One year later... (AF nursing)

aura_of_laura · Feb 8, 2012

They are opening an inpatient mental health unit at Elmendorf late next year, to serve PACAF (this will allow PACAF - Japan, Korea, Alaska) to keep their people in majcom for med-boards, instead of sending them to Travis patient squadron. Unfortunately, PACAF transfers makes up a large percent of our active duty patients, so I predict that we'll really be dominated by VA patients.

Our nurse-patient ratio is frequently 1:2, 1:6 at the very maximum. The other day I had 11 direct care staff (techs and nurses) caring for 4 depressed VA patients - not suicidal, just sleepy and depressed. And that wasn't counting the two NCOs, two nurse managers, two psychiatrists, two psychologists, social worker, occupational therapist, and unit secretary. And because VA staff are contractually obligated to get 40 hours per week, and AF staff are free labor, we don't send any staff home. LVNs pass almost all of the meds, techs run the groups. RNs go to treatment teams and kind of supervise, though really the NCO shift leader supervises the techs.

We cut our unit from 20 to 12 beds last year because we couldn't fill beds. Even now, our census stays right around 6-8 most of the time. Length of stay is >10 days, typically, and it is not uncommon for our VA patients to remain for 1-3 months awaiting conservatorship and/or placement.

At this time, there are no positions for MH nurses to deploy. As for assignments, most recruiters assume that MH nurses can go the same places as a MH tech. Techs work in clinics, which are at almost every base, and they man the clinics overseas, too. Same with SWs and psychiatrists. We only work inpatient. There is a small possibility to work with the Army in Germany, but it's usually just one opening for a senior Captain or Major.

The AF really doesn't know how to use MH nurses, and it's a kind of a dead-end career field. Your options will be to become a psych NP, which will allow you to work in clinics, or to go into middle management. To ever make Sq/CC or higher, you have to have critical care experience or be a flyer. Even my flight CC is an OR nurse. I was personally told by General Sinischalchi that the AF will not use a psych CNS role (and even the CC CNSes get stuck working as floor nurses), "because inpatient MH makes up such a small part of the Air Force healthcare system."

allnurses Guide · Feb 9, 2012

You don't need to have critical care background or have done a flying assignment to become a commander. A lot of commanders that are nurses came from clinic and/or med surg backgrounds.

aura_of_laura · Feb 9, 2012

A few questions I forgot to respond to:

Night shift - We all have to do a rotation on nights. On my unit, we usually work two months of night shift, and then 4-6 months of days. It does vary, though - I haven't been on nights since last June.

Charting - We use almost exclusively electronic charting.

WBTCRNA, I don't speak for the whole Air Force, nor for the experience of all military nurses. No doubt your experience is very different than my own - as a CRNA, you are in a totally distinct career field. In your specialty, you experience all of those things that I expected (and was told to expect) when I joined - travel, deployments, advanced training, having your skills desperately needed.

RN4Life2,

The mental health nursing profession is a small world, and in the AF, it's very, very small. You will know (and most likely work with) everyone in your specialty - and a lot of them share my sentiments. In the civilian sector, you can write your own ticket as a qualified, experienced psych nurse. I have worked for some wonderful hospitals that challenged me professionally, valued and improved my clinical skills, and offered really good compensation. I'm not particularly motivated by money (it's certainly not why I joined the AF), but even as an O-5, I would not make what my civilian counterparts make (at least in California), and there is always the issue of time commitment - we work significantly more than civilians. There is nothing that I hate more than wasting time, but we don't have enough work to keep us busy - we put in the hours (72 in the last seven days, myself), but we are so overstaffed/underutilized that it's shameful.

I guess it all comes down to motive. If one is joining primarily for benefits, retirement, and job security, I recommend the AF. In the world of mental health, you will serve far more patients (and a much greater variety of patients) at a good civilian hospital, and the care will almost certainly be superior.

allnurses Guide · Feb 9, 2012

A few questions I forgot to respond to:
Night shift - We all have to do a rotation on nights. On my unit, we usually work two months of night shift, and then 4-6 months of days. It does vary, though - I haven't been on nights since last June.
Charting - We use almost exclusively electronic charting.
WBTCRNA, I don't speak for the whole Air Force, nor for the experience of all military nurses. No doubt your experience is very different than my own - as a CRNA, you are in a totally distinct career field. In your specialty, you experience all of those things that I expected (and was told to expect) when I joined - travel, deployments, advanced training, having your skills desperately needed.
RN4Life2,
The mental health nursing profession is a small world, and in the AF, it's very, very small. You will know (and most likely work with) everyone in your specialty - and a lot of them share my sentiments. In the civilian sector, you can write your own ticket as a qualified, experienced psych nurse. I have worked for some wonderful hospitals that challenged me professionally, valued and improved my clinical skills, and offered really good compensation. I'm not particularly motivated by money (it's certainly not why I joined the AF), but even as an O-5, I would not make what my civilian counterparts make (at least in California), and there is always the issue of time commitment - we work significantly more than civilians. There is nothing that I hate more than wasting time, but we don't have enough work to keep us busy - we put in the hours (72 in the last seven days, myself), but we are so overstaffed/underutilized that it's shameful.
I guess it all comes down to motive. If one is joining primarily for benefits, retirement, and job security, I recommend the AF. In the world of mental health, you will serve far more patients (and a much greater variety of patients) at a good civilian hospital, and the care will almost certainly be superior.

