Our professional values of ethics, altruism, and regard for human dignity serve as guides to provide a quality education that considers the unique needs and situations of our learners (American Nurses Association, 2015). As educators encounter an increasingly diverse student population, it is important that nurse educators be informed and effective in connecting with nursing students who are engaged in some aspect of military service—whether with current service members such as the active duty, reserve and National Guard components, Veterans, or as Reserve Officer Training Corps (ROTC) cadets.
In 2013, over 1 million student Veterans had used benefits from the Post-9/11 Veterans Educational Assistance Act of 2008 in the pursuit of higher education (U.S. Department of Veteran's Affairs, 2013). By 2020, over 5 million post-9/11 service members will transition out of the military (Molina, 2015). For many, that transition will involve either beginning or returning to college. In addition to the Veteran population, students who participate in ROTC, who remain in active military service, or who serve as a member of a branch of the reserve or National Guard add to the campus population and may be enrolled in undergraduate and graduate nursing programs.
The national profile of undergraduate student Veterans reveals that 54% are in associate degree or certificate programs, they have an average age of 25 years in beginning postsecondary education, and 20% are enrolled in STEM (Science, Technology, Engineering, and Mathematics) programs (Molina, 2014). This suggests that educators may encounter this student cohort across the gamut of nursing education from community college through terminal degree programs.
Addressing the Need for Faculty Education
Nurse educators serving diverse student populations, including those with the unique experience of active or past military service, aim to create an inclusive and welcoming academic environment. Some nursing students carefully balance military service in active duty, the National Guard, a reserve component, or the ROTC while enrolled in their nursing program, in which clinical rotations add extra obligations. Other students may have a partner, child, or family member serving in the military, which may pose a personal stressor as they proceed through their nursing program.
As a nursing program in a comprehensive university, a need was identified to provide information and education to faculty about best practices in working effectively with this student population. Faculty risk mismanagement of situations when they lack the needed information and connection to resources. Recognizing this reality, an educational session was held for faculty with the intent of increasing faculty awareness about this student population, identifying strategies to enhance faculty connection with students, and forging awareness of supportive campus and community resources.
The learning outcomes for the session were:
- To increase awareness of potential issues and concerns of service members, Veterans, and families and the challenges faced in the transition from military to college life.
- To understand the emotional cycle of deployment for service members and their families.
- To identify resources available to faculty.
- To build confidence in connecting individuals to campus and community resources.
- To understand the significance of understanding the needs of this student cohort and their families.
The intent of this article is to share information included in this faculty educational session as a guide to others who encounter such students or who would like to develop a similar session in their nursing college.
In order to garner faculty engagement, continuing education credit was awarded and lunch was served. Time allotted was 2 hours, and the event was strategically scheduled on the academic and college calendar to afford maximal faculty participation. A faculty member collaborated in the development of the program provided by two presenters: the campus Director of the Military Service Center, who serves as a Lieutenant in the United States Navy Reserve with a history of multiple overseas deployments, and a Clinical Nurse Leader program student, also with a history of overseas deployment, currently serving as a Captain in the United States Army Reserve. Their rich personal experiences and understanding of military service, deployment processes, and transitioning out of the military enriched the session. A summary of key content presented in the educational session follows.
Historical Perspective and Transition to College
The sheer volume of those who served in World War II and the Korean War created a shared experience between faculty and students. Many faculty in those eras also served and were familiar with military culture, service, and the experience of war. Similarly, many other campus personnel served in the military or had a high likelihood of having family members who were engaged in military service. The unrest and controversy surrounding opposition to the Vietnam War and campus involvement in protests contributed to isolation and a sense of “Other” for Veterans returning to the college campus during that era. Veterans who served in Iraq and Afghanistan may share in that experience, feeling vulnerable in an environment in which opposition to American involvement has occurred.
Veterans may be uncomfortable with attention or public praise directed their way. For these reasons, it is important to recognize that today's Veteran or those in active military service may opt for nondisclosure in the campus community or classes. It is also vital to appreciate that the point of view or experiences of an individual service members is their own. Each military service–involved student and Veteran is different—some may be open about their involvement, others may be private. It is also important to not focus on or talk to the individual as if he or she represents the collective group or experiences in the military at large.
