ANMJ Featured Story

ON THE FRONT LINE: The rewards of life as a military nurse

Friday 24th March, 2017

The brave men and women of Australia’s military put their lives on the line to defend the country at home and abroad. Behind the scenes, military nurses work alongside troops to provide support across the gamut of healthcare. At any given time, military nurses could be working in field hospitals, supporting training exercises across Australia, or deployed overseas in war zones. Filled with adventure and unique challenges, Robert Fedele explores the highs and lows of life as a military nurse. 

Australia’s military outfit, run under the banner of The Australian Defence Force (ADF), comprises the Royal Australian Navy (RAN), Australian Army, and Royal Australian Air Force (RAAF).

The ADF boasts a rich and colourful history and today retains almost 80,000 members made up of full-time active-duty personnel and part-time reservists. Nursing and the military are inextricably linked. A military nursing career invariably involves nurses caring for troops in dangerous settings. 

While it can be stressful and heartbreaking, it can also offer unrivalled adventure and unique challenges. Despite the drawbacks, many nurses who take up a career in the military never look back. 

ENLISTING IN DFENCE 

Lieutenant Nursing Officer Alison Pickersgill plotted a pathway into the Australian Army while studying nursing at Perth’s Curtin University. Alison was recruited through the Army’s undergraduate scheme, which signs up prospective members and funds the remainder of their degree.

Alison’s sister was in the British Army at the time and hearing her accounts of adventure sparked the interest. “After a few placements from university I decided I kind of wanted a little bit more from my nursing role. The more I read the more I liked. It was pretty much an immediate decision for me.” 

Army nurses undertake two years’ experience in a civilian setting to consolidate their skills prior to joining the fold.  Alison learnt the ropes at the Royal Perth Hospital in Western Australia before she received her maiden post to Brisbane. 

New recruits undertake a range of courses on arrival covering general military skills, weapons handling, leadership, and specific military nursing skills such as incubation
and ventilation.

Army nurses can work in units, field hospitals, treatment teams on Army bases providing primary healthcare, and on deployments in peace-keeping and humanitarian relief operations.  

Nursing Officers usually spend two to three years at a post before being re-assigned.

They also maintain their clinical skills by regularly undertaking secondments at major metropolitan hospitals.

Alison recently took on a new role providing combat first-aid training to three brigades.

The three-week course teaches soldiers how to deal with traumatic combat injuries like amputations, how to cannulate, and how to administer IV fluids and medication.

Based at the Lavarack Barracks in Townsville, Alison is also responsible for training clinicians including doctors, nurses, medics, and physios, via large-scale exercises held throughout the year. 

Alison describes military nursing as a constant challenge. “When we’re out treating patients in a treatment team we literally have a tent with a stretcher, a few boxes of equipment, and a couple of things like a defibrillator and a ventilator and that’s it. So we don’t have access to imaging. We have very limited access to pathology. It’s like a whole new world and it’s probably similar to what remote and rural nurses have to deal with on a daily basis.”

A large contingent of Army nurses work within Australia supporting troops during training operations. Soldiers are largely young, fit males, and unsurprisingly there is less chronic illness and disease and greater acute trauma injuries like head, spinal and musculoskeletal issues.

Alison acknowledges trauma as the common theme but says Army nursing is not purely about patching up bullet wounds. “There is a wide range of things that you’ll do as a nurse and it changes every day. If you’re supporting a training activity you’re out in the middle of nowhere providing resuscitation care. When you’re not on a training activity you could be stationed at the medical centre on base just providing everyday GP practice kind of care. You can do what I’m doing, which is coordinating military training for combat medics. There’s instructor roles. You could be in a managerial position. It’s just so different.”

Alison has yet to be deployed overseas but says she would jump at the chance. “It’s something that every nurse wants to do. It’s the culmination of all the training that you do and the main reason you probably join. I don’t know of any nurse who doesn’t want to.”

DUTY FIRST

Air Commodore Jenny Lumsden CSC has been a member of the Royal Australian Air Force (RAAF) for more than three decades.Her decorated career has included roles as a nurse clinician, personnel manager, administrator and military leader both in Australia and overseas.

Jenny’s deployments span East Timor, as part of a United Nations military hospital, the Australian Defence Force’s response to the second round of Bali Bombings, and Iraq with the United States Air Force’s hospital overseeing medical evacuations from around the world.

Currently, Jenny splits her time between her role as Director General Health Reserves – Air Force, and working as a Clinical Consultant in Intensive Care at the Royal Melbourne Hospital. Her military position entails looking after all Health Reserves in the Air Force, about 500 people, including nurses, doctors, dentists, and physiotherapists.

Wider responsibilities extend to strategic management focused on recruiting, retention, and training. Jenny, whose last deployment took place in Iraq in 2005, says working alongside nurses and health professionals from other nations helped her become a better nurse.  “The work is very rewarding. You’re helping people in a time of crisis often and I guess you feel like you’re making a difference.”

Looking back on her deployments, Jenny paints a vivid picture, from dealing with major heart attacks in the desert in Iraq to being part of the relief effort during the second round of Bali Bombings where Australians were injured and killed. 

