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NICoE Features and Articles

neurology1s.jpgNICoE's Neuroimaging
Research Core

The Strategic Communications Team

22 AUGUST 2012

Guided by recent studies linking mild traumatic brain injury to damaged white matter axons in the brain, the NICoE’s Neuroimaging Research Core, a part of the Research Directorate, has delved head first into developing the tools and software needed to accurately clinically diagnose mild TBI.

Until now, TBI has been difficult to diagnose because of the lack of physical clinical evidence of the injury. “The definition of a mild TBI is that there are no visible lesions in a standard radiology exam,” said Dr. Terry Oakes, chief of imaging processing at the NICoE.

In order to tackle this complex challenge, the Intrepid Fallen Heroes Fund equipped the NICoE with six state-of-the-art imaging machines: a magnetic resonance imaging (MRI) scanner, a positron emission tomography (PET) scanner with computed tomography (CT) abilities, a magnetoencephalography (MEG) scanner, an electroencephalography (EEG) scanner and a fluoroscopy x-ray.

Each neuroimaging scanner is distinguished by its precision in temporal resolution (timing), spatial resolution (anatomical accuracy)
neurology10.jpg and biological specificity (functional processes). MEG and EEG are the fastest; the MRI has the best spatial resolution, identifying small structures in the body; and the PET-CT offers the best biological specificity, focusing on a single biochemical reaction of
interest to a disease process with the help of radioisotope tracers. When analyzed together, each scanner’s images complement the others’. Together, they present a holistic picture of the brain’s anatomical and functional activity.

NICoE patients are recruited for neuroimaging research within the first two weeks of the NICoE program. Neuroimaging scans are available “a la carte,” but most patients choose to have a MRI or PET-CT scan. Approximately 90 percent of the NICoE patient population elects to participate in neuroimaging research. Subjects perform resting state, memory and executive function tests for 90 minutes as researchers conduct detailed anatomical examinations and capture functional brain activity.

Since moving from the former Walter Reed Army Medical Center in 2010, the Neuroimaging staff has made significant progress in acquiring patient images for its mild TBI database with the help of the NICoE’s state of the art equipment. “We had scanned about 60 or 65 people at the old Walter Reed in two and a half years,” recalls Oakes. “In the last six months [at the NICoE] we’ve scanned [more than] 225.”
As a result, the Neuroimaging Division has been able to develop one of the largest databases of TBI images in the world. Through its collaborations with institutions such as Walter Reed National Military Medical Center and the Uniformed Services University, the hope for the NICoE’s Neuroimaging Division is to “combine the focus and expertise of the NICoE with the diverse expertise of other researchers [in TBI].”

The long-term goal of the division is to establish clinical benchmarks, and to use data gathered at the NICoE to provide researchers with information to better evaluate, diagnose and treat this comorbid condition. Until then, NICoE researchers will continue to work on characterizing the disease and developing the techniques needed to detect and display characteristics of comorbid TBI and PH conditions.

Spiritual Healing at the NICoE
Chap_Houk2.jpgThe Strategic Communications Team

16 AUGUST 2012

Care at the NICoE goes beyond appointments with neurologists and evaluations by physical therapists.

While these critical components comprise an important aspect of the NICoE’s treatment plan, the NICoE’s approach to care encompasses so much more. Navy Chaplain CDR Ray Houk, head of the NICoE’s spiritual healing program, helps service members and their families examine not only their physical and mental states, but their spiritual states as well.

“The chief goal of the spiritual healing program is to help the patient identify, within their own history, tradition, culture and worldview, what is important to them and how that importance impacts their healing process,” said Houk, an ordained pastor of The Foursquare Church.

Every service member who is admitted to the NICoE, regardless of religious affiliation, denomination or preference, meets with the Chaplain during the second week of his or her treatment as part of an overall patient evaluation. In this initial meeting, Houk conducts a comprehensive spiritual assessment to get more acquainted with the individual. The assessment’s aim is to learn about the service member as a whole. It surveys the patient’s spiritual history, current spiritual practices, and any challenges he or she is experiencing that may be inhibiting the healing process.

“It looks at where they’ve been,” says Houk. “This is different than just looking at their religious practices, which may or may not be helpful to them. It links up to their spiritual health, which is how they’re feeling about themselves, the relationships they’re in and their family members. Really, it is about what is most important to them as a person, continued Houk.

