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Military Unit or Civilian Job: Support Versus Lack of Support
Some nurses were welcomed back with coworkers listening to their stories with empathy, interest, and compassion. A few told how their leadership, both military and civilian, eased them back into the work schedule. A navy nurse remembered how she found solace in talking to people at her base who had also been deployed. She told how they shared their experiences which helped them form a bond. Conversely, some nurses felt ignored by coworkers and abandoned by their leadership. They believed that coworkers expected them to jump right in at work, without needing time to process things and transition back into a stateside work setting. They felt rushed, misunderstood, and pressured to keep up with everyone else. Some vented their frustration and explained that their deployment nursing position was completely different from their stateside one. This was especially true for the nurses who were part of a provincial reconstruction team. It also took the primary health care providers such as nurse-practitioners and nurse-midwives a little time to get back in the groove of seeing patients in a clinic setting after they had done a different mission during deployment.
LIEUTENANT COLONEL TONI
Toni was a Critical Care Air Transport Team (CCATT) nurse who had been deployed to Iraq and Afghanistan. She outlined the predicament of many reservists.
She stated:
For reservists, there are really no resources available for us. When you get home, you are really on your own. The active duty people return to their base, in-process, and are offered mental health counseling. Then, they get 30 days of leave before returning to work. They have resource people who check on them to make sure they are doing OK. On the other hand, reservists have no paid leave; so, most of us return to our civilian jobs a lot sooner than 30 days. We have to hit the ground running because it is like we never left. There are no resources to follow up on a regular basis.
Toni related a vivid example:
I know a pilot who committed suicide. His wife found him. His friends said he seemed fine, and he looked fine, but he committed suicide. There was no one to follow up with him, and I have to believe that following up can make a difference. He was flying C-17 missions with the back of his plane filled with wounded soldiers. This guy was hurting, and no one knew it. People don’t know that having PTSD [posttraumatic stress disorder] is the “new normal” if you served in these wars. It is a normal reaction to an abnormal reality.
Toni described how her civilian colleagues at her hospital were helpful when she returned from deployment:
My colleagues in the trauma ICU were supportive. They wanted to know what I did, how it went, what I saw, and to hear about the experiences I had. It was helpful to speak of it. I think the more people hear about our experiences over there, the more they can understand why some of us come back with PTSD or compassion fatigue. One thing that bothers me is when people tell me I’m a “hero.” I’m not a hero, I did what was important to me and what feels good to me. I’m serving my country in the best way I can. It takes an army of people to save one life. It wasn’t just me, it was the pilots that flew the air evacuation plane, the troops working on the flight line to maintain that plane, the medics who carefully load and unload precious human cargo, to the guy refueling the plane, to the communications and admin people reporting the patients who need to be transported. The whole hospital welcomed me back. The new unit I worked on had some wonderful nurses who welcomed me, too.
Toni described her homecoming to her reserve unit:
My colleagues at the base welcomed me back. Many of those folks had deployed before, so they understood. I drill out of an Air Force Base in California. I’m in one of the squadrons there. But, I was asked to start in a new unit there where I didn’t know anyone. I felt cheated that I couldn’t go back to my old unit. I needed time to recuperate and rejuvenate, and by sending me to a new unit there was no time for that. I thought it would be better to let me return to my old unit and then 4 or 5 months down the road I could get transferred to the new unit. It was too much change too fast. Things worked out OK in the long run, but it would have been better if I had some say in the transition. I felt very respected at my Reserve base. A lot of good reports came back to the wing headquarters about how well our CCATT team did in Afghanistan.
LIEUTENANT COLONEL CHRISTA
Christa, an air force reservist, described her return to work.
She stated:
I was off for about a month before I went back to work at the hospital. Some people were so happy to see me and they thanked me for my service. Some other people were not very friendly at all, and they took my job away from me, or rather, parts of my job away from me with no real explanation. So, it was pretty tough going back to my civilian job. Then I got my most recent performance evaluation, and they had downgraded my proficiency rating. They put on there that I had been gone for over 6 months from the job, so that is why they downgraded me. I went back in my records, and I saw that they had done the same thing when I deployed the first time. So, it was not a very nice “welcome home” in my civilian job. Now, my friends at the hospital were great, it was just the administrative side that was really bad. Other nurses, the logistics folks, the pharmacy guys, and everyone else, not in nursing administration were great.
On my first UTA [Unit Training Assembly] back, it was business as usual. There was nothing special about us having been gone, and there were 60 of us that deployed, which was half of our unit. We didn’t have the “yellow ribbon” program back then. That is when the people who were deployed get some time set aside on drill weekends where they can spend time together, sort of debrief and reflect on what you have just been through. Unfortunately, we didn’t have that. We didn’t have any time to talk with each other, to just chill out with each other.
