Article: Men Make Their Mark in Military Nursing

  1. men make their mark
    in military nursing
    janet boivin, rn

    masthead date october 07, 2002
    drawn by adventure, leadership, and education, men fill one-third of military nursing's ranks.

    nurses from the army's 250th forward surgical team who arrived in kandahar, afghanistan, on christmas day last year say it was just coincidence they all happened to be men-men like chief nurse maj. michael sadler, 53; capt. brad west, 32, the chief certified registered nurse anesthetist (crna); capt. jim rigot, 28, crna; capt. glen carlsson, 36, ed nurse; and capt. darrel dodge, 37, or nurse.

    maybe it was coincidence. but the chances of having an all-male team of rns is more than five times as likely to occur in the military than in the civilian healthcare world. one of the little known facts of military nursing is the extraordinarily high percentage of men in all three services. in the army, 35.5% of its 3,381 nurses are men; in the air force, 30% of 3,790 nurses are men; and in the navy, 36% of 3,125 nurses are men. the numbers make the mix of 6% of men in civilian nursing look anemic.

    the reasons for the military's enormous infusion of testosterone in the traditionally female-dominated nursing profession are varied, but not complex. they are factors that appeal to male or female nurses, civilian or military. but they are characteristics few civilian healthcare settings are willing or able to offer. in a random sampling of male nurses across all three branches of the military, the predominant reasons given for entering the military included-


    • fast and well-defined career tracks
    • generous educational benefits
    • guaranteed roles in leadership, even at the beginning of a military career
    • unparalleled opportunities for travel and adventure
    • camaraderie among nurses and other members of the healthcare team, including physicians
    many men who choose to be nurses in the military have had previous careers, either in the civilian or military world; were often enlisted soldiers in the military, in particular medics or corpsmen; and have a penchant for adventure and travel. air force capt. michael mccarthy, rn, bsn, who this month was awarded the dolly vinsant flight nurse award (see related story, "combat mission earns air force flight nurse 2002 award") for a medical mission in afghanistan while under enemy fire, is typical of male nurses. he was an enlisted airman with the air force security police before becoming a nurse. mccarthy left the service to go to college with the intent of becoming a teacher. he decided to study nursing instead after a college counselor encouraged him to shadow an rn for a weekend.

    "i followed an ed nurse and an icu nurse," says mccarthy, 37, a staff nurse in the surgical-trauma icu at the air force's wilford hall medical center in texas. "i thought it was intense and something i wanted to do."

    mccarthy entered the air national guard as a security policeman again, a position that helped pay his tuition while in school. after graduating, he became an active duty air force nurse.

    "military nursing is different," he says. "you get the opportunity to lead and have responsibility early in your career. as a civilian nurse, it takes a long time to get the same leadership opportunities."

    navy nurses lt. cmdr. william "dave" clark and lt. mark marva each worked as navy corpsmen for more than a dozen years, watching and learning from rns before deciding to become nurses themselves. "a lot of us come into the navy as corpsmen," says clark, who is division officer of a large clinic at the naval hospital in cherry point, north carolina.

    says marva, an ed nurse at camp lejeune naval hospital in north carolina, "you watch the nurses and think, 'i could do that.' it's a logical step; it's an upgrade in rank, respect, and pay."

    both clark and marva were among the first navy nurses sent to guantanamo bay in cuba to care for detainees being held in the war against terrorism.

    col. keith essen, rn, msn, cnor, chief of the perioperative nursing section at walter reed army medical center in washington, dc, was an army photographer during the vietnam war. his photographic documentation of combat medical care inspired him to be a nurse.

    "you could see these nurses and physicians were making a real contribution; there was a sense of something good going on in a very tragic context," says essen, who also is perioperative nursing consultant to lt. gen. james b. peake, the army's surgeon general.

    "you can enter the military as a nurse, and there is no limit to the spectrum of specialties in which you can work," says essen. "i also like working in different venues, and i knew i could do that while continuing my career progression without having to start over with each new position."

    bursting through the "green" ceiling

    the army nurse corps was formed in 1901, but male nurses were not allowed to serve in the military until 1955, according to maj. debora cox, rn, msn, an evening night supervisor at walter reed army medical center and the former nurse historian for the army. the first man to be commissioned in the army nurse corps was edward lyon, a nurse anesthetist from kings park, ny. he was commissioned as a second lieutenant on october 10, 1955.

    but men have come a long way, soldier. in 2000, gen. bill bester became the first male nurse to be promoted to chief nurse of the army. he was the first man to head any of the three military nurse corps.

