Vets to Nurses: Lessons Learned

INVITED COMMENTARY Vets to Nurses: Lessons Learned Susan Letvak In 2014, UNC-Greensboro School of Nursing launched its Veterans Access Program for Nurses, which is designed to assist military Veterans in becoming bachelor’s prepared Registered Nurses. Program specifics and lessons learned are shared here to encourage other health professions to develop academic pathways for military Veterans. n 2014, UNC-Greensboro’s School of Nursing (UNCGSON) was awarded five years of competitive funding from the Health Resources and Services Administration (HRSA), Bureau of Health Professions Nurse Education, Practice, Quality and Retention (NEPQR) Program to assist military Veterans’ enrollment, progression, and graduation with Registered Nurse (RN) baccalaureate nursing degrees (BSN). UNCGSON named its unique program the Veterans Access Program for Nurses (VAP). The specific purpose of the program, which continues to thrive to this day after the end of HRSA funding, is to provide military Veterans (especially those who medically trained) with specialized support in an innovative and accelerated educational program to obtain a BSN and be employed. Admission and credit-awarding processes, as well as course scheduling, are flexible and timely to facilitate enrollment, progression, and graduation. Graduation time may be as short as nine months for RNs earning the BSN, and as short as 18 months for Veterans earning the initial BSN degree leading to RN licensure. To do this, we made modifications to the existing generic BSN and RN-to-BSN programs. Nursecast has stated, “I’ve never been so worried about a workforce in my life based on the data,” and that burnout and early retirements could double this number to a shortage of over 21,000 nurses [4]. Military Veterans are skilled, goal-oriented individuals with a strong work ethic and leadership experience, which are ideal attributes for RNs. Moreover, all military Service Members receive some medical training, making them excellent candidates for careers as RNs. Military Veterans also have financial incentive to return to school. Educational benefits include the full cost of public, in-state tuition and fees for up to 48 months (rates are capped for private and foreign schools), a housing allowance, money for books and supplies, and assistance with moving from rural areas to attend school [5]. For those whose service ended before January 1, 2013, post-9/11 benefits expire 15 years after separation from the military. However, for those discharged after January 1, 2013, the “Forever GI Bill” signed into law in 2017 prevents these benefits from ever expiring. Developing nursing programs for military Veterans not only assists in building a strong nursing workforce for North Carolina but also offers enhanced employability and career mobility. The UNCGSON faculty recognized that military Veterans’ learning needs are often different from traditional college students. Military Veteran students are more likely to be first-generation college students, are usually older, may be balancing work and family demands, and may feel isolated on college campuses [6]. Thus, it was important that resources and supports be put into place to assure their success. Needs Assessment VAP Program Development and Implementation The US Department of Veterans Affairs National Center for Veterans Analysis and Statistics reports there were 703,142 Veterans living in North Carolina in 2020, with 305,666 having served in the Gulf War [1]. In 2022, North Carolina had over 100,000 active-duty military personnel, of whom 75,000 are projected to leave the military over the next four years, as well as over 100,000 National Guardsmen and 10,000 reservists [2]. Significantly, North Carolina is currently in the midst of a severe nursing shortage. The Cecil G. Sheps Center for Health Services Research’s NC Nursecast “supply and demand” analysis predicts that by 2033, North Carolina will be short nearly 12,500 RNs, with the largest shortfall (10,000) among hospital-employed nurses [3]. More alarming, the lead researcher for NC The VAP project director is an experienced RN with many years of teaching experience in the UNC system and a Veteran of the US Navy Reserves. This experience is significant, as research has demonstrated that faculty and staff in higher education often lack knowledge of military culture and the unique experiences of Veterans, which may impact Veterans’ academic success [7]. Introduction I Electronically published November 6, 2023. Address correspondence to Susan Letvak, 270 Nursing & Instructional Building, UNC Greensboro, PO Box 26170, Greensboro, NC 27402 (Saletvak@uncg.edu). N C Med J. 2023;84(6):381-383. ©2023 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved. 0029-2559/2023/84612 NCMJ vol. 4, no. 6 ncmedicaljournal.com 381 It is important to note that VAP students do not “take seats” from other potential nursing students; the VAP is a separate program with its own admission processes as a program within an academic major. VAP students are required to have a minimum GPA of 3.0, have been honorably discharged or actively serving in the Guard or Reserves, and must have completed all required BSN major pre-requisite courses. Specific changes to the BSN curriculum had to be requested