The overarching ethos surrounds physically caring for people as part of a team. 

“In East Timor, basically we were working as part of a United Nations Hospital and they took over what was a museum and cleaned the building up, which is often what you have to do, start off with a blank canvas and empty room. You have to clean it up and then try and set it up to meet your needs, create wards, or create operating theatres.”

Throughout her career Jenny has always divided her time between the Air Force and mainstream nursing. “I really like Intensive Care. It’s probably combined some of the things that maybe attracted me to the military. Being challenged. Being putin situations where hopefully you can make a difference.”

She says Bali ranks among her most rewarding deployments due to the nature of the disaster and high-intensity effort. “I guess I was asked [to go to Bali]. That’s the thing. You know there’s a need. You know that someone needs to go and if I feel like I’ve got the skills where I can contribute to that I think that’s my duty if I’m going to be part of the Reserve.”

Jenny credits her career in the military with encouraging her to step outside her comfort zone and expand her skills. “It’s probably not for everyone but neither is working in intensive care for everyone or working in communities or aged care and I guess people get attracted probably personality wise to certain areas of health and I think that’s the same with the military.”

While she misses the excitement of deployments she is now content imparting her vast knowledge onto the next generation. “I think it’s important we continue to grow the workforce to follow on behind. There’s no point in me doing something for 20 years and then there be a gap after I leave. I think it’s a responsibility, probably for all nurses, to continually train newer, younger people as they come on. Because somebody has to continue the legacy.”

RISK AND REWARD

Retired Australian Defence Force Nurse Sharon Bown came inches from death while serving in the Royal Australian Air Force (RAAF).

The experience left her emotionally scarred for life and suffering post-traumatic stress disorder (PTSD).

In 2004, the RAAF Wing Commander was deployed to East Timor to work as an aeromedical evacuation nurse, transporting people back home to Australia and also from around East Timor back to Dili to receive healthcare.

The relief effort ended precariously when the helicopter Sharon was travelling in lost control during a thunderstorm and plunged to the ground while trying to land in the remote village of Same. 

“When I realised it wasn’t ok there was this incredible fear that I was either about to die or be very seriously hurt,” she recalls. “Sitting in the back of the aircraft you have no control. There’s nothing that you can do. But there’s also a sense of peace in that I said goodbye to my friends and family.”

The account is just one of many penned in Sharon’s gripping autobiography, One Woman’s War and Peace, released last year, that documents a 16-year career with the RAAF in which she served in East Timor, Bali during the second round of Bombings, and Afghanistan.

In her early career, Sharon worked at the Calvary Hospital in Hobart for three years, before seeking a new challenge. “I was quite intrigued at what the Air Force speciality of nursing is or of healthcare, being aviation medicine. The ability to deliver health rapidly to other parts of the world but also to be able to care for people in the back of an aircraft as well.”

Sharon describes deployments as incredibly rewarding and a chance to test one’s nursing skills. “Our resources can be quite limited so it’s very different to working in a large inner city hospital where you have access to many specialists and teams and equipment and the next shift is coming on. In terms of limited resources it tested our ability to provide high standards of care within a very constrained environment.”

After sustaining horrific injuries during the helicopter crash in East Timor, including a broken back and fractures to her jaw, Sharon miraculously returned to work within five weeks.

“I was determined not to lose my career,” she explains. “I loved my job. I felt that I had lost my health and my fitness at a very young age. I was 29. I didn’t feel like I’d seen the world. I hadn’t any children. I felt robbed of that part of my life and I wasn’t about to give up my career as well.”

Her ultimate return to operational service occurred in 2008 when she spent three months in Afghanistan in the thick of war, providing intensive care as the Commander of a Critical Care Team.

“We saw the outcome of combat in that we treated NATO soldiers. We treated Afghan forces who had been involved in fighting.

“It’s very different to peacekeeping but still incredibly rewarding. To deal with that trauma, particularly in a place like Afghanistan, it calls upon everything that you’ve ever learnt, everything that you’ve ever done in your career, to be able to care for people in war zones.”

MENTAL HEALTH

The fateful helicopter crash that unfolded in East Timor triggered Sharon’s PTSD and left her with nightmares, flashbacks, and ongoing suffering.  

“I think it was happening all along. I think I fought against it for a very long time,” she reveals. “I was very aware of the stigma surrounding mental health within Australia and the Australian Defence Force at the time. We must continue to talk about our experiences and tell these stories so that fear of the unknown and fear of the unfamiliar starts to subside and with that the stigma as well.”

Sharon, who now lives in Canberra and sits on the Australian War Memorial Council, has become a mental health advocate in a bid to improve awareness within the ADF. 

Her motivation stems from a desire to expose the hidden toll of war. 

Suicide, the leading cause of death in Australia, remains problematic among veterans, with a Senate Report into the Mental Health of Australian Defence Force members revealing that since 2000, 108 ADF personnel have been suspected or confirmed to have died as a result of suicide. The National Mental Health Commission is tackling the problem by reviewing suicide and self-harm prevention services available to Australian Defence Force Personnel members and veterans. 

