Veterans take care of Veterans. It is a statement that rings true in military communities and Veterans Health Administration (VHA) hospitals, but not as much in civilian health care institutions. More Veterans are receiving care outside the VHA, but civilian health care providers may not be up to the task to address their health care demands. In West Virginia, where approximately 45% of Veterans receive care outside the VHA (U.S. Department of Veterans Affairs, 2016b), the suicide rate for Veterans is significantly higher than the national average (U.S. Department of Veterans Affairs, 2016a). Over concern for the Veteran's safety and the provider's competency, three progressive steps have been taken within our state. First, in 2014, the West Virginia legislature enacted a licensure mandate that requires nurses to receive 2 hours of annual continuing education (CE) on Veterans' mental health needs. The purpose of the required CE is to increase the nurse's awareness of the military experience and resulting health issues (West Virginia RN Board of Nursing, 2017). Second, 2 years after the CE program was implemented, a descriptive study was undertaken to assess the status of nursing care for Veterans following the mandatory annual CE. Researchers found that despite education, civilian nurses continued to express uncertainty in how to care for military personnel. Nurses were concerned about how routine care should be delivered, how to interact with Veterans, and how to protect themselves from potential for violence (Maiocco, Stroupe, Rhoades, & Vance, 2018). Immediate action to address the nurses' trepidations included mandatory electronic documentation of Veteran status at hospital admission. This documentation included designation of military branch, combat service, and VHA use. Lacking was a means of putting nurses at ease with delivery of care to Veterans and making Veterans feel welcome.
Development of the Veteran-to-Veteran program was the third crucial step taken to blend the demands of both nurses and Veterans. The outline of the program was born out of a hospital experience of the program founder Dr. Gina Maiocco. During a Veteran's hospital admission, inpatient Veterans and Veteran's Affairs (VA) employees who were Veterans visited her daily. “How are you doing, honey?” was a common welcomed phrase. Veterans joked with each other about their branch of service and talked about their missions. That impromptu Veteran-to-Veteran support was invaluable during that stressful time. Dr. Maiocco took that positive experience and worked with Dr. Lya Stroupe (hospital administration), Nancy Becker (head of volunteer services), and Sarah Snider (wing-man and fellow Veteran) to get the program started in a nonmilitary health care environment.
The Veteran-to-Veteran program has two objectives. The first aim is to support Veterans and their families during admission to a civilian hospital. Types of support provided included clarification of hospital procedures, facilitation of care management, and emotional encouragement. With each encounter, the volunteer Veterans would ask the Veterans about their military service. These interactions often evoked strong emotions and jovial responses. One can never underestimate the power of laughter in a stressful environment like the hospital. The second objective is to educate nurses on Veterans' needs and to assist the nurses in personalizing the electronic medical record to reflect military-specific conditions. For example, Veterans often develop tinnitus during their military missions (i.e., infantry), but often this information is not shared with nurses because of the stigma of “weakness.” Likewise, nurses without military experience are not aware of the need to verify if tinnitus is present. In this example, with the Veteran's permission, the Veteran volunteers worked with nurses to personalize the electronic medical record to reflect this information so future interactions with the patient, such as educating the patient on care procedures, could be made hearing friendly. Another example involves a prior service Navy seaman who shared with Veteran volunteers that part of his mission was to “pick up Navy seaman—not all were survivors.” This information was shared with nursing staff and clinicians to raise awareness for the possibility of affective and/or behavioral changes while in the stressful hospital environment.
The Veteran volunteer group began with two members and has grown to include seven Veterans who represent the Army, Navy, Air Force, and one mother of an Army Veteran. Prior to doing Veteran visits, volunteers complete an orientation that covers specifics about the program and Health Insurance Portability and Accountability requirements. Each Veteran volunteer wears a special ribbon (Figure 1) on the volunteer jacket to denote military service.
Camouflage ribbon with flag designates volunteer as prior military.
Under the guidance of Snider and Hildebrand, the Veteran volunteer group has added a “pet Vet” named Pepe to accompany the Veteran volunteers. Pepe's human dad was Adam Snider, Hildebrand's son and Snider's brother. Now deceased, Adam was an Afghanistan Veteran who served as a Paratrooper with the U.S. Army, 82nd Airborne Division. Pepe carries on his dad's legacy during each Veteran-to-Veteran visit and has lifted the spirits of staff members, Veterans, and families of Veterans (Figures 2–3).
Nurses engage with the pet Vet as a welcome relief to the workday (photograph courtesy of Daniel Shrensky).
Patient John Nice gives a treat to Pepe (Pepperoni), a therapy dog who visits Veteran patients at J.W. Ruby Memorial Hospital, Morgantown, West Virginia (photograph courtesy of Daniel Shrensky).
As part of evidence-based practice, feedback is encouraged from both Veterans and nursing staff to assess the program's effect. Veterans have commented the following:
- I really enjoyed talking to you—it's hard to be in the hospital and this helped cheer me up.
- Great to see representation of the military make their appearance, to offer support.
- Glad to see help for Veterans. Please keep up the good work! [It is] encouraging to know someone is here for us.
Family members also noted:
It was nice for my father to see fellow Veterans and acknowledge one another's services. He loved talking about the good old days. Would love to see more!
The nursing staff have grown to support these efforts. Following the annual CE seminars on Veterans' mental health needs where the intention of the Veteran-to-Veteran program is brought to the nurses' attention, nurses have commented on seminar evaluations:
- The seminar brought to nursing practice skills and how to approach this subject with our Vets.
- I will utilize our Veteran-based questions on admission and keep them in mind throughout their stay.
- There should be a Veteran-to-Veteran program set up 24/7 in the emergency department.
Additionally, as nursing staff's awareness has grown about this service, the volunteer office now receives weekly consultation requests for care from care management and clinical nurses. Examples of consultation requests include pain management and use of VHA services.
Overall, this program honors Veterans for their service and sacrifice while supporting nurses as they update their practice to meet this population's many needs. Indirectly, Veterans who volunteer not only receive overwhelming gratitude from Veterans, families, and nurses, but they also reexperience what it means to lead and undertake a mission that truly helps others. It is a novel, no cost, win–win approach that all hospitals should consider as they advance Veteran-centric care.