Nursing Care for Veterans’ Unique Health Problems

Articles | Family Nurse Practitioner | Master of Science in Nursing

Nurse practitioners are on the front lines of veterans’ healthcare.

In 2006, Army veteran Bobby Body was serving in Iraq when an underground bomb went off and blew a Humvee door into his left side, causing severe damage to both his left shoulder and leg, according to Rachel Greco’s Lansing State Journal article, “’I Wasn’t Going to Allow It to Defeat Me,’ Says Disabled Veteran Setting New Powerlifting Records.” Surgery repaired his shoulder injury, but extensive cartilage and tendon injuries to his left knee made a future in the military impossible for Body.

Body was medically retired from the service after three years of rehabilitation and surgery. Unfortunately, he continued to have trouble walking on his wounded leg, and in 2013 his doctors told him the leg would have to be amputated. Body’s ex-wife Terri noticed, however, that Body actually experienced fewer falls with his prosthetic than he did with his wounded leg.

Starting in 2014, Body began training himself for competitive powerlifting. He had to learn how to lift without needing to put weight on his prosthetic (which wasn’t built to withstand such stress). He went on to win his first national competition for his weight division by bench pressing 386 pounds.

The medical staff at Michigan’s Ann Arbor Veteran’s Administration (VA) Hospital is largely responsible for Bobby Body’s care and recovery after his amputation. Nursing care for veterans is different in a lot of ways from nursing care in the civilian world (outside of the VA healthcare system).

Graduates of an online master’s in nursing program should consider employment with the VA, which offers practitioners more rights and responsibilities than most non-VA facilities.

Full Practice Authority Granted to VA-Employed Nurse Practitioners

Recent MSN graduates sifting through the available family nurse practitioner information should consider what the VA has to offer. Perhaps the most exciting benefit is that the VA has granted full practice authority to advanced practice nurses (including certified nurse practitioners), according to “VA Grants Full Practice Authority to Advance Practice Registered Nurses” published by the VA’s Office of Public and Intergovernmental Affairs.

Full practice authority means that nurse practitioners can operate almost like physicians in the VA system, which offers them more experiences and a wider range of professional opportunities. VA nurse practitioners also have the authority to prescribe medications (even some controlled substances) in some cases, a privilege not generally afforded to non-physicians.

Full practice also offers benefits for patients, according to the American Association of Nurse Practitioners (AANP). Its publication, “Issues At-A-Glance: Full Practice Authority,” lists a number of advantages, including:

  • Improved Access: More patients have access to essential healthcare services, especially in rural areas. Full practice authority also requires less oversight and physician involvement.
  • Streamlined Care: Nurse practitioners can deliver more and higher quality care efficiently at the point of care, eliminating delays caused by waiting for physicians to sign off on treatment.
  • Decreased Costs: Billing costs associated with physician oversight are eliminated and repeat office visits are reduced.

Unique Health Issues Associated with Veterans

People who have been in the military and who have served in physically and psychologically demanding situations and/or combat zones can have health problems different from those of most civilian patients. Mental health issues, injuries, chronic pain, chemical exposure, rare diseases and addiction are just a few of the most commonly seen conditions at VA clinics.

Many complex health issues, however, either don’t show or go untreated for years after a veteran’s active duty or active reserve service, which means military nurses and doctors might never have had a chance to diagnose the problem. For example, unusual conditions such as AL amyloidosis, which affects the heart, kidneys, liver, lungs and joints, can affect veterans who were exposed to herbicides while serving overseas, according to UnityPoint.org’s “10 Common Medical Conditions in Veterans.”

Science writer Maureen Salamon details issues seen in former servicemen and women in her LiveScience.com article, “After the Battle: 7 Health Problems Facing Veterans:”

  • Musculoskeletal injuries and pain: Because of the strenuous daily existence most servicemembers experienced, lingering back, leg, knee and shoulder problems are common. Nurse practitioners with full practice authority can help patients’ pain in several different ways, from educating them about maintaining a proper exercise routine to prescribing medication for pain management.
  • Chemical exposure: Veterans who served in combat zones or countries with looser regulatory restrictions on the environment are sometimes exposed to chemical agents that can have a lasting negative effect. Gulf War nerve agent sarin or sarin gas and Agent Orange from the Vietnam era are well-known examples of chemical exposures that have affected veterans.
  • Infectious diseases: Despite the fact that servicemembers receive inoculations before serving overseas, some vets suffer from infectious diseases contracted in foreign countries. Leishmaniasis, for example, is typically caused by a small sand fly found in the Middle East. This potentially life-threatening disease can cause weight loss, fevers, weakness, anemia and dangerous enlargement of the spleen and liver.
  • Noise and vibration exposure: The decibel level of gunfire, artillery fire and aircraft can cause a range of health problems, including deafness. Pain and numbness can also occur after long exposure to heavy vibrations.
  • Traumatic brain injury (TBI): A blow to the head during training exercises or in combat can cause irreparable damage. Veterans who have suffered such injuries have experienced memory and language problems, an inability to process information correctly, PTSD and headaches.
  • Mental health issues: The trauma of serving in a combat zone often causes psychological damage. Veterans suffering from depression or PTSD can also suffer from problems related to their primary issues, such as alcoholism, drug addiction, paranoia and violent behavior. Nurse practitioners can be invaluable to PTSD patients who may need psychiatric anti-depressants and anti-anxiety medicines.

The suicide rate is also higher in the veteran community than elsewhere. “With 18 to 22 veterans committing suicide on a daily basis, risk assessment and intervention are paramount,” explain researchers Maria Olenick, Monica Flowers and Valerie J. Diaz in their academic paper “U.S. Veterans and Their Unique Issues: Enhancing Health Care Professional Awareness,” on the National Institutes of Health website. “Private and public health care professionals must be aware of patients’ military history … and be able to recognize suicide risk factors, regardless of age.”

Nurse practitioners are on the front lines of veterans’ healthcare. Armed with full practice authority, NPs in the VA system are able to address the unique health issues that veterans face, from mental health concerns to amputations and disease exposure related to deployment. Their skills enable them to make a difference in the lives of America’s servicemen and women.

Duquesne University Master of Science in Nursing Program

Students in Duquesne’s online Master of Science in Nursing (MSN) program can become FNPs who develop the skills to work with veterans, either in Veterans Administration hospitals or in private healthcare facilities.

The MSN program also offers concentrations in Nursing Education and Forensic Nursing and nurses can choose to pursue a post-master’s certificate (PMC) after earning their degree.

Sources:

Veteran Powerlifts Despite Amputation – Lansing State Journal

VA Grants Full Practice Authority – VA.gov

Full Practice Authority – CDN.YMAWS.com

10 Common Medical Conditions in Veterans – UnityPoint.org

After the Battle – LiveScience.com

US Veterans and Their Unique Issues – National Institutes of Health