Incorporating the spiritual assessment into service members’ overall treatment plan allows NICoE providers to learn more about the patient and what is causing him or her personal difficulty. Service members often cite grief, guilt and loss as being resultant feelings from moral injury or inner conflict Houk works with service members individually by listening to their challenges and offering suggestions or techniques that may help them on their path to recovery.

One of the techniques he teaches involves the labyrinth in NICoE’s “Central Park.” Popular among cathedral builders during the Medieval Ages, labyrinths were built into the cathedral floors for congregants who wanted to meditate on particular struggles confronting their lives. By slowly walking the labyrinthine circuits from start to finish, service members at the NICoE benefit from not only a relaxing environment, but also an uninterrupted chance to reflect on issues that may be causing them distress.

At the conclusion of their four week stay, Houk finds that many service members are more relaxed then when they first entered the NICoE’s doors. Teaching service members self-management skills—and then watching as they use these skills to manage strong emotion—is a hallmark success of the spiritual healing program. By helping service members better recognize, as Houk says, “self-compassion, self-awareness and self-control” in their own lives, the spiritual healing program compliments the NICoE’s many care modalities and helps the entire organization achieve its mission.  

NICoE Service Dog Training Program: Helping Wounded Warriors “Heel”
The Strategic Communications Team

25 JUNE 2012

At the National Intrepid Center of Excellence, help and hope for wounded service members suffering from mild traumatic brain injuries and psychological health conditions comes in a variety of forms. Neuroimaging, physical therapy and acupuncture are all critical aspects of the NICoE patient-centric care model. Some of the less obvious contributors to patient wellness, however, are young, furry, four-legged canines who are partners in the healing process. 

Rick Yount, a social worker with more than 25 years of experience, got involved in animal-assisted therapy 17 years ago. Today, Yount is the Executive Director of Warrior Canine Connection, Inc., a 501(c) 3 non-profit. The WCC is a therapeutic service dog training program that works with service members suffering from post-traumatic stress disorder to train service dogs that are later partnered with mobility-impaired veterans. The program draws upon the warrior ethos – a commitment to mission and team before self – to motivate emotionally numbed service members to help other service members. Training service dogs requires patience, consistency and the use of positive affect: behavioral traits that are inhibited by Post Traumatic Stress. The Warrior-Trainer’s role in conveying a sense of security to their young dogs during public field trips provides a reason to challenge their own intrusive thoughts and begin to experience their community as a safe place. 

Yount began his career in social work assisting abused and neglected children in foster care. He was given a Golden Retriever puppy, Gabe, as a Christmas gift and started bringing him to work. Immediately, Gabe began connecting with children during difficult experiences, lessening their trauma. Yount soon began using Gabe regularly in his interactions with children and families and registered him as a therapy dog. He moved on to begin a collaborative program with the West Virginia University School of Service Learning called Golden Rule Assistance Dogs. The GRAD program taught troubled teens how to train mobility service dogs for placement in the community, two of which were placed with veterans. 

Meanwhile, Yount began to learn about breeding service dogs and had his loyal companion, Gabe, evaluated as a stud. Through the GRAD program, Yount bred Gabe to another Golden Retriever. Five puppies from his first litter were placed as mobility service dogs. In 2008, Yount created the Paws for Purple Hearts program at a Veterans Affairs residential treatment facility as part of his thesis for a Master’s degree in Assistance Dog Education. Combat veterans training the PPH dogs under Yount’s instruction and guidance reported significant improvement in their PTSD symptoms, and Yount was inspired to continue his work. 

george3s.jpgNow at the NICoE, on the campus of Walter Reed National Military Medical Center in Bethesda, Md., Yount and the Warrior Canine Connection have 12 dogs and four breeders. As his young dogs mature under the guidance of the NICoE’s service members, Yount and his team are focused on maximizing the dogs’ therapeutic benefit for the NICoE’s particular patient population. As Yount says, dogs have been “serving humankind for 30,000 years,” and the NICoE provides his program access to the technology to better understand that human-animal connection. 