    "there was a feeling among my peers that i broke through a glass ceiling," says bester. "but i always felt i had been given equal opportunity throughout my career because of the army system, which allows both genders to compete equally."

    in march, bester's responsibilities were expanded when he was selected to command the center for health promotion and preventive medicine, an organization comprising 43 different programs, including preventive medicine, industrial hygiene, laser safety, and water quality.

    achieving higher rank in the military requires traveling far from the traditional bedside. nurses must be willing to take a variety of assignments to gain a range of military knowledge. this knowledge includes military war tactics and leadership training, in addition to the traditional nursing education and experience they receive.

    "in the military, it is important our nurses be excellent nurses; but they are expected to be officers and leaders as well," says bester.

    bester entered the army clinically focused, first as a critical care nurse and then as a crna. he quickly moved on to assignments that included teaching lpns and rns; recruiting healthcare personnel in a 12-state midwest region; and working as a personnel management officer in alexandria, va, where his position included the management and assignment of 800 officers. in addition, he has been the director of nursing at three different army hospitals.

    and after 1998 when the army opened up the leadership of army hospitals to healthcare professionals other than physicians, bester was selected as the commander of the army hospital at ft. jackson in south carolina.

    the military's macho appeal

    while they don't list it high on the reasons they became military nurses, men do admit being in the army, air force, or navy carries less of a stigma than the still-stereotyped image of civilian male nurses. after all, they may be nurses, but they are still soldiers who need to know how to carry and use weapons.

    "i can do the he-man stuff in the military," says sadler. "i can go into battle with special operations soldiers and get shot at. i wear a uniform with patches and medals that say i'm tough, too; and what's more, i can save lives every day."

    nurses in the military can also earn expert field medical badges, be involved in field training exercises, or become jump- or air-assault qualified. the 250th forward surgical team is one of only three such army teams in which every member is airborne-qualified. nurses, medics, and physicians are prepared to make airborne jumps into the field to care for wounded soldiers if need be, says sadler. and air-assault qualified nurses know how to rappel out of aircraft to reach soldiers wounded in battle.

    icu nurses can be flight nurses on the air force's critical care air transport teams (ccatts), flying into moscow to pick up ailing department of defense employees or transporting seriously wounded soldiers in afghanistan to germany.

    "being a member of the ccatt is the greatest job i've ever had," says air force capt. ray nudo, rn, bsn, cen, who went to yemen to care for sailors injured in the terrorist bombing of the uss cole.

    men say they are also attracted to military nursing because of the travel and opportunity to move frequently. most assignments vary from two to five years.

    military nurses can be stationed at military healthcare facilities around the world, from europe to the far east to central and south america. they can also travel to far-flung locations, such as botswana or honduras, as part of humanitarian missions. these missions include setting up healthcare clinics in remote environments, helping train native healthcare workers, or assisting struggling public health programs.

    "these are unique skill sets you can't learn anywhere else," says capt. eric watson, rn, bsn, ccrn, who has been in the army for 10 years and traveled to africa as part of a humanitarian mission.

    military men in nursing also gravitate toward more fast-paced specialty areas, such as the ed, or, and icu. "floor nursing isn't as appealing to many men," says marva.

    in the army, 67% of crnas are men, 40% of or nurses are men, 34% of ed nurses are men, 29% of critical care nurses are men, and 39% of medical/surgical nurses are men.

    education takes priority

    the military offers educational benefits unequaled in the civilian healthcare sector. civilians who want to become nurses and enter the military can do so by applying for rotc scholarships or by joining the air force, army, or navy reserves or the national guard.

    enlisted soldiers from mechanics to air traffic controllers who want to become nurses can choose the army's enlisted commissioning program. they will continue to be active-duty service members and receive their pay while going to school to become commissioned officers and nurses. upon graduation and licensure, they become second lieutenants in the army nurse corps.

    clark was in the first class of the navy's medical enlisted commissioning program, which began in 1984. the navy sends about 50 enlisted service members through the program every year. "we get great training and education," he says.

    all three services require active duty nurses to have a minimum of bachelor of science in nursing degrees. rns are then strongly encouraged to pursue advanced degrees, which, in most cases, are paid for by the military.