Christa went on to explain how she and her deployed colleagues found time to talk. She stated:
One thing that did happen was we got a short field exercise deployment to Kuan-Ju in Korea, and we moved some of our ASTS [Aeromedical Staging Transportation Squadron] equipment over there. We met up with a unit from Luke AFB, Arizona, in Korea. It was an awesome short deployment because we finally had time to chill out, catch up, and debrief each other and just spend time together and rekindle the camaraderie we had. We needed that so much. But it took a year before we could get together as a group.
The leadership from my reserve unit did not deploy to Iraq. I went as the chief nurse and one of our medical services officers (MSCs) was made commander of our unit when we deployed. We both led our unit in Iraq. He was pretty inexperienced and did not always include me in the decision making, even though I had years of administrative experience and he had practically none. However, I found ways to stay informed and work around the fact that he [commander] did not always keep me in the loop. For example, I became very good friends with the chief nurse of the air evac unit and her flight nurses. Her call sign was “Mother Goose.” She kept me informed about missions, equipment, and any other things going on. When my commander made up his organizational chart for our deployed unit, he did not even include me [the chief nurse] on the organizational chart. Our Med Group Command above saw what was going on, and they realized that I was the one that should be running the place rather than him [the MSC commander]. It went full circle, because when something needed to be done, the Med Group Command began contacting me instead of him. They respected me and knew I was results oriented.
LIEUTENANT KATE
Kate was a navy nurse who was deployed to Afghanistan.
She reported:
When I came back from Afghanistan my work life at Portsmouth was OK. There was new leadership at the top. I had asked for a couple of things when I returned to work. When I left for Afghanistan I had been the charge nurse of the ER. When I came back, I asked for an orientation and did not want to just jump in and be in charge again. They said that wasn’t allowed. So, I had to jump right back into the thick of it. It was difficult for me because my coping skills were not up to what they should be to assume the charge role again. All my staff was new except for the civilian RNs I worked with. It was really hard to go back without an orientation since a lot had changed in a year. I didn’t know who any of the military people were, so there was a lot to being in charge again.
I took 30 days of leave when I first got home. That was when my husband and I were having adjustment problems. When I went back to work, the new leadership was pretty poor. They didn’t know who I was or what I had done there in the time before I left to deploy. They hadn’t had the experience of helping people reintegrate after a deployment to a war zone. So, a lot of things weren’t very supportive.
When I compare my homecoming to the way the hospital does things now, it is like night and day. Now, we all go to meet the people coming back from deployment at the airport. The hospital commander or the executive officer, the director of nursing services, the other key leaders make it a point to go to the airport to welcome everyone home. It doesn’t matter what time of day or night a flight comes in, they all make it a point to be there to greet all returning hospital personnel. Everyone is so supportive, so caring, and so available. We all pride ourselves on being there and available to meet every single flight. Everyone reaches out to the returning medics and their families, if they have families. We do everything that we can to ensure that they have everything that they need.
It is the opposite of what I experienced when I came home. When I came back the leadership had changed and no one knew who I was or even that I had deployed. I was glad to leave Portsmouth Naval Medical Center to go to Guam because I really didn’t feel like I belonged there anymore because I had been there for 3 years before I deployed and I was treated like I didn’t count when I came back from Afghanistan. I felt I was “out of sight, out of mind” while I was gone. I think because of the change in leadership, people returning from deployment were lost in the shuffle of the comings and goings of a big medical center.
LIEUTENANT COMMANDER KATHLEEN
Kathleen, a navy nurse, reported:
It was good coming back to the same unit. They were very supportive while I was gone. They sent me stuff, and e-mailed me all the time, and sent care packages and cards. I really felt appreciated and missed. Now, the students look at me differently, I have the credibility and respect for having been in a war zone on a combat hospital tour. All the students were wide-eyed and wanted to hear my stories. Through counseling I learned that I have a different memory bank now, and at times I have to remind myself that I’m not there anymore. I have a picture of every patient we took care of on a thumb drive, but I don’t even know where the thumb drive is. I know it is around somewhere in the house, but I don’t feel any urgency to go look at it. Most of the photos were taken by the trauma photographer and was given to us in case we wanted to do research or write clinical papers. I haven’t looked at it since I got back, and I don’t even know where it is. It is around somewhere in one of my boxes. I even have a picture on there of me with Prince Charles when he visited the hospital. Most things are in my head, the memories, I don’t need to go back through stuff from 3 years ago.
LIEUTENANT LORETTA
Loretta is a navy operating room nurse.