While clinical guidance is limited, Meg Olmert, Director of Research and Development at Warrior Canine Connection, is busy identifying scientific evidence that supports the benefits of the human-animal bond. Oxytocin, a hormone often referred to as the “love molecule,” is released in both the animal and the human during interaction. This natural hormonal increase has a calming, connecting effect in humans that counters the fight-or-flight mechanism, an automatic physiological response to increased physical or emotional stress, often prevalent in combat veterans. 

At the NICoE, patients involved in the program report feeling less depressed and anxious, more willing to interact with others, and better able to sleep. Their spouses and children are benefiting from their improved social and emotional skills. To Yount, Olmert and the rest of the team, it is clear that “something is going on underneath the skin.” A gap exists in best practices regarding placing service dogs with combat veterans with psychological health injuries. By working with the NICoE, the Warrior Canine Connection hopes to fill that void by creating and disseminating best practices based on solid research – not only to shape policy, but to educate and extrapolate this model to other sites across the country. 

On a Friday in March 2011, on his farm in Brookeville, Md., Yount paid his last respects to his beloved Gabe, who was nearly 16 years old. A group of wounded Marines were onsite that day and had the opportunity to say goodbye to their steadfast ally, an opportunity not afforded to many during combat. For Yount, it was a proud, though somber, moment. Even Gabe’s last half-hour of life was therapeutic.

Healing Arts - Creating Tools to Help Service Members Heal
The Strategic Communications Team

19 JUNE 2012

melissa_art2.jpg“I have been an artist for as long as I can remember, which at its root is what led me to this career,” begins Melissa Walker, the
NICoE’s resident art therapist. “My own love for the arts, combined with an interest in psychology, is what led me to pursue a Masters of Arts in Art Therapy.” Walker’s passion for art is evident as you look around the NICoE’s art studio at the countless masks, montages and projects that line the walls. But most impressive about the artwork at the NICoE are the service members responsible for creating it. “I tell them when they first get here that what they create is going to be rich because of what they have experienced.” 

While art is an integrative part of the Healing Arts Program at the NICoE, the program itself actually employs many different types of artistic and creative modalities, such as creative writing, music and—of course—visual art. Together, these modalities complement each other and serve as a means of therapy and expression for service members with comorbid traumatic brain injuries and psychological health conditions. Walker has designed the program from the ground up, taking into account the needs and suggestions of the NICoE’s service member population. “We currently have a musician volunteer who provides guitar and piano lessons, and we have also partnered with the National Endowment for the Arts to bring Operation Homecoming, an expressive and creative writing project, to the NICoE,” Walker explains. 

By integrating art into the NICoE’s continuum of care, the Healing Arts Program helps provide each individual with new tools to mitigate anxiety, trouble focusing and racing thoughts, and it serves as a nonverbal outlet to help service members express themselves and process traumatic experiences from their past. As Walker says, “The hope is that any engagement in and focus on a positive outlet will spill into other aspects of their lives and aid in the reconnection to things they used to enjoy while helping them formulate who they have become and will become.” 

melissa_art6.jpgWhen service members meet with Walker, they share their history if they are comfortable. Most importantly, however, they share and discuss their goals for the program. “Depending on their goals, I tell them how art can help them meet and achieve those goals. So if it’s ‘I’m having trouble focusing,’ then I let them know art can help them focus by allowing them to spend time just sitting and concentrating on one project for a while,” says Walker. If there is a particular trauma they are trying to overcome, she helps them to create a project where they try to express that trauma and process it through their art. 

The art therapist meets individually with every service member at least once during the NICoE program, and also holds weekly group sessions for each cohort. In the first week of the program, service members are encouraged to make masks, which Walker uses as an outlet for the identity struggles they may be facing as they begin the program. “During that first week they are processing so much that this gives them an opportunity to bring everything up and put it into the mask,” explains Walker. The session is two hours long, which gives the service members enough time to make their mask and to do a bit of writing to help them process what they have created. 

The second week of the four-week curriculum focuses on writing, and the service members take part in an expressive writing session led by a combat veteran writer. Service members are invited to write about something important to them and then are given the option to shred, keep or share their work with others. Additionally, service members and their families are invited to attend weekly Creative Writing Workshops. During these workshops, a family-style meal is shared and writing instructors facilitate and inspire service members to experiment with new writing outlets. Service members have explored poetry, fiction and non-fiction, and often share their work with the group. Walker says the writing program “provides an additional creative outlet for service members to express themselves, create a sense of community, increase self-esteem and develop a coping skill that may be utilized after discharge.” 

melissa_art4.jpgMontages are created in the third week, because they allow service members the time to reflect on complex feelings. At this point, “they just have so much going on,” says Walker. “They can symbolically layer what’s going on internally during this project. The montage is about looking at their past, present and future.” 

