical or financial needs occur (e.g., attend a care conference and ensure they understand what is happening to their child; help them fill out forms to solicit charitable funds for rent or food). We encourage the kids to come with their parents so they can meet others going through the same thing. It gives them a sense of community and peers who can understand their challenges. Our group is close-knit. Much of the meeting time is social and fun, though it can be serious at other times. Still, we provide a safe and warm space to discuss whatever the families face
A healthcare career as a pharmacy technician at VA offers unique opportunities and excellent benefits and might be the prescription some need.
The VA is always looking for candidates with top-notch organizational skills to help keep their pharmacies running.
Pharmacy Technician Role Offers a Unique Environment
A pharmacy technician at VA works closely with pharmacists to ensure the health and safety of our Veterans. However, it’s the pharmacy technician’s responsibility to locate, dispense, pack and label prescribed medication for patients.
Since VA offers some pharmacists the unique ability to write prescriptions independently, the work of a pharmacy tech is even more critical in assisting our Veterans.
The VA’s work environment is unique, offering the opportunity to work in outpatient and inpatient settings.
While some veterans may require prescriptions they take home with them, other patients might need the pharmacy technician’s assistance in the halls of VA medical centers. For example, veterans needing chemotherapy or IV dosages look to pharmacy technicians to ensure their medications are provided safely and securely.
When not interacting with veterans, a pharmacy technician also helps pharmacists with administrative tasks such as processing insurance claims, tracking inventory and filing paperwork, or even updating and replenishing the supplies on the emergency carts used by VA teams.
Career Growth at the VA
When pharmacy technicians are ready for a new challenge, the VA offers ongoing leadership development through every level of employment, whether mandatory programs or competitive opportunities. The VA also provides resources making it easier to continue education.
Trade your student debt for a promising career serving Veterans. If you’re looking for help repaying your student loans, you can qualify for the Public Service Loan Forgiveness (PSLF) program with a VA career.
By canceling loans after 10 years of public service, PSLF removes the burden of student debt on public servants and entices people to work in high-need fields. Because VA is a federal employer, new and existing VA workers with federal student loans may be eligible for this national loan forgiveness program.
Qualifying for the program
The PSLF program forgives your remaining loan balance after you have made 120 qualifying monthly payments under a qualifying student loan repayment plan while working full-time for certain employers, like VA.
Right now, the U.S. Department of Education has waived some requirements for applications submitted through Oct. 31, 2022, opening up loan forgiveness to more borrowers.
Still, though, you need qualifying employment to be considered, which is one of many reasons why you should consider a career at VA.
Investing in your future
Despite the short-term waiver that expands PSLF, the program is ongoing, which means that anyone looking for a career at VA can participate once they begin their employment.
But that’s not all VA has to offer. With our Education Debt Reduction Program (EDRP), VA employees with qualifying student loans who are in specific, difficult-to-recruit direct patient care positions may receive up to $200,000 over a five-year period.
And for those looking to continue their education, the Employee Incentive Scholarship Program (EISP) offers significant support. This program provides eligible VA employees with tax-free scholarships of up to $41,572 toward the cost of higher education, including tuition, registration fees and books. In return, you agree to work at VA for one to three years after you complete the program.
We offer some of the most comprehensive employee education benefits in the nation, and we work hard to ensure you have access to tools, benefits and training that provide the personal and professional growth needed to take your career to next level.
Work at VA
A job at VA could provide some relief from your student loans and be the next step on your journey to a fulfilling career.
With all that nurses do for our patients, it is only fitting that we do just as much for them, supporting nurses as they grow in their VA career.
Whether at the bedside of a Veteran or working in an outpatient clinic, our nurses deliver quality care and lead the way in innovating how we provide nursing care. Nurses also develop patient safety initiatives, conduct research to improve care delivery, and help guide the next generation of nurses.
VA and schools of nursing around the country offer academic affiliations. These collaborative efforts between VA facilities and the country’s finest nursing schools provide students with clinical experiences that specifically address the unique needs of Veteran population and prepare them to excel in careers at VA.
These partnerships offer nursing students a comprehensive and intensive four-year clinical training. The programs create a stronger, mutually beneficial relationship between nursing schools and VA facilities by giving students the opportunity to engage with faculty and ultimately provide better patient care as they put classroom concepts into practice.
By the end of the program, graduates are fully accustomed to the culture and mission at VA and ready to care for our Veterans.
Transition to practice
For over a decade, VA has promoted Registered Nurse Transition-to-Practice (RNTTP) residency programs to provide a transition from school to the more complex clinical environment for RNs with less than one year of experience.
The comprehensive 12-month curriculum explores the clinical, leadership and professional dimensions of nursing at VA. Post-graduate RNs perform the typical roles, duties, patient care activities and procedures that are carried out by nurses on our team.
Availability varies by location, so contact the nurse educator or nurse recruiter at a facility near you for more information.
VA offers eligible employees and students nursing scholarships to advance their education and skills training through the following programs:
The VA National Education for Employees Program (VANEEP) is offered to employees in a clinical program pursuing first-time licensure in a clinical occupation. Participants can earn their degree faster by attending school full time, with VA covering not only some education costs but also replacement salary while they are enrolled.
The VA Learning Opportunities Residency (VALOR) program provides an opportunity for outstanding college nursing students to develop clinical competencies at an approved VA Medical Center. VALOR is designed to increase participants’ clinical skills, clinical judgement and critical thinking while caring for our nation’s Veterans. This program provides opportunities for learning with a qualified RN preceptor. Students must have completed their junior year in an accredited baccalaureate nursing program. VALOR students are offered up to 800 hours of salary dollars.
Work at VA
Are you ready to help us heal and care for Veterans so they can thrive in life after military service? Apply for a job as a VA nurse.