Improvements in triage, treatment, and transfer of the injured have resulted in increased numbers of returning service members to the civilian population and, in turn, to the college campus. Complexities of short- and long-term injuries ranging from physical damage, acute and chronic pain, sexual trauma, psychological wounds, traumatic brain injury, and posttraumatic stress disorder can be complex and exacerbated by other health conditions and disease (Allen, Armstrong, Conard, Saladiner, & Hamilton, 2013; Greenberg & Chapital, 2016). Some students have sustained such injuries and are coping with them on a daily basis while not always disclosing the effects of their injury to others, including nursing program faculty, student peers, and staff.
Several factors have been identified as possible challenges in the transition into and through college for this student population. These include converting military skills into college credit, entering a new profession, understanding and utilizing earned benefits, being a nontraditional or older student, living off campus, feeling alienated, feeling attacked when asked about military experience, and undergoing trigger experiences (Elliott, Gonzalez, & Larsen, 2011; Kirchner, 2015). On the other hand, it is critical to recognize that these students possess noteworthy attributes valuable to their student experiences and future nursing careers. Traits of integrity, a sense of duty, mission orientation, leadership aptitude, and a strong sense of responsibility align well with a practice discipline and the values of the nursing profession (Dyar, 2016; Syracuse University, 2017). Advisors, faculty, and administrators need to be sensitive to potential transition issues while also recognizing the exemplary talents, life experiences, and aptitudes of these learners.
Building a Campus Culture of Support and Services
Support for this student population begins at the top, with an institutional commitment. At our university, a previous president with a military background was interested in expanding services to build a culture of support and advocacy for military-active or Veteran students. The development of a military service center including a director, a coordinator, work-study opportunities, an assigned success coach, and an available intern provides a one-stop resource to serve students. Ideally, such campus services should integrate with admission representatives, student affairs professionals, academic advising, and focused military counseling services for a congruent student experience (Williams-Klotz & Gansemer-Topf, 2017). With military service as a self-identifying question on university applications, it can be difficult to quantify active military or Veteran students on campus and capture those who might benefit from services.
At our institution, students who apply for and use Department of Veterans Affairs educational benefits are required to attend a briefing through the Military Service Center before beginning their program of study to receive information about resources and expectations at the university. Students in various majors have reported that knowing about benefits and resources is a helpful measure in their transitional success. It is important to note that within the university community, faculty work with peers who may be service members or Veterans or who have family members in the military. These colleagues might also need support, advice, and direction from the service center or campus resources.
Appreciating Group Differences
Each student experience is unique. What may be useful for one student may not work for another in a similar circumstance, so institutional approaches and program adaptations must consider the experience of the individual and the individual's identity (Griffin & Gilbert, 2015). For example, a group of infantry soldiers may enlist on the same day, complete training together, deploy together, and transition together, yet their experiences and response will be unique. The military experiences include separation from family, friends, and loved ones, as well as the adjustment to a new culture—one where you are told where to be, when to be there, and what the mission is. The military culture to compartmentalize one's own needs to focus on the mission and to “take care of the person on your left and right” stands in contrast to the academic culture that stresses individual responsibility and the navigation of experiences and systems with little to no hands-on direction.
Students who have deployed also have a unique perspective, compared with their comrades who have not deployed, reflected in the five-phase emotional cycle of deployment. These phases include the predeployment experience of anxiety, anticipation, denial, and mental/physical distance, and the deployment phase, which can include sadness, loneliness, and being overwhelmed with new responsibilities. The deployed service member then enters a sustainment phase in which new routines, independence, and confidence evolve. After this stage is the redeployment anticipation of homecoming with a sense of both excitement and apprehension, followed by the postdeployment phase composed of a honeymoon reconstitution period with negation of deployment routines and reintegration (Joint Services Support, n.d.). Students going through emotional phases of deployment are doing so while also meeting the social and academic expectations of student life.
Compounding these variables is the possibility of injury experienced by some students that can include both physical wounds and “invisible wounds” (i.e., posttraumatic stress and impact of traumatic brain injury). Extending flexibility in class attendance and adjusting clinical rotation schedules is necessary to accommodate appointments with the Veterans Health Administration or other medical providers as necessary. Failure to complete required appointments may result in the loss of benefits or entitlements.
