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Discussion of Findings

Through the telling of the individual nurses’ stories, a readable narrative is constructed that reflects the diversity and eclectic nature of their deployment, homecoming, and reintegration. Their stories reveal a complex reality with regard to their clinical assignments and missions, the patients they cared for, and the military hierarchy in which they practiced. Reintegration for some nurses proved to be complicated as they referenced their social network, workplace, and community. Reactions to coming home were varied; some were met with surprise, guilt, anxiety, and frustration. Others felt surrounded with the love of their families and friends. Some felt appreciated and honored by their social and work networks. Many nurses had difficulty finding their place in society and in nursing because they felt “forever changed.” Some assimilated in a more regular fashion, especially when they were graced with a strong support system. Marriages and relationships were tarnished, some ended, others miraculously endured, and still others were strengthened.

When examining the research findings, two distinct elements of reintegration stand out the most. First, reintegration is a very individual process for each returning nurse. Second, there is no specific timetable to complete the reintegration process. As with all processes, there is a beginning, a middle, and an end. Some of the nurses indicated key points in their reintegration and others described when they felt a sense of closure. For example, Captain Earl, who was an air force flight nurse in a reserve unit, exclaimed that he did not feel “reintegrated” until he was home for about 10 years. However, even when nurses recognize closure to the reintegration process, they still readily admit that they are “forever changed” as a result of their deployment experience.

With each theme identified through this research, there were mitigating factors that colored each nurse’s reintegration. The same could be said of each nurse’s deployment. Just like people could not control what they did and what they saw, they could not control their homecoming reception or lack thereof. There were positive homecomings with family, friends, and coworkers greeting returnees with open arms. Conversely, there were negative homecomings with late night arrivals and lengthy airport layovers, which led to disappointment and frustration. Yet, many nurses realized that it was relatively easy for the military to identify aspects of homecoming that could be improved with proper planning and anticipatory guidance. For example, after a flight back to the United States, transportation could be provided to deliver returnees to lodging for the night, which would preclude them having to rent a vehicle to get them where they needed to go. Military units could make plans to host a “welcome” reception especially when returnees are traveling in a group.

Although the military cannot dictate what families do to welcome their loved ones back on U.S. soil, they can encourage military units to see that their returning members are greeted with gratitude and acknowledgment. The key to all of this is good communication on all levels.

Each chapter introduced a theme that was the thread woven through the narratives in that chapter. Chapter 1 traced the historical roots of the wars in Iraq and Afghanistan. Chapter 2 discussed the military medical assets deployed to each war and the concept of operations and doctrine underpinning medical unit deployments. Chapter 3 presented the nurses’ narratives regarding positive homecoming experiences. Chapter 4 described disappointments and negative homecoming experiences. Chapter 5 told how the nurses renegotiated roles within their families. Chapter 6 presented the nurses’ testimonies of painful memories of trauma associated with their wartime deployments. Chapter 7 focused on how the nurses sorted things out and made decisions to seek help. Chapter 8 described how some nurses sought a clinical change of scenery on returning home, electing to try a different area of nursing. Chapter 9 told how some nurses had difficulty tolerating the petty complaints of others after serving in a war zone. Chapter 10 presented narratives about the nurses’ return to work and the support or lack of support they received. Chapter 11 described the nurses’ families and social networks in terms of support or lack of support. Chapter 12 focused on the entire reintegration experience and how a “new normal” was created. Chapter 13 discussed the findings of the research that led to this book. Chapter 14 presented the clinical implications of the research. Finally, Chapter 15 presented recommendations for preparing nurses and their families for wartime deployment, suggested homecoming and reintegration strategies to foster a smoother transition, and highlighted areas needing further investigation.

This book presented the testimonies of 35 nurses who participated directly in the wars in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom). They wanted their stories to be told. Some simply wanted their voices to be heard. Others wanted to awaken the American public about the service they provided as a result of a void in the news about the nurses’ mission in these wars. They also wanted people to know that nurses are not immune to posttraumatic stress disorder (PTSD), compassion fatigue, and burnout. These maladies can be a direct result of what nurses see and do. Just like soldiers, sailors, airmen, and marines, nurses are “forever changed” as a result of their wartime deployment.

Reintegration with family and friends, workplace, and community was a challenge for the majority of the nurses. The themes reflected in the chapters depict trials and tribulations, but also victories and triumphs. What came across loud and clear was the individuality and uniqueness of each nurse’s reintegration. One size does not fit all.

The nurses’ voices are represented in excerpts from verbatim transcriptions of oral testimonies. All names have been changed for privacy reasons, yet their words remain true. The book is replete with vivid descriptions of their clinical experiences in war, which provided the backdrop for their reintegration. Their stories speak of what they saw and did and how these past experiences informed and shaped their reintegration. There is a mention of traumatic amputations, burns, mutilated bodies, and the measures used to treat the injured.

Many nurses talked of what it was like to come home, to return to work, and to resume their previous lives amid much change in themselves. Many wondered if life would ever be the same; others wanted a clinical change of scenery; and some questioned previous decisions. Their stories are full of emotion and convey how deeply these nurses were touched by the human suffering they witnessed. The emotional depth of feelings was clearly evident in their interviews as voices quivered and eyes moistened when the nurses recalled details of their deployment, homecoming, and reintegration.

This book provides a social history told by military nurses, who experienced these wars firsthand. Their accounts detail nursing work set against two major sociopolitical conflicts. It is important to document nursing work in military conflicts because this is definitely a significant piece of nursing history.

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