She reported:
I really didn’t know anyone back at the hospital, and I had difficulty trusting people. So, I didn’t know anyone or what their motives were. I had already been in a shutdown mode. I wasn’t gonna open up to anybody. So, I didn’t really have a whole lot of friends when I came back. The nature of the military is that you always have friends leaving. It was hard. There’s definitely a difference talking to someone in person as opposed to on the phone, even if you are saying the same things. I didn’t have much of a support system. You have a few days off when you get back and then you have to check in to the command. So, even though you are staying at the same place, they make you go through this process of checking out and checking back in. Then, you don’t have to be back at work for 2 weeks. All in all, I got roughly 2 weeks before I had to be back at work, unless I wanted to take leave and go on vacation. I was trying to coordinate my schedule with my boyfriend’s schedule so, I really didn’t take leave until I was back for 2 months. I was pretty much right back at work.
LIEUTENANT COLONEL JULIE
Julie, an air force reserve flight nurse and CCATT nurse, described the lack of support she experienced at her civilian hospital.
She stated:
I was angry at the facility to begin with, because when I came back I found out that I had been demoted. I was no longer in an assistant nurse manager role. When I returned to work after my deployment, they said they had to move me out of that role because they said they couldn’t count on me to be there all the time that I might be deployed again. They were afraid I’d be deployed again. They put me back to being a staff nurse. It was a decrease in pay, and I did not have as much say or control of my schedule as I did as an assistant nurse manager, and I had to pull a whole lot more call.
So I was penalized for being in the air force reserve, and I was in a sense punished for being deployed. This type of situation is not that uncommon for reservists. Some of us come back to our civilian job and are treated this way by our civilian employers. I was just very put off by the lack of support of my medical facility when I returned from Iraq. My friends at work were there for me, but I was just kind of amazed that the leadership was not. I didn’t talk about what it was like in Iraq because these people had no frame of reference. They just wouldn’t have understood how we had to live and work over there. Truly, I believe only military folks can understand this stuff and empathize, most civilians in my opinion don’t have a clue. But my friends were glad to have me home and safe on U.S. soil.
LIEUTENANT COLONEL TAMMY
Tammy, an Air National Guard nurse, described her return to her civilian job after returning from Afghanistan.
She stated:
I was teaching at a college before I left. I was granted a leave of absence, and I returned to that position when I came home. I was on active duty orders for a month after returning, and it was mandatory that I didn’t work so I had the time to reintegrate with my family. When I returned to work it went OK. I received some honors as well as having some misunderstandings with people I worked with. Some of my peers didn’t understand the military at all, and they didn’t really understand what I was doing in a mentoring role over there. I did do a presentation for faculty, and that was an eye opener for some of them. I was given some honors for my service to our country. Some of my peers had friends or relatives in the military, and those peers said they were proud of what we did over there. I shared with them pictures of me in military gear and various uniforms, because they only see me on a regular basis when I’m at the college teaching students in my professor attire, or my clinical attire when I’m teaching students in clinical.
Tammy continued to describe some of the misunderstandings and obstacles she encountered in her work environment when she returned from deployment. She reported:
Some of the misunderstandings actually started before I even left. A few other faculty members questioned me about Why would I want to do this? Why would I want to leave? Did I volunteer for this? I responded by saying, I volunteered to be in the military. They just didn’t understand why I would want to put myself in harm’s way, and why I would want to leave here to go to a war zone. I believe some of them are very connected to what they do at the college, and they don’t see the big picture of what is going on in the world. I see the big picture, and have been in the military for 20 years. They thought, Why would someone leave us “short” to go to a war zone? They only saw how it might inconvenience them, not the benefit of serving our country.
Another thing that happened was that the college kept paying me while I was gone. I did not know that because it was direct deposit into my stateside bank account. I wasn’t told that I would be paid, but I wasn’t told that I wouldn’t be paid either. I had heard that some employers continue to pay people while deployed. I didn’t know what was going on. My husband handles all the finances, so he didn’t know what to expect. When I got home, right away I was asked to pay the money back. They wanted me to pay them back before I returned to work. That was kind of hard to take. I told them I would pay it back, but I couldn’t pay it back in a lump sum. Then, I found out I accrued vacation time while I was gone, and I get paid during vacation, so I had to forfeit the vacation time. It would have just been good if all of this was communicated to me ahead of time rather than messing it up and having to straighten it out when I got back. It was irritating, and made my reintegration a little less pleasant. I think the human resources people at the college should have briefed me on the pay and vacation issues before I left.
Tammy described how some people relate to her differently since she returned from deployment. She reported:
I think I get more respect for who I am since I returned. I still feel that some people are envious or jealous, or maybe more competitive. More people seem to want to do foreign travel in terms of humanitarian projects. That’s not a bad thing because that will expand their horizons and provide help to others. Some people feel that they have to justify who they are to me by saying things like, “I wish I could have joined the military, but I have three small kids,” or “I wish I could join now, but I’m too old, or I have elderly parents.” It is interesting to hear what people have to say to me.