Students serving on active duty in the reserve or National Guard may be called up for service and deployment at any time. Students in this situation should be referred to the institution's Military Service Center to help minimize any negative financial, benefit, or academic credit consequences that could result from being called to active service. It is critical that faculty adhere to federal law, state statutes, and university policies when students are called to meet military service responsibilities and to make every effort to ease the transition times between student and military roles. If students agree, it can be meaningful to recognize their service in college communications or to recognize them at celebratory campus events.
Connecting with Resources
Transition issues, financial concerns, psychological issues, and impact of injury can be impediments to student academic success. Academic help-seeking can be influential in successful achievement of student learning outcomes (Lee, 2007). It is imperative to create an environment that encourages academic help-seeking as needed and connects students to support resources. Faculty are influential in helping students to reduce any perceived stigma associated with seeking and accepting help. Given that military service has taken Veterans away from school, some may need learning assistance or tutoring in subject areas. Others may need accommodations for physical injuries, psychological trauma, or cognitive difficulties stemming from brain injuries.
As with all students, faculty are responsible to meet academic accommodation plans and disability plans in compliance with university policies and laws. Student service and campus disability services offices are invaluable resources for information and guidance in these matters. Expert personnel in disability services and academic accommodations can collaborate with faculty to develop suitable interventions mindful of student military service and individual needs. It can be valuable for faculty to personally engage in the conversation between student and disability and campus services such as tutoring and counseling instead of simply directing students to set up an appointment.
Taking a customer service approach is key and can contribute to positive interactions for all concerned. Communicating genuine concern and engagement with students is invaluable and appreciated. Even the small extra effort to inform students of your personal availability and additional office hours conveys a caring willingness to help and encourage these students.
Support to students can be further extended in connecting them to student organizations such as a campus Student Veterans of America chapter or local American Legion or Veterans of Foreign Wars chapters. Many service members and Veterans are more willing to share struggles or personal stories with someone who has a shared understanding. Although an educator may be somewhat educated on the experience of active military or Veteran students, it is important to avoid acting as if he or she understands stressful events that have not been experienced personally. If the educator personally has not been in combat, he or she should not pretend to know what it is like or how it may affect a Veteran. Trust is important, and embellishing relatability is one way to lose essential trust.
The Student Perspective
During the educational session, a nursing student currently serving in the United States Army Reserve provided personal insights. Awareness of the student Veteran population does not necessarily mean a desire for special treatment. However, a grasp of certain aspects builds an understanding that helps student Veterans best transition into student life and serves to link both faculty and students to appropriate campus and community resources. In connecting with these students, nurse faculty are afforded the opportunity to take advantage of the strengths of this student cohort who often have strong leadership capabilities, advanced clinical skills, and acquired aptitudes in discipline and focus that can be assets to the nursing program.
Aside from demographic differences between Veterans and their traditional college student counterparts, student Veterans may interact with faculty, staff, and other students in a non-traditional way. Students from a military background may not disclose their military service, especially on college campuses perceived as being liberal. These students may have come from successful military careers and may be too proud to ask for help in this new academic setting. Service members are accustomed to a world with a rank structure and chain of command with formal interactions between members of different ranks. This may affect interactions with an instructor who a student Veteran feels outranks him or her and lead to hesitancy in approaching a faculty member when in need of guidance or help.
Key Take-Away Points
A key point in this educational session was to focus on developing trust with the student. Being that faculty member who shows genuine interest in a trusting framework is invaluable. Take time to sincerely inquire about issues the student may be having. Know, and have available, the resources and information the institution has to offer. Remember that each Veteran student is unique. Discuss his or her career aspirations and continually communicate support of their progress and goals. Follow through with what you say you will do. It is important to reiterate that service members and Veterans are typically independent and taught to be self-reliant. As a result, it may be difficult for them to ask for help or an accommodation, even if it would enhance their academic success. If a Veteran's classroom behavior or academic work reveals discomfort, consider offering help even if it is un-solicited.
It is important to be mindful that events in clinical rotations, often unexpected, may elicit a different response in these nursing students than in others. Acute situations, even when managed well, may trigger memories of a difficult situation or previous trauma. Students may need time to process these experiences differently than others. Pay attention in the moment and recognize the need for providing private and ongoing support and accessing resources as needed. Alternatively, the military experience of these students in prioritizing, decision making, leading, and taking action are significant assets in the clinical learning environment. These students can teach and mentor their more novice student peers in the classroom and clinical rotations.