During the commencement session in the fourth and last week of the program, the service members have the opportunity to talk about everything they will be taking away from the NICoE, such as the tools they’ve learned, the friends they’ve made and the realizations they’ve had throughout their sessions. The fourth week project includes creating post cards to send to fellow service members who have already been through the program. Walker explains that this is a way of “sending their experience forward.” She says, “This allows them the opportunity to say, ‘Okay, a couple months down the road, where will I be? What will I need to hear?’” 

After completing the program, most service members will tell you that making masks in their first week at the NICoE was really their “ah ha” moment. For many of these individuals, it’s their first foray into exploring the arts and really exploring themselves. Some will continue to pursue art once they get home, and Walker can tell countless stories of service members with whom she is still in touch, who continue to explore their creative writing or who have even gone so far as to set up an art studio in their home. But once again, it’s never just about the art; it’s about the tools that the process provides. Walker sees those who graduate from the program benefit from an increased ability to focus and improved frustration coping skills. She also understands the sense of mastery that comes from completing a project. In turn, this mastery can improve overall self-esteem and self-understanding.

Walker says the most rewarding element of this modality is that service members are able to use art to tell their stories, and find a voice in a visual product. As she proudly explains, “Looking at most of this work you can see the emotion these service members put into it and you can feel the personal experiences they’ve been through. For me, that’s what tells me this is really working. At the end of the day, these men and women are really talented.”

The NICoE Satellite Centers Break Ground
The Strategic Communications Team

14 JUNE 2012

photo14.JPGOn Wednesday, June 13, ground was broken on the new National Intrepid Center of Excellence Satellite Center at Fort Belvoir in Springfield, Va. Army Col. Susan Annicelli, commander of the Fort Belvoir Community Hospital, welcomed the crowd, and said, “We are so humbled and grateful [for] this gift that the Intrepid Fallen Heroes Fund has given to Fort Belvoir.” 

Both the design and mission of this Satellite Center—and another to be built at Camp Lejeune in Camp Lejeune, N.C.—are mirrored after the original NICoE, which is located at the Walter Reed National Military Medical Center in Bethesda, Md. The goal of these individual centers is to bring the successful NICoE clinical program to installations throughout the country, increasing the overall number of service members with comorbid mild traumatic brain injuries and psychological health conditions who can be seen and treated at a NICoE facility. Placing these essential treatment and care facilities right in the soldiers’ communities will create more immediate access for thousands of service members throughout the military. 

“The NICoE’s charge is to make visible what is invisible,” said Dr. James Kelly, director of the original NICoE. He also emphasized the importance of collaborating with these new Satellite Centers to create a network of treatment, research and education centered on mTBI and PH conditions. 

“Recovery from brain injury varies by individual degree of damage,” Kelly said. “Although little can be done to reverse the initial damage, immediate medical treatment is essential for stabilizing, preventing further damage and beginning physical and mental rehabilitation. For many TBI sufferers, there is medication and alternative medicines which can mitigate symptoms such as headaches, chronic pain, behavioral problems, depression and seizures, once the extent of the injuries are diagnosed. “ 

DrKellyUpright.pngThe NICoE in Bethesda, Md., works to explore and research these different treatment options to see which are most effective. All of these practices will be shared with the NICoE Satellite Centers to expand this continuum of care. 

Army Staff Sgt. Spencer Milo and Air Force Master Sgt. Earl Covel, both former patients at the NICoE, attended the ceremony as honored guests. Before the ceremony, Milo told reporters that the “NICoE gave me the tools I needed to be a better husband, father and soldier. Their staff was able to understand that not all of my wounds were visible.” 

Both Milo and Covel credit their success today to the men and women who worked with them at the NICoE, and are excited to help promote the expansion of the NICoE program. 

“The staff at the NICoE led me back from a very dark place. Now I can see the light at the end of the tunnel and I’m looking to the future for the first time in a long while,” Covel said. 