    "the things the army nurse corps wants you to do-graduate school, military education, publishing, research-will make you successful," says maj. john nerges, rn, ms, ccns, critical care clinical nurse specialist at walter reed.

    "the army invests in its nurses," says watson, 34, who is studying for a master's degree in long-term healthcare at the university of massachusetts in boston while receiving his full rn salary. watson was a combat medic who joined the army reserve and rotc to earn his nursing degree. he wants to make army nursing his career.

    "i enjoy the camaraderie, the respect, and the relationship we have with doctors," he says.

    essen says there are other career enhancement advantages, including fellowships in such lofty arenas as the white house, capitol hill, jcaho, and the centers for medicare and medicaid services. the leadership training, such as the command and general staff college, and the senior service college (war college) offered by the military is second to none, he adds.

    the pay ain't so bad, either

    in the first few years of new nurses' careers, the pay in the military tends be less than civilian salaries. but as military nurses' careers progress, their salaries can surpass those of their civilian counterparts, depending on the specialty, says bester.

    a july 2000 study completed by the center for naval analysis and sent to congress reported the average military nurse's salary with 15 years of service is $69,842, compared to an equivalent civilian's salary of $52,358.

    in the army, the base pay for nurses who are majors with 14 years of service is $61,116. the major also receives $11,064 (nontaxable) for housing, $2,004 for subsistence, and $9,000 in indirect compensation for medical care and benefits for a total of $83,184 in total salary and benefits, says bester.

    rns who are lieutenant colonels with more than 20 years experience receive base salaries of $72,960, $12,522 for housing, $2,004 for subsistence, and approximately $9,500 for medical care and benefits for a total of $96,986.

    there are also critical skill retention bonuses this year in or nursing and nurse anesthesia. the yearly professional bonus for army crnas is $15,000 once they complete their school obligation. prior to that, it is $6,000 a year.

    the military isn't a lifestyle to which all or even most nurses would be suited. but the army, navy, and air force must be doing something right when it comes to attracting and keeping men in nursing. whether it's allowing nurses to "be all they can be" or to "aim high," male rns are finding, just like the navy ads say, "it's not a job; it's an adventure."


    "you can enter the military as a nurse, and there is no limit to the spectrum of specialties in which you can work."
    col. keith essen, rn, chief of the
    perioperative nursing section
    at walter reed army medical center


    "i like being a soldier, and i like being a nurse. i like being adventurous, and i like doing different things."
    maj. michael sadler, rn, former chief nurse
    of the 250th forward surgical team


    "the civilian world needs to stop stereotyping all nurses as females."

    lt. cmdr. william "dave" clark, rn,
    (right) guantanamo bay, cuba


    "as a corpsman, you watch the nurses and think, 'i could do that.'"
    lt. mark marva, rn (right),
    guantanamo bay, cuba




    capt. brad west, a chief nurse anesthetist who was in afghanistan earlier this year, says it's just coincidence all the nurses on his team were men.

    gen. bill bester burst through the army's "green" ceiling in 2000 to become the first male chief nurse of any military nurse corps.

    rns (front row) 1st lt. xavier munoz, mercedes bagby; (middle row) emmanuel samedi, capt. roddex barlow, lt. col. wayne combs; (back row) 1st lt. yauger young, capt. mark wimmer, capt. josh paul, jonathan branch

    capt. ed balvez, a critical care air transport team rn with the 40th expeditionary medical squadron in diego garcia, monitors an iv pump on board a navy p-3 aircraft.

    army nurse lt. claude fourroux, rn, cares for soldiers wounded in afghanistan at the army's regional medical center in germany.



    capt. eric watson, rn, is earning a master of science in nursing, courtesy of uncle sam.

    the "men of the ed" at the naval medical center, portsmouth, va: rns (back row from left) lt. mark marva, lcdr (ret) paul oliverio; (front row, from left) lt. jack wilcox, lt. mark jones

    the all-male nurses and physicians of the 250th forward surgical team experienced the high drama of war when they operated on a wounded soldier while under live combat fire in afghanistan.
    janet boivin, rn, is editorial director of nursing spectrum.
    •  
  2. 1 Comments