When meeting one-to-one with a student, it is okay to ask, “Are you a Veteran?” or “Have you served in the U.S. military?” Most Veterans are happy to hear that you appreciate their service. Refrain from expressing your personal opinions about military service or recent wars or conflicts in your classes or advising appointments. Veterans may interpret critical viewpoints as a negative attitude toward their own service. If aspects of any course bring up military policy in any way, ask Veterans about how they wish to participate. Even if Veterans are otherwise outspoken in class, they may not wish to talk about their time in the military. Welcome Veterans to talk about their experiences without putting them on the spot or making them feel uncomfortable. Insights they share will likely be mutually beneficial to them, their peers, and faculty.
Make sure that faculty and staff can easily connect with the institution's military service center. All faculty should also know the general on-campus emergency/crisis telephone numbers, resources, and policies for managing any student in crisis. If you do not know the resources, connect with your college administrators for information and direction. Many resources are available online for military-connected and Veteran students. It is critical to be aware of resources for crisis contacts, as Veterans have been identified to be at higher risk for suicide (Table 1).
Resources for Military-Connected Students and Veterans
At the conclusion of the described training session, all faculty received a colorful “Veteran Friendly” sticker for their office door and learned that information or crisis support for a student is as easy as dialing the campus number “VETS.” Be sure to identify a way in your college that those with experience and training can be readily identifiable to students and others.
Attendees participated in a pre- and postsurvey of the educational session rating their levels of awareness of student Veteran issues and campus resources (Table 2). Results indicate success in meeting the program objectives in that participants reported an understanding of why the issues presented in the training session were of significance to nurse faculty. Results were overwhelmingly in the direction of increased knowledge and awareness. A few faculty members still identified a gap in identifying available resources suggesting a need to supplement educational sessions with face-to-face follow up as needed, printed resources, and ready access to web links to resources. Faculty described that they were more knowledgeable and able to address concerns in both the classroom and clinical setting and in connecting students to resources, whether the student is doing well or in difficulty. Some participants identified ways in which they would incorporate what they learned into practice as an educator (Table 3).
Participant Pre- and Postsurvey
Participant Comments About Applying Information to Educator Practice
Many higher education institutions have adopted the concept of what has come to be called Green Zone Training with the purpose of providing campus personnel and faculty-enhanced understanding of the military student and family, transition issues, and ways to promote student satisfaction and success. The initiative described in this article focused on such an initiative as a useful first step in educating nurse faculty.
Education is a foundation to improve interactions with prospective and active service members who are students. Being more informed about the military experience also elevates our encounters with service members or families while supervising students in the clinical setting or in faculty work as advanced practice nurses. Faculty, administrators, advisors, and staff all play an important role in providing advice, resources, and attention toward the shared goal of social and academic success for these students.
Nursing college academic administrators should include content on Veteran and service members in new faculty orientation and continually work with campus entities such as student services, disability services, counseling services, and faculty development resources to learn and share best practices (Alschuler & Yarab, 2016). A need has been identified to prepare students and nurses in all settings with the competencies to effectively meet the health needs of Veterans and to strengthen our curricular content to Veterans' health care (Carlson, 2016; Champlin & Kunkel, 2017; McMillan et al., 2017). It makes intuitive sense that in order to do so, faculty must first be educated on the issues and needs of their military-active and Veteran students. A sensitive approach socializes our students to provide similar support when working with active military members or Veterans as nurses.
The authors encourage others to implement a similar event to successfully meet the needs of this student group. A limitation of this training was that it was held once in a face-to-face session. Faculty may benefit from a follow-up session to explore strategies to implement student-centered strategies for military-connected students. Although the military service center stands ready for further training, recording the session would have been valuable to those unable to attend and to create a digital resource for ongoing use with new faculty orientation sessions. Time constraints and demanding calendars are a challenge in scheduling educational sessions. Placing faculty education sessions on the college master calendar at the start of the semester may facilitate attendance and convey their significance. Advanced planning is also suggested to coordinate the training across health profession programs to allow interprofessional collaboration and participation. Recommendation for future training sessions could be to include a nursing student panel composed of students who are ROTC cadets, Veterans, in active service, or in the Reserve to present a broader student perspective. It might also be valuable to include a nursing student who has a military-active or Veteran family member to provide insight into family needs and experiences.