I think it is important that nurses experience other cultures when they have the opportunity. I learned a lot about the Afghan culture while I was over there. One important point was not to assume that things mean the same in their culture as they do in our culture. Don’t assume that things have the same value. What is nursing there versus here in the U.S.? What are the basic human needs there as opposed to here? Traffic lanes are nonexistent there and they don’t have sidewalks. They don’t have flush toilets and toilet paper. Feeding yourself and showering is different. People don’t frequently shower over there and water is scarce. Drinking water is sometimes hard to come by. Shoes don’t fit, clothing is different. The male roles are very dominant. Women are silent. The rules about touching and who you can touch are different. Facial expressions and body gestures are different. How they teach, and how they learn is different. Girls don’t go to school over there. If there is a girls’ school, it will probably be blown up. The girls are like people who have been starved. Now, they want to learn so much; they want more and more. They are so eager to learn. They can’t get enough. They want to hear everything you have to say. They don’t have books in their language. To take an individualized exam was a whole new thing for them. They have a different view of cheating; to them it is just helping your brother or sister out.
Tammy admitted that she felt a lack of support from her National Guard unit when she returned from Afghanistan:
Reintegration into my Air National Guard unit was my major trouble spot. Well, before I left I was the chief nurse of my unit. While I was gone I think there was a whole lot of negativity towards me. I was replaced in my unit by another chief nurse. I would get regular e-mails from the new chief nurse asking me to do this or that. I couldn’t do everything they asked because I was in a very austere environment. I was tasked with writing OERs [officer effectiveness reports] on people who used to work for me, and I don’t think that was right or fitting to require that of me while I was deployed. I did what I could, but I didn’t have the resources available to me to do everything they asked. When I returned we had a new commander. I was basically told I was not needed. I was also questioned on why I had not done a report, and I had proof that I had done it. I have not changed units. I have stood my ground, and I have filed complaints. I’m going to ride it out. Another guy in my unit who had deployed before me said this was not at all uncommon. He was gone for a year, and he basically said they had forgotten about him. I was horrified that people in my unit did this. It took me totally by surprise. The low point of coming home was the way my unit treated me. It was completely unexpected and very, very disheartening.
LIEUTENANT COLONEL REGINA
Regina, an Army Reserve lieutenant colonel who had been deployed to Ramadi, Iraq, as the military senior officer on a Provisional Reconstruction Team (PRT) described how she generally felt supported by the Army Reserve when she returned home from Iraq.
She stated:
The army transferred me to the reserve brigade headquarters in New York. I had just come back from Iraq, and I really didn’t have any peers at the headquarters who had also just come back from Iraq. It was challenging, and it was lonely, but I spent all that time in Iraq, and I just trusted myself that I would be able to maneuver through this. I had a lot of scary experiences in Iraq, but I tried to see them as challenging rather than scary. I didn’t go to Iraq as a young nurse. I went to Iraq as a lieutenant colonel. You are in a world of men, and they are highly competitive, and everyone is trying to do their best, get ahead, and make everyone proud of them at home. If you are scared, you hold that inside, you don’t really show that side. I learned a lot in Iraq, and the skills that I learned there I brought home with me. I just tried to be confident, to be positive, and to demonstrate that I was a worthwhile team player, who also just happened to be a woman and a lieutenant colonel. I wanted to get my final promotion to full colonel; so, I worked very hard, and it paid off.
After my promotion to full colonel, I really didn’t have a position in the reserves, so I invented one as a war-training consultant for the Army Reserve nurses. Then, I got selected for active duty again. I went to Little Rock, Arkansas, and it was a really good assignment. I had a lot of credibility with our troops there because I was a senior Nurse Corps officer who had spent considerable time in Iraq. I didn’t feel alone any more. I had lots of people to teach, and I didn’t feel or go through the disengagement that many reservists go through when they come home because I was back on active duty again. We were assigned to training teams because a lot of people were being deployed from there to Iraq and Afghanistan. There was a lot of work to do, and we were inspired to prepare our troops as best we could. It was a soldier readiness processing (SRP) center. We had an SRP team of a physician, a nurse, and a personal affairs officer. The nurse served in a case manager type of position. We served people who were deploying as well as those returning from deployment. It made an amazing difference for these soldiers to talk to someone who had been there. I felt that I made a very valuable contribution on the SRP. I was back on active duty doing this case management job for 2 years. It was very gratifying to make this kind of difference for the troops going over and the troops coming back. I made many referrals and followed up to ensure things were in place for the troops I managed coming home. I was valued for my rank. I was valued for my knowledge. I was valued for my caring and thoroughness. It was a really good experience for me personally as well as professionally. It was a very positive way to end my army career. I felt very supported and valued.
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