Both the Fort Belvoir NICoE Satellite Center and the Camp Lejeune location broke ground on Wednesday. During the ceremony, Mr. Richard Santulli, chairman of the Intrepid Fallen Heroes Fund, said that the IFHF hopes to fund more than seven centers located at military bases across the country. The IFHF relies on the donations of private citizens to meet this goal. To donate to the IFHF, please go to:

Mr. Arnold Fisher, honorary chairman of the Intrepid Fallen Heroes Fund, encouraged the crowd to begin this important work. 

“It is our duty as Americans to care for our military men and women who have worn the cloth of our nation in battle, and sacrificed a piece of themselves for our freedom,” said Fisher. “We owe it to these service members and I’m ready to get started now.”

NICoE Integrates Sleep Program into Interdisciplinary Care Model

Original publication appeared in DCoE's TBI Case Management Quarterly Newsletter  
The Strategic Communications Team

11 JUNE 2012

In the past ten years, the science of sleep has developed rapidly. Today, the NICoE integrates a full sleep assessment into its interdisciplinary care model, including appointments with a specialist, ongoing activity monitoring, and a night in a sleep lab. Every service member at the NICoE meets with Dr. Anthony Panettiere, a former Navy neurologist who now spends his days observing and treating the sleep habits of those suffering from traumatic brain injury and psychological health conditions. While their initial appointment occurs within their first two days in the program, by the end of the first week, they have spent a night in the sleep lab, attended an educational session about normal sleep and sleep abnormalities, and worn a special sensor for four full days and nights that tracks motion and from which Dr. Panettiere can identify the sleep habits of each individual service member. 

sleeplab1.jpgBy analyzing the findings of these many data sources, Dr. Panettiere has identified sleep apnea in an overwhelming majority of the nearly 130 patients he has seen. Identifying these patients’ root sleep issues early on in the program allows Dr. Panettiere to begin treating them right away, ensuring that other diagnostic exams and tests aren’t affected by a patient’s sleep deprivation. He shared anecdotally that service members who are extremely tired will test poorly on neurological diagnostic evaluations conducted prior to sleep studies. Once they have been diagnosed as suffering from sleep apnea or other sleep conditions, and begin receiving treatment, the same service member will test much better. 

Being tired affects more than just a service member’s diagnostic evaluations, Dr. Panettiere explains. Exhaustion can affect cognition, cause headaches and increase pain in general. It also affects a service member’s mood and even their ability to lose weight. 

“Sleep is addressed in their first week because abnormalities there cover most of what they come in with,” Dr. Panettiere said. “If we can recognize the sleep disorder right away, it overarches all those other things, [which can then] be better treated and we can get a better assessment. 

Diagnosis is only half of the battle. Dr. Panettiere spoke of three main treatment options for people suffering from sleep apnea. sleeplab4.jpg
The first is one of the most common solutions, a Continuous Positive Airway Pressure machine, or CPAP. This is a mask that patients wear when sleeping that delivers compressed air throughout the night. The NICoE is able to secure a device for patients covered by TRICARE North shortly after diagnosis, and works closely with a team at Walter Reed National Military Medical Center to ensure service members have a good fit and are comfortable working with the device. The other types of treatment – an oral appliance, which is a dental device that helps to open the airway, or surgery – are not available during their time at the NICoE, but are built into the customized treatment plan that service members take with them upon graduation. 

Dr. Panettiere was featured last week in a DCoE webinar about the NICoE sleep program. Listen to the webinar to learn even more information about how the NICoE is leveraging its interdisciplinary program to change the lives of service members suffering from traumatic brain injury and psychological health conditions:

To connect with the NICoE online, find us on Facebook at the National Intrepid Center of Excellence, or follow us on Twitter @NICoEpage.

The NICoE’s Speech-Language Pathology Program:
 ​Helping, Educating and Empowering Pat​ients

The Strategic Communications Team
4 JUNE 2012

Today, Erin Mattingly, a speech-language pathologist at the National Intrepid Center of Excellence, is evaluating a patient and assesses his communication and cognitive abilities. “Now,” she says to him, “let’s take a look at this picture, can you tell me what this is?” This is part of a typical speech-language pathology evaluation session at the NICoE. The information gathered during this session will be shared with the interdisciplinary care team responsible for painting a comprehensive picture of each patient’s needs, with the goal of designing a treatment care plan that paves the way toward recovery. Speech Photo 1.jpg

Service members at the NICoE face an array of complications resulting from their comorbid traumatic brain injury and psychological health conditions. These complications often include short-term memory problems, inability to concentrate or multi-task, and difficulty with goal-setting and problem-solving. As Mattingly says, “Many of our patients have difficulty organizing thoughts, using words [or] remembering where they put things. When you have TBI and PH co-morbidity, these symptoms are exaggerated.” As a result, the speech-language pathology program is a vital aspect of the care provided at the NICoE. 