and approved by both the UNCGSON and the UNCG Undergraduate Curriculum Committee. These changes included the creation of two specialized transitionto-civilian-nursing courses and awarding of academic credit for military experience by portfolio review of students’ Joint Service Transcript (JST). The course NUR 395: Transition to Civilian Nursing was designed specifically for those VAP students who received academic credit for their nursing fundamentals and nursing health assessment courses. This course covers the fundamentals of professional and civilian nursing with discussion of the similarities and differences between military and civilian models of care. NUR 396: Transition to Civilian Nursing Seminar was designed for all VAP students as a weekly opportunity to discuss transition issues and continue the culture of military camaraderie. UNCGSON HRSA grant faculty team members and the Student Affairs Director, who oversees all UNCGSON nursing student admissions, met with the UNCG Registrar and transfer student advising staff to educate them on how to use the American Council on Education (ACE) standards to award military training and education for academic credit. Once HRSA grant funding was obtained, active recruitment began for VAP students. We directly recruited students of culturally, linguistically, and socioeconomically diverse backgrounds from medically underserved and rural areas. Faculty and staff who would be directly working with VAP students were provided Green Zone Training by the project director and program manager, who was also a military Veteran. Green Zone Training, which is modeled after “safe zone” training programs, provides education to those without military experience on the unique characteristics and potential academic challenges of military Veterans. We also formed an advisory board made up of community-residing Veterans who were working in health care to assist with recruitment, transition course content, and peer mentorship and support. Military Veterans with extensive medical training and experience are offered the opportunity to accelerate through the pre-licensure BSN program. After JST review, students are still required to demonstrate clinical competency by skills-testing in the simulation lab. Specialized clinical experiences also may be offered; for example, a student may have 1:1 preceptor experiences instead of being in traditional clinical groups of 8–10 students per faculty member. Additionally, for those VAP students who are commuting long distances from UNCGSON, clinical experiences closer to their home may be provided. 382 The UNCGOSON VAP also provides additional unique resources, many of which are now generously funded by donors. Financial aid scholarships have been targeted toward VAP students, there is a VAP study room that can only be used by VAP students, and they may be provided with “starter kits” that contain stethoscopes, pen lights, clamps, and bandage scissors. Customized academic tutoring and counseling specific to VAP students is made available. Financial support for a RN-NCLEX board exam review course is provided. Resume building and mock employment interviews are offered for all VAP students. Finally, military Veteran “stoles” that identify their branch of service are proudly worn by VAP students at graduation. VAP Program Outcomes and Lessons Learned Since 2016, UNCGSON has graduated over 150 new BSN-prepared RNs. Despite typically having lower academic profiles due to frequent moves and taking courses on top of their military duties, VAP students’ retention and passage of the RN licensure exam are identical to those of UNCGSON’s highly competitive BSN programs. VAP students are consistently leaders in their classes, serving as class president, secretary, and fundraising organizers. The VAP has greatly increased the diversity of UNCGSON’s BSN programs, with over 50% of VAP students being male and/or members of racial minority groups (unpublished data). Importantly, while military Veterans have come to UNCGSON’s VAP from all over the country, over 90% have chosen to stay and work in North Carolina, greatly enhancing the state’s RN workforce (unpublished data). What lessons have we learned? First, not all VAP students want to be recognized as members of the VAP. Veterans are considered a “protected class,” and thus they are offered anonymity if they so desire. While only a very few have requested anonymity, it is important that this is offered when starting a program designed to support military Veteran students. Second, university/community college staff and faculty have to be educated on reading JSTs and willing to accept military education and experience as college credit in a transparent and consistent manner. There must be openness and transparency in accepting transfer credits from more nontraditional educational programs— including online programs, such as American Military University and Portage Learning—as well as from challenge exams through the College-Level Education Program (CLEP). Camaraderie and opportunities for peer support are critical for Veteran students. Cox and colleagues’ study of successful nursing programs for military Veterans found that providing opportunities for camaraderie among Veteran students and hiring faculty who are Veterans are