Aura,

I have been in the USAF over 10 yrs now. I carry 4 AF nursing identifiers (CRNA, ER, ICU, and General nursing/46N3). I have been to stationed at 4 bases, worked at 6 different military hospitals and 3 VAs, and was at Sheppard when there was still an inpatient mental health hospital. I had to be the night shift nursing supervisor when I was at Sheppard which included being over the mental health ward. I still have a few mental health friends that are nurses. Two of them became mental health NPs.

When you make statements that are not true about the USAF in general i.e. only critical care nurses/nurses with flying experience can become Squadron CCs then I am going to chime in and say no that isn't correct because I know nurses personally that have been Squadron CCs/Chief Nurses/Deputy CCs with only clinic experience.

Every career is different. This is my 1st deployment in 10yrs. Even with all my credentials/CC background I didn't deploy until I became a CRNA. I have yet to do a humanitarian mission. Which I have always wanted to do, but have watched many of clinic nurses go on humanitarian missions (which had more to do with who you know vs. actual skills). I will probably at some point put in for permissive TDY to go do a NGO humanitarian mission on my own. I put up with a lot of crap to get where I am, and still do. My life as a provider is not that exciting...lol. We deploy a lot as CRNAs, but a lot of our deployments are crap(meaning that we don't do a lot). One colleague/CRNA friend did one case in 4 months while deployed, another did 7 cases in 6 months (and over half of those were on the police dogs), and there are several advisory/teaching missions where we don't even get to touch a patient for over 6 months.

The AF is the smallest of all the services and our hospitals are a reflection of that. I moonlight when I can to keep up some of my skills and have moonlighted on and off since I was at Sheppard.

All I am saying is that everyone's experiences are going to be different in the military.

midinphx, BSN · Feb 9, 2012

I have to chime in.

I was prior enlisted Army, not in the medical field but line side. The comradery is definitely not the same or what I expected. But it is there, just looks different now. I do know that my fellow AF nurses will watch out for me, whether we play and party together or not.

Wilford Hall was the biggest AF hospital until last year when we gotten eaten up into BAMC/SAMMC with the army. Some nurses worried about having to work with the army nurses (though I'm still not sure why). I find that now, the army and AF nurses get along really great - it's the civilians that we have to worry about! lol. Actually, my unit has more civilians than military. I have great leadership under the direction of an army LtCol. In this system, I feel really disconnected from my AF people - there are only a few of us on my unit. But this is the future under BRAC. I don't mind working all together, but there are definitely bugs to be worked out. Is there ever a perfect world? no

I don't work as hard as I did as a civilian. I used to carry 2 heavy ICU pt's. Now I usually have 1. Electronic charting was hard for me to learn, but I got it down. I may not work as hard, but I work MORE. Extra duties and meetings along with more shifts than I worked before. It was hard to swallow that I worked more for less and to learn that my time has no value. My deployment cured me of that distaste - after working 4 on 1 off, I feel great having 3 days off a week!

Communication and opportunity availability is a chaotic mess to figure out. The only way to get through it is to talk to others. I plan on going CCATT - which is more paperwork. So all that paperwork getting in is just a taste.

Thanks for the thread.

RN4Life2 · Feb 10, 2012

To clarify, you are working more hours and doing less? If you don't mind me asking why 72/7days? Did you have to pull an extra shift, considering the panama schedule? Yesterday I had eight patients, orienteering our new education nurse and two admissions. That was an easy day considering no seclusion or deescalation. With the new research with treatments and volume of troops coming back with severe psych injuries I would not be surprised to see a, slow, movement to in-Pt. considering the increase of suicides and domestic and other types of violence. My perspective out here (civ) is that there are many that are being discharged to the VA and the VA is swamped or the Pt's. are triggered because of the scene in the VA and can not go. I have had several young Vets needing stabilization (S.A/H.A) because they felt they could not utilize the VA.

My experience while enlisted , Assistant NCOIC, change is slow and painful but doable.

I am looking into MHNP as soon as I get based. Never too early to start planning.

Thank you for this thread it has answered so many questions and given my a good perspective and a sense of readiness. The selection board has met and I will find out in several weeks. It sounds like there are no slots open in Travis. Is this a fair assessment? Travis is my preference.

Thanks again

aura_of_laura · Feb 10, 2012

There should be slots at Travis coming open, I know we have a few people PCSing in the next month or two. I'll PM you if I find out more. Best of luck in the boards!

RN4Life2 · Feb 10, 2012

Thanks

RN4Life2 · Feb 12, 2012

ATLRN0828, I also am waiting for the "good" word. Good luck and hope to see you at COT. I'll post here if I made it.

ATLRN0828 · Feb 15, 2012

Hey RN4Life2,

The time is drawing more and more near. Good luck to you as well. Hopefully we all make it.

RN4Life2 · Mar 3, 2012

Aura, I have some good news, I have been selected and I am assigned to Travis. I will be arriving around the first several weeks of July. I am greatly looking forward to being part of the team.

NursePamela · Mar 3, 2012

Congratulations RN4Life2!!!!