  3. by   LJZP
    i can not say a word for the article you wrote. it is amazing to me. i always dream about become one of the military nurse.thank you for the article.
    Quote from thunderwolf
    men make their mark
    in military nursing
    janet boivin, rn

    [color=silver]masthead date october 07, 2002
    drawn by adventure, leadership, and education, men fill one-third of military nursing's ranks.

    nurses from the army's 250th forward surgical team who arrived in kandahar, afghanistan, on christmas day last year say it was just coincidence they all happened to be men-men like chief nurse maj. michael sadler, 53; capt. brad west, 32, the chief certified registered nurse anesthetist (crna); capt. jim rigot, 28, crna; capt. glen carlsson, 36, ed nurse; and capt. darrel dodge, 37, or nurse.

    maybe it was coincidence. but the chances of having an all-male team of rns is more than five times as likely to occur in the military than in the civilian healthcare world. one of the little known facts of military nursing is the extraordinarily high percentage of men in all three services. in the army, 35.5% of its 3,381 nurses are men; in the air force, 30% of 3,790 nurses are men; and in the navy, 36% of 3,125 nurses are men. the numbers make the mix of 6% of men in civilian nursing look anemic.

    the reasons for the military's enormous infusion of testosterone in the traditionally female-dominated nursing profession are varied, but not complex. they are factors that appeal to male or female nurses, civilian or military. but they are characteristics few civilian healthcare settings are willing or able to offer. in a random sampling of male nurses across all three branches of the military, the predominant reasons given for entering the military included-


    • fast and well-defined career tracks
    • generous educational benefits
    • guaranteed roles in leadership, even at the beginning of a military career
    • unparalleled opportunities for travel and adventure
    • camaraderie among nurses and other members of the healthcare team, including physicians

    many men who choose to be nurses in the military have had previous careers, either in the civilian or military world; were often enlisted soldiers in the military, in particular medics or corpsmen; and have a penchant for adventure and travel. air force capt. michael mccarthy, rn, bsn, who this month was awarded the dolly vinsant flight nurse award (see related story, "combat mission earns air force flight nurse 2002 award") for a medical mission in afghanistan while under enemy fire, is typical of male nurses. he was an enlisted airman with the air force security police before becoming a nurse. mccarthy left the service to go to college with the intent of becoming a teacher. he decided to study nursing instead after a college counselor encouraged him to shadow an rn for a weekend.

    "i followed an ed nurse and an icu nurse," says mccarthy, 37, a staff nurse in the surgical-trauma icu at the air force's wilford hall medical center in texas. "i thought it was intense and something i wanted to do."

    mccarthy entered the air national guard as a security policeman again, a position that helped pay his tuition while in school. after graduating, he became an active duty air force nurse.

    "military nursing is different," he says. "you get the opportunity to lead and have responsibility early in your career. as a civilian nurse, it takes a long time to get the same leadership opportunities."

    navy nurses lt. cmdr. william "dave" clark and lt. mark marva each worked as navy corpsmen for more than a dozen years, watching and learning from rns before deciding to become nurses themselves. "a lot of us come into the navy as corpsmen," says clark, who is division officer of a large clinic at the naval hospital in cherry point, north carolina.

    says marva, an ed nurse at camp lejeune naval hospital in north carolina, "you watch the nurses and think, 'i could do that.' it's a logical step; it's an upgrade in rank, respect, and pay."

    both clark and marva were among the first navy nurses sent to guantanamo bay in cuba to care for detainees being held in the war against terrorism.

    col. keith essen, rn, msn, cnor, chief of the perioperative nursing section at walter reed army medical center in washington, dc, was an army photographer during the vietnam war. his photographic documentation of combat medical care inspired him to be a nurse.

    "you could see these nurses and physicians were making a real contribution; there was a sense of something good going on in a very tragic context," says essen, who also is perioperative nursing consultant to lt. gen. james b. peake, the army's surgeon general.

    "you can enter the military as a nurse, and there is no limit to the spectrum of specialties in which you can work," says essen. "i also like working in different venues, and i knew i could do that while continuing my career progression without having to start over with each new position."

    bursting through the "green" ceiling

    the army nurse corps was formed in 1901, but male nurses were not allowed to serve in the military until 1955, according to maj. debora cox, rn, msn, an evening night supervisor at walter reed army medical center and the former nurse historian for the army. the first man to be commissioned in the army nurse corps was edward lyon, a nurse anesthetist from kings park, ny. he was commissioned as a second lieutenant on october 10, 1955.

    but men have come a long way, soldier. in 2000, gen. bill bester became the first male nurse to be promoted to chief nurse of the army. he was the first man to head any of the three military nurse corps.