Following each initial evaluation session, the speech-language pathologist provides recommendations to the interdisciplinary care team, which works to design a customized treatment plan. This spirit of collaboration is also fostered with military treatment facilities across the U.S. “I have made strong contacts with MTFs which allow me to collaborate and discuss referrals. Developing partnerships is important for the work that I do,” says Mattingly. While this is still an ongoing and evolving learning process, the NICoE speech-language pathologists are committed to their work with MTFs to allocate resources, discuss referrals and figure out ways to ensure the patients’ success. 

“The main concern is to provide our service members with tools that will improve their day-to-day experience,” says Mattingly. 

With this in mind, speech-language pathology follow-up sessions provide concise strategies for use in everyday life and with interpersonal interactions. “I teach our [service members] internal memory strategies, using acronyms, visualization and association,” Mattingly says. By engaging her patients in exercises designed to improve concentration and attention difficulties, Mattingly works with service members to improve accuracy in recalling information and improving their attention. These exercises, however, are not always easy. They require practice and repetition, which Mattingly achieves with a stop-watch and time-related goals. “They call me the tyrant but I know they like a good challenge,” Mattingly says with a grin. 

Speech Photo 2.jpgIn addition to helping find treatment options that improve a service member’s quality of life, the speech-language pathologists at the NICoE are dedicated to educating and empowering patients. As Mattingly says, “To me, education is critical in helping our service members navigate what they are experiencing.” Service members report feelings of frustration and confusion in their inability to carry out tasks they were once so easily able to tackle. Confronting this is complicated – especially while trying to explain it to one’s significant other. “Spouses often tell me ‘he doesn’t listen to me,’ so I am then able to explain that there may be an underlying cause to this behavior and we work together to come up with solutions,” says Mattingly. 

Group classes form a significant part of this education. As part of the speech-language pathology program, Mattingly and her coworkers convene a weekly cognitive group class session developed to provide patients with general information about the program and the factors that affect cognitive ability and performance. “I want to focus on giving our service members confidence and empowering them. That’s why education is so important,” says Mattingly. 

So, what is the best part of Mattingly’s job as a NICoE speech-language pathologist? “I just can’t think of a more deserving group than these [service members]. I really love this patient population,” says Mattingly. As the child of an Army parent herself, Mattingly is familiar with aspects of her patients’ lifestyles and the sacrifices their family members are often asked to make. She has genuine empathy for her patients and knows this is something to embrace. Still, she remains humble and says, “I don’t want to pretend I know what it’s like for my patients because I don’t, but I am here for them and that’s what’s most important.” 

During her tenure at the NICoE, Mattingly has evaluated close to 200 service members and continues to learn and grow while giving her patients the confidence they need to continue on their journey. As she proudly says, “Each individual is unique, which is challenging. My job is not cookie-cutter – it’s interesting, inspiring and I love it.”

It's National Nurses Week
Navy CAPT Pamela Giza
11 MAY 2012

National Nurses week begins each year on May 6th and ends on May 12th, which is Florence Nightingale’s birthday. An English nurse, writer and statistician, Nightingale laid the foundation for professional nursing with the establishment of her School of Nursing at St Thomas’ Hospital in London in 1860. She rose to prominence for her pioneering work in nursing during the Crimean War. Through her implementation of hygiene improvements, quite revolutionary at the time, she is credited with reducing the hospital death rate from 42% to 2%. Nightingale was dubbed “The Lady with the Lamp” due to her habit of making rounds at night. As with other professional recognition days or weeks, this time is set aside to reflect upon and honor the unique contributions of nurses. This year’s National Nurse’s Week theme is: Advocating, Leading, Caring. 