Educated and sensitive nurse faculty can be critical aids in promoting student success as they transition, juggle responsibilities, cope with injuries, and connect to campus life (Kirchner, 2015). Our engagement also provides an opportunity to capture the unique strengths and aptitudes born from military service into our student population and our profession. Indeed, if faculty mentor our military-active and Veteran students effectively, our profession benefits when their leadership skills of collaboration, motivation, and communication serve to fill the well-documented void in faculty and academic leadership positions (Chargualaf, Elliott, & Patterson, 2018; Lake, Allen, & Armstrong, 2016).
Nursing program administrators are encouraged to partner with campus military service centers, student services, and admission offices to recruit and support student Veterans. A need exists to reach out to Veterans about health profession careers, to help them traverse access and use of benefits, and to consider how Veterans' military knowledge and experience can be considered in program placement decisions (Snyder, Wick, Skillman, & Frogner, 2016; Voelpel, Escallier, Fullerton, & Rodriguez, 2018). Further research is needed to examine interventions that prove successful in advancing the social and academic success of nursing students who actively serve in the military or are Veterans.
A commitment in serving as both support system and advocate is consistent with the definition of professional nursing “that encompasses the protection, promotion and restoration of health and well-being” of others (American Nurses Association, 2015, p. 9).
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- Joint Services Support. (n.d.). Understanding the phases of deployment: Knowing what to expect is the first step to ensuring readiness and resiliency. Retrieved from https://www.jointservicessupport.org/YRRP/DeploymentCycle.aspx
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Resources for Military-Connected Students and Veterans
|Directory of Veteran services organizations||https://www.va.gov/vso/|
|National Military Family Association||https://www.militaryfamily.org/|
|Scholarships for military families||https://studentaid.ed.gov/sa/sites/default/files/scholarships-for-military.pdf|
|State and county Veterans service officers||https://www.longtermcarelink.net/ref_list_state_county_veterans_service_officers.htm|
|Student Veterans of America||https://studentveterans.org/|
|The American Legion||https://www.legion.org/|
| Local response||911|
| Veteran's Crisis Line||Phone 1-800-273-8255 or Text 838255|
| Vet2Vet Hotline||Phone 877-VET2VET (838-2838)|
| 24/7 Veterans Crisis Line||https://www.veteranscrisisline.net/get-help/chat|
Participant Pre- and Postsurveya
|Program Learning Outcome||Strongly Agree||Agree||Neutral||Disagree||Strongly Disagree|
|I am aware of potential issues and concerns faced by service members, Veterans, and families.||3||14||12||4||0||0||4||1||0||0|
|I have an understanding of the experience of military-connected students and families and the emotional cycle of deployment.||2||11||7||6||1||0||5||1||4||0|
|I have an awareness of potential challenges that student service members, Veterans, and families may face when transitioning from military to college life.||0||13||10||5||1||0||5||1||3||0|
|I know what resources are available to me as an educator regarding student service members, Veterans, and military family members.||0||13||3||4||4||0||8||2||4||0|
|I am confident in connecting student service members, Veterans, and family members with support and information about resources on campus and throughout the community.||0||13||4||5||3||0||9||1||3||0|
|I understand the significance of awareness of needs of student service members, Veterans, and families to nurse educators.||6||14||4||5||2||0||6||0||1||0|
Participant Comments About Applying Information to Educator Practice
|“By being readily available to those students, staff in need. An open door.”|
|“I now know how to assist military students with available resources.”|
|“I will be more prepared if a situation arises.”|
|“It will help me with working with Veterans.”|
|“More knowledge of potential concerns by those in the military and Veterans available in the classroom and clinicals.”|
|“Paying more attention to make note of Veterans in my courses. I am thankful for them and all who serve. It never crossed my mind that some people wouldn't identify.”|
|“Provide appropriate services to students.”|
|“Refer active and Veteran military students for support. Share information with community military friends and acquaintances.”|
|“Refer students in teaching.”|
|“To support our students and connect them with resources when well or in difficulty.”|