    "there was a feeling among my peers that i broke through a glass ceiling," says bester. "but i always felt i had been given equal opportunity throughout my career because of the army system, which allows both genders to compete equally."

    in march, bester's responsibilities were expanded when he was selected to command the center for health promotion and preventive medicine, an organization comprising 43 different programs, including preventive medicine, industrial hygiene, laser safety, and water quality.

    achieving higher rank in the military requires traveling far from the traditional bedside. nurses must be willing to take a variety of assignments to gain a range of military knowledge. this knowledge includes military war tactics and leadership training, in addition to the traditional nursing education and experience they receive.

    "in the military, it is important our nurses be excellent nurses; but they are expected to be officers and leaders as well," says bester.

    bester entered the army clinically focused, first as a critical care nurse and then as a crna. he quickly moved on to assignments that included teaching lpns and rns; recruiting healthcare personnel in a 12-state midwest region; and working as a personnel management officer in alexandria, va, where his position included the management and assignment of 800 officers. in addition, he has been the director of nursing at three different army hospitals.

    and after 1998 when the army opened up the leadership of army hospitals to healthcare professionals other than physicians, bester was selected as the commander of the army hospital at ft. jackson in south carolina.

    the military's macho appeal

    while they don't list it high on the reasons they became military nurses, men do admit being in the army, air force, or navy carries less of a stigma than the still-stereotyped image of civilian male nurses. after all, they may be nurses, but they are still soldiers who need to know how to carry and use weapons.

    "i can do the he-man stuff in the military," says sadler. "i can go into battle with special operations soldiers and get shot at. i wear a uniform with patches and medals that say i'm tough, too; and what's more, i can save lives every day."

    nurses in the military can also earn expert field medical badges, be involved in field training exercises, or become jump- or air-assault qualified. the 250th forward surgical team is one of only three such army teams in which every member is airborne-qualified. nurses, medics, and physicians are prepared to make airborne jumps into the field to care for wounded soldiers if need be, says sadler. and air-assault qualified nurses know how to rappel out of aircraft to reach soldiers wounded in battle.

    icu nurses can be flight nurses on the air force's critical care air transport teams (ccatts), flying into moscow to pick up ailing department of defense employees or transporting seriously wounded soldiers in afghanistan to germany.

    "being a member of the ccatt is the greatest job i've ever had," says air force capt. ray nudo, rn, bsn, cen, who went to yemen to care for sailors injured in the terrorist bombing of the uss cole.

    men say they are also attracted to military nursing because of the travel and opportunity to move frequently. most assignments vary from two to five years.

    military nurses can be stationed at military healthcare facilities around the world, from europe to the far east to central and south america. they can also travel to far-flung locations, such as botswana or honduras, as part of humanitarian missions. these missions include setting up healthcare clinics in remote environments, helping train native healthcare workers, or assisting struggling public health programs.

    "these are unique skill sets you can't learn anywhere else," says capt. eric watson, rn, bsn, ccrn, who has been in the army for 10 years and traveled to africa as part of a humanitarian mission.

    military men in nursing also gravitate toward more fast-paced specialty areas, such as the ed, or, and icu. "floor nursing isn't as appealing to many men," says marva.

    in the army, 67% of crnas are men, 40% of or nurses are men, 34% of ed nurses are men, 29% of critical care nurses are men, and 39% of medical/surgical nurses are men.

    education takes priority

    the military offers educational benefits unequaled in the civilian healthcare sector. civilians who want to become nurses and enter the military can do so by applying for rotc scholarships or by joining the air force, army, or navy reserves or the national guard.

    enlisted soldiers from mechanics to air traffic controllers who want to become nurses can choose the army's enlisted commissioning program. they will continue to be active-duty service members and receive their pay while going to school to become commissioned officers and nurses. upon graduation and licensure, they become second lieutenants in the army nurse corps.

    clark was in the first class of the navy's medical enlisted commissioning program, which began in 1984. the navy sends about 50 enlisted service members through the program every year. "we get great training and education," he says.

    all three services require active duty nurses to have a minimum of bachelor of science in nursing degrees. rns are then strongly encouraged to pursue advanced degrees, which, in most cases, are paid for by the military.