Did you know that since 1999, nurses have been ranked as the most trusted profession in America in Gallup’s annual survey that ranks professions for their honesty and ethical standards? Approximately 81% of Americans believe nurses’ honesty and ethics are “high” or “very high”. In the past eleven years, there has only been one year where nurses lost that top distinction; in 2001, firefighters were recognized as the most trusted profession. 

The public’s high regard for the nursing profession, coupled with nurses’ education and skills, makes them well positioned to play a major role in the transformation of the nation’s health care system. Currently, nurses hold positions as direct care givers, and as the Surgeon General of the Army. We are Primary Care Managers and Perioperative Nurses, Case Managers and Administrators, statisticians and Quality Managers, Commanding Officers and CEOs, Executive Coaches and principal investigators conducting research, ward nurses and politicians. Seven members of Congress are nurses (three current and four incumbents) and as such, they are in pivotal positions to positively influence policy decisions that impact the nursing profession. “Because when nurses talk, Washington listens.” 

But will there be enough nurses to meet the future demand? I don’t know, but I will offer a challenge. I challenge every RN to make a commitment to yourself and our profession to do three things, on however small or grand a scale: 

1) ADVOCATE. Value what you do. Never miss an opportunity to educate or articulate the value nurses bring to the health care team—to the public, a patient or our health care colleagues. If you don’t value what you do, no one else will. 

2) LEAD. Be professionally engaged. Read, discuss, and compare notes and knowledge in your workspace, in your facility, and on the local or national level. Understand the issues our profession is facing: the implications of the Affordable Care Act; changes in clinical practice; concerns of license portability; the education level for entry-level practice; online programs; and Doctorate of Nursing Practice as the entry-level for advanced practice. Do you belong to a professional organization? Get involved in groups that will help you better understand the profession, its successes and its challenges. 

3) CARE. Find a mentor; be a mentor. It is a powerful relationship. RNs, reach out today to a student or junior nurse and offer to be there to guide them. To the younger nurses, keep us on our toes by challenging us professionally. We are counting on you to keep us moving forward as a profession. Collectively, we are a force to be reckoned with. We all have the privilege and responsibility of growing America’s next generation of nurses. 

​To the nearly three million licensed registered nurses in America, thank you for the contributions that you make in advocating, leading and caring to provide safe, quality health care. Happy National Nurses Week.

An interview with LCDR Jena McLellan – Clinic Manager at the NICoE jenna_headhot.jpg
The Strategic Communications Team
7 MAY 2012 

U.S. Public Health Service LCDR Jena McLellan’s commitment to nursing is evident the minute she begins to discuss her career trajectory and her current position at the NICoE. As the Clinic Manager, she is charged with overseeing and ensuring the continuous improvement of all the NICoE Clinic’s operations, a job which frequently presents both expected and unexpected roles. One day she is involved in discussions regarding direct clinical practice, the next day, she is addressing a potential viral outbreak. Above the day-to-day, she remains dedicated to empowering and guiding the highly-skilled nursing team at the NICoE. These nurses, she says, “are at the very center of the care provided to our patients – they are critical to our success.” 

Nurses at the NICoE play diverse roles and impact patient care in many different ways on a daily basis. Whether involved in continuity services, discharge planning, research, regulatory compliance matters, clinical trial coordination, or direct clinic care, nurses at the NICoE, LCDR McLellan says, “are driven by their genuine dedication and commitment for our patients and our patients’ families.” She adds that it is this level of dedication and professionalism that makes the NICoE’s nurses so unique and special. She says, “our nurses are always striving to do their best and it shows.” 

LCDR McLellan joined the NICoE in 2010, before patient care had even begun. Before arriving, she thought she had done it all. She had experience in psych, cardiac critical care, med-surg, and labor and delivery. Working at the NICoE, however, is like no other experience she’s had. She expected to work with her team to better understand the complexities involved in the care of service members dealing with TBI and PH-related conditions. Once here, however, LCDR McLellan has also had to function outside of her comfort zone—a challenge she is willing to embrace. 

“I am grateful for my job and I am passionate about my work here,” she says. This passion drives LCDR McLellan’s focus, empowering her team, helping them to succeed and serving as a resource to them. While the day-to-day may not always be easy, the overall goal for her team is constant, rewarding and dictates their actions every day. 

“We are the bridge between our patients and our doctors,” LCDR McLellan said, “and what we do matters.”