important for student success [8]. The Transition to Civilian Nursing Seminar course not only included needed information for VAPs who had received credit for six required nursing courses but also provided camaraderie in the classroom. However, a growing number of VAP students were not accel- NCMJ vol. 4, no. 6 ncmedicaljournal.com erating and receiving six credits of required nursing courses. These students felt the transition course was more of a burden due to the work required, however they did not want to miss out on the camaraderie with other Veteran students. They requested that the camaraderie component of the transition course be met through organized events, such as bowling nights, lunches, and informal get togethers. This has proven to be successful in maintaining camaraderie without the burden of an additional course for academic credit. Green Zone Training is essential for faculty and staff and needs to be updated as new needs arise. We recently had an experience where a faculty member demanded a VAP student take off their bracelet due to policies and concerns about test cheating. The student got very upset because the bracelet was not just “any bracelet,” but a memory bracelet with the names of lost platoon members. VAP students are now reminded to inform their faculty if they wear memory bracelets, and faculty are educated on what they look like and the significance of students not wanting to take them off. Most health profession programs are known to have rigid attendance policies, especially for tests and simulation experiences. Active Reservists and Guardsmen must be allotted time off, without penalty, to attend monthly drill and annual training requirements. Faculty also need to adjust to last-minute medical appointments within the VA medical system. If faculty suspect a Veteran is abusing “protected absences,” documentation can be requested. Finally, be open to expanding Veteran programs to activeduty Service Members. After the VAP was established, UNCGSON was quickly identified as a target university by active-duty Service Members seeking admission to enlisted commissioning programs. These commissioning programs offer top-performing enlisted Service Members, many of whom are medics or licensed practical nurses, the opportunity to attend an upper-division BSN program to be commissioned as a military officer and serve as an RN in active duty. UNCGSON now has active-duty VAP alumni serving throughout the United States and the world. Conclusion North Carolina has long been known as a militaryfriendly state. UNCGSON’s VAP has demonstrated that military Veterans are exceptional students who are greatly needed to grow and enhance the North Carolina nursing workforce. However, military obligations require obtaining college credit through less traditional means, often leading to a lower academic profile, which makes it difficult to be accepted into North Carolina’s highly competitive nursing programs. When tailored admission processes are put into place alongside supports to ensure academic success, military Veterans can greatly enhance the diversity and quality of nursing and health profession programs throughout the state. Susan Letvak PhD, RN, FAAN LT Commander (Veteran) USN Director, PhD Program; Coordinator, Veterans Access Program; Eloise R. Lewis Excellence Professor, UNC Greensboro School of Nursing, Greensboro, North Carolina. Acknowledgments Disclosure of interests. S.L. is coordinator of the UNCGSON VAP. No further interests were disclosed. References 1. Veteran Population. US Department of Veterans Affairs National Center for Veterans Analysis and Statistics. Updated September 7, 2022. Accessed July 26, 2023. https://www.va.gov/vetdata/veteran_population.asp 2. Military Economic Impact on North Carolina. Regional Economic Models, Inc., NC Department of Commerce. October 2022. Accessed July 26, 2023. https://www.commerce.nc.gov/report-military-economic-impact-north-carolina/download?attachment 3. NC Nursecast: A Supply and Demand Model for Nurses in North Carolina. The Program on Health Workforce Research and Policy at the Cecil G Sheps Center. Published November 1, 2021. Accessed July 26, 2023. https://ncnursecast.unc.edu/key-findings/ 4. Hoban R. Within a decade, NC could be short more than 21,000 nurses. NC Health News. Published March 2, 2022. Accessed August 29, 2023. https://www.northcarolinahealthnews.org/2022/03/02/ within-a-decade-nc-could-see-nursing-shortage-of-morethan-21000/ 5. Post-9/11 GI Bill (Chapter 33). U.S. Department of Veterans Affairs. Updated July 18, 2023. Accessed July 26, 2023. https://www. va.gov/education/about-gi-bill-benefits/post-9-11/ 6. Cox CW. Military students’ strengths and challenges based on their military experiences: An integrative review. J Nurs Educ. 2019;58(7):392–400. https://doi.org/10.3928/0148483420190614-03 7. Elliott B, Chargualaf KA, Patterson B. Committing to my mission: faculty experiences with student veterans in baccalaureate nursing education. Nurs Forum. 2019;54(4):619–627. https://doi.org/10.1111/ nuf.12386 8. Cox CW, Wiersma GM, McNelis AM, Beebe SL. Facilitators and challenges to military undergraduate nursing student success. J Prof Nurs. 2021;37(6):1057–1062. https://doi.org/10.1016/j.profnurs.2021.08.002 NCMJ vol. 4, no. 6 ncmedicaljournal.com 383