    "the things the army nurse corps wants you to do-graduate school, military education, publishing, research-will make you successful," says maj. john nerges, rn, ms, ccns, critical care clinical nurse specialist at walter reed.

    "the army invests in its nurses," says watson, 34, who is studying for a master's degree in long-term healthcare at the university of massachusetts in boston while receiving his full rn salary. watson was a combat medic who joined the army reserve and rotc to earn his nursing degree. he wants to make army nursing his career.

    "i enjoy the camaraderie, the respect, and the relationship we have with doctors," he says.

    essen says there are other career enhancement advantages, including fellowships in such lofty arenas as the white house, capitol hill, jcaho, and the centers for medicare and medicaid services. the leadership training, such as the command and general staff college, and the senior service college (war college) offered by the military is second to none, he adds.

    the pay ain't so bad, either

    in the first few years of new nurses' careers, the pay in the military tends be less than civilian salaries. but as military nurses' careers progress, their salaries can surpass those of their civilian counterparts, depending on the specialty, says bester.

    a july 2000 study completed by the center for naval analysis and sent to congress reported the average military nurse's salary with 15 years of service is $69,842, compared to an equivalent civilian's salary of $52,358.

    in the army, the base pay for nurses who are majors with 14 years of service is $61,116. the major also receives $11,064 (nontaxable) for housing, $2,004 for subsistence, and $9,000 in indirect compensation for medical care and benefits for a total of $83,184 in total salary and benefits, says bester.

    rns who are lieutenant colonels with more than 20 years experience receive base salaries of $72,960, $12,522 for housing, $2,004 for subsistence, and approximately $9,500 for medical care and benefits for a total of $96,986.

    there are also critical skill retention bonuses this year in or nursing and nurse anesthesia. the yearly professional bonus for army crnas is $15,000 once they complete their school obligation. prior to that, it is $6,000 a year.

    the military isn't a lifestyle to which all or even most nurses would be suited. but the army, navy, and air force must be doing something right when it comes to attracting and keeping men in nursing. whether it's allowing nurses to "be all they can be" or to "aim high," male rns are finding, just like the navy ads say, "it's not a job; it's an adventure."


    "you can enter the military as a nurse, and there is no limit to the spectrum of specialties in which you can work."
    col. keith essen, rn, chief of the
    perioperative nursing section
    at walter reed army medical center


    "i like being a soldier, and i like being a nurse. i like being adventurous, and i like doing different things."
    maj. michael sadler, rn, former chief nurse
    of the 250th forward surgical team


    "the civilian world needs to stop stereotyping all nurses as females."

    lt. cmdr. william "dave" clark, rn,
    (right) guantanamo bay, cuba


    "as a corpsman, you watch the nurses and think, 'i could do that.'"
    lt. mark marva, rn (right),
    guantanamo bay, cuba




    capt. brad west, a chief nurse anesthetist who was in afghanistan earlier this year, says it's just coincidence all the nurses on his team were men.

    gen. bill bester burst through the army's "green" ceiling in 2000 to become the first male chief nurse of any military nurse corps.

    rns (front row) 1st lt. xavier munoz, mercedes bagby; (middle row) emmanuel samedi, capt. roddex barlow, lt. col. wayne combs; (back row) 1st lt. yauger young, capt. mark wimmer, capt. josh paul, jonathan branch

    capt. ed balvez, a critical care air transport team rn with the 40th expeditionary medical squadron in diego garcia, monitors an iv pump on board a navy p-3 aircraft.

    army nurse lt. claude fourroux, rn, cares for soldiers wounded in afghanistan at the army's regional medical center in germany.



    capt. eric watson, rn, is earning a master of science in nursing, courtesy of uncle sam.

    the "men of the ed" at the naval medical center, portsmouth, va: rns (back row from left) lt. mark marva, lcdr (ret) paul oliverio; (front row, from left) lt. jack wilcox, lt. mark jones

    the all-male nurses and physicians of the 250th forward surgical team experienced the high drama of war when they operated on a wounded soldier while under live combat fire in afghanistan.
    janet boivin, rn, is editorial director of nursing spectrum.

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