“I don’t believe that anybody is unaffected by their service. It’s just the way in which that impacts upon their life. Everyone that serves is changed by their service. For some people that change is difficult and develops into conditions like PTSD. But I still believe we can emerge from that with the right support.”

A recent documentary produced by the Australian War Memorial details the accounts of members of the military who fought in Afghanistan. 

Titled Afghanistan: The Australian Story, the documentary traces the stories of men and women who served during the 12-year fight against the Taliban.

Sharon is among the brave young men and women who bared their souls. 

“Military nurses experience service themselves because we’ve deployed and experienced war in our own right. But we care for those who experience it as well. So our insight into service is two-fold. It’s that of our own service and that of those whom we provide care for.”

Reflecting on her military career, Sharon says she has no regrets and would do it all over again. 

“I miss the war because it was an environment and a situation where I felt valued. I felt useful. And I felt that I was ultimately making a very positive impact.”

BUILDING PATHWAYS

Academic and Emergency Nurse Practitioner Kathleen Tori spent 18 years in the military working across a variety of settings. 

Kathleen enlisted in the Army in 1983 and worked her way through the ranks, starting in the Nursing Corps under the direction of an RN, moving to the Medical Corps as a medic, and then upon completing her nursing degree was granted a commission and worked in the role of Nursing Officer. 

She describes military nursing as like nothing else, evidenced by makeshift environments where periodically on exercises, wards usually have to be created. “A lot of it was primary care and could be classed as being a little mundane but the way and the manner in which you’re actually trained in the military sector is unbelievable.”

When Kathleen returned to the civilian sector, taking up a post in a large regional hospital as an ED nurse, she quickly became frustrated by the newfound lack of autonomy. “There were things I was used to treating, for example, bites, stings, and minor wounds, that I was able to assess, treat, suture and everything else within the military. I found I could no longer do it due to state legislations and regulatory laws that governed my practice.”

The setback spurred Kathleen to embark on becoming a nurse practitioner in order to extend her scope. 

Kathleen, who is the Postgraduate Course Coordinator (Nursing) at La Trobe University’s Department of Rural Nursing and Midwifery, and also coordinates the Nurse Practitioner study stream, believes that nurse practitioners could provide a great addition to the military.

She is currently in the process of trying to trigger a feasibility study to see whether more nurse practitioners could increase the health capabilities of the Australian Defence Force.

Kathleen contends that nurse practitioners could alleviate the shortage of medical officers currently faced by the military and provide more effective, accessible, and timely healthcare.

Establishing the pathway would also help enhance career progression for prospective military nurses, she adds. 

“The nurses in the military are actually working at an advanced level anyway. So they’re able to integrate their theory, their practices and experiences, and they have increased autonomy. They can initiate interventions. They can make judgements. They can do the decision making. It’s shown and proven in the civilian sector that NPs are positive and competent practitioners.”

Kathleen, who regularly deals with undergraduate nurses, says military nursing is often overlooked as an option. “They want to work in the acute care hospital setting or they want to work in midwifery or paediatrics. That seems to be the three predominant focus areas that we see from our students.

“[Military nursing] provides additional opportunities. It’s a different way of practicing. It’s a different way of nursing and it can allow you to advance your clinical skills – skills that are transferable to the civilian sector. I think it’s an ideal lifestyle.”

LASTING LEGACY

Undoubtedly, the military nurses of today continue to build on the traditions of those that have gone before them. Lieutenant Nursing Officer Madeleine Ferguson-O’dea returned home from her first deployment at the start of the year after spending six months in Afghanistan.as part of a medical team working in a Coalition hospital providing healthcare to Coalition and Afghani forces.

She says she was trained up medically but that nothing could have prepared herself for the experience. “Medically, it was a steep learning curve. I was exposed to different illnesses and injuries that I wouldn’t see back here.”

Originally from Sydney, Madeleine signed up to the Army while in her third year of nursing at Notre Dame University. She undertook two years of training at Liverpool Hospital before joining the Army full-time. Madeleine is currently based in Sydney as part of the 1st Close Health Battalion. The team provides integral support and aid to soldiers from the front line, forward of field hospitals, strategically placed to deliver emergency care within an hour.

Madeleine says the thing she values the most about being in the Army is being pushed to her limits and beyond. “I’ve loved every moment. I’ve had some great opportunities. I’ve been deployed and worked with some great people. The thing about Defence, particularly the Army, is it pushed me and challenged me and I’ve done so much that I thought I could never do.”

Madeleine counts the camaraderie and interesting people you meet along the way as the best parts of working overseas on deployment.

At the moment, she doesn’t have children or a family so is fairly flexible and available to serve both in Australia and overseas. “I love my job and I love looking after the troops and supporting them medically when required.

“I constantly work in different areas, both physically and medically. Overseas, it made me realise how lucky we are in Australia with our healthcare and standard of living because it’s a completely different world over there day to day. They’re not as lucky as us.”

To read more articles from ANMJ, view the full journal online at https://issuu.com/australiannursingfederation/docs/anmj_april_2017_issuu_254b95647bcb50