The picture windows in the new Rutgers School of Nursing–Camden building offer a broad view of the city of Camden and, just beyond it, the Benjamin Franklin Bridge leading into Philadelphia. For Kyle Jackson, that view is an apt metaphor for the path he’s embarking on. A veteran of the U.S. Army Reserve since 2014, Jackson SBC’18 is part of the first cohort of eight students enrolled in a new undergraduate program at the nursing school designed to train veterans to be nurses.

What makes the program special isn’t just its focus on veteran students, but also its intention to train those students to work with fellow veterans after graduation—in the community, where most day-to-day medical care is given. Jackson’s plan is to get his nursing degree and then cross that bridge to a position as a clinical nurse at the Veterans Affairs medical center in Philadelphia.

When Jackson learned of the program from a friend and an alumnus of the nursing school, he was taking prerequisite science courses at Rowan College in preparation for applying to nursing schools. The idea of working with other veterans, he says, “struck an emotional chord with me.” He’s not alone. 

“It’s not a requirement that our graduates go out into the community and serve veteran populations, but that’s our goal,” says Kevin Emmons, the program’s director and a veteran of the U.S. Army.  “Every time I talk to veterans who are interested in this program, that’s what they want. And they didn’t know they wanted it until they heard about it.”

The same might be said of the administrators at the nursing school when they learned, in January 2019, of a grant opportunity offered by the federal Health Resources and Services Administration (HRSA). Through a program with the impressively lengthy title of Nurse Education, Practice, Quality, and Retention—Veteran Nurses in Primary Care, HRSA was seeking something equally impressive: an accredited nursing school that emphasized community health care, had extensive experience with military veterans, and was therefore solidly placed to offer degree programs for veterans looking to work in primary care. 

The nursing school, it turned out, was perfectly situated to do just that. “Every piece that HRSA was looking for fit nicely into our mission and vision,” says Emmons CCAS’04, who lists among those pieces the school’s dedication to training nurses to practice in the community. Another essential piece was a long-held interest in meeting the needs of vets. In fact, Rutgers University–Camden was designated a Purple Heart University by the Military Order of the Purple Heart for its dedication to veterans, and the nursing school had already graduated a large number of  veteran students. Topping it off was  the fact that both Emmons and Donna Nickitas, dean of the nursing school, are nurses and veterans themselves. “I don’t want to use the word ‘kismet,’” says  Emmons, “but our role in this did seem  to be written in the stars.”

Interest in the program, known officially as Veterans Serving Veterans Nursing Fellowship Program, has been intense. A press release announcing its founding, first posted only on Facebook, generated scores of phone calls and emails from  veterans eager to know more. In its inaugural year, which began this fall, enrollment is limited to eight students, with the goal of enrolling a minimum of 12 students in its second year and at least 16 in its third. Judging by the response so far, there’s every reason to believe those minimums will be met and even exceeded. That’s because no one understands the unique medical needs of veterans—and the  barriers to getting those needs fulfilled—like veterans themselves. 

Veterans who’ve experienced active duty face a host of medical issues, both physical and emotional. In addition to visible injuries, more than half of returning veterans—including some 100,000 who fought in the Second Gulf War, an engagement that lasted from 2003 to 2011—report some type of chronic musculoskeletal pain in their backs, necks, shoulders, or knees. Veterans may also have been exposed to debilitating chemical toxins, from Agent Orange, the defoliant used extensively during the Vietnam War, to sarin, the nerve agent afflicting so many Gulf War vets. These toxins can cause serious illnesses, including heart damage, cancer, and memory impairment. Veterans in large numbers are also subject to traumatic brain injuries, which between 2000 and 2018 affected nearly 384,000 service members, according to the Department of Defense. And because they’re often posted overseas, they’re far more likely than the American public to be exposed to infectious diseases.

And then there are the mental and emotional ailments that plague so many vets. One in five veterans who served in Iraq or Afghanistan, for instance, suffer from major depression or post-traumatic stress disorder. In the larger military population, service members have to cope with the intense sense of isolation that can arise from prolonged periods of separation from home and family. Many have experienced trauma as a result of sexual assault perpetrated by fellow soldiers: in 2018 alone, 1 in 4 women and 1 in 100 men experienced military sexual trauma, numbers that are considered underreported. Health care providers need to be aware of all of these issues in order to accurately and effectively diagnose and treat veterans.

Unfortunately, many providers don’t know that they’re treating veterans, both because their patients don’t think to inform them and because those providers don’t think to ask. Several years ago, the American Academy of Nursing launched a campaign to educate primary care physicians to ask, of all their patients, “Have you ever served?” But the message may not be getting through. “I can tell you that Kevin and I have never heard those words spoken by our providers,” says Nickitas, a veteran of the U.S. Air Force.

Conversely, veterans may be reluctant to share medical information, especially if it pertains to mental and emotional challenges, which often carry a stigma for those in the military who pride themselves on strength and self-sufficiency. And sometimes, that reluctance is practical: “Service members,” says Emmons, “are afraid to report mental health issues because they may believe that they will be discharged or disallowed to continue their military training if they seek care for mental health.”

That’s one of the many reasons that only 30 percent of all veterans get their health care through the Veterans Health Administration (VHA); long wait times are another. And if they’re not getting care through the VHA, they’re probably seeking it in the community, where they’re unlikely to find care specialized to their particular needs.

When veterans treat veterans, many of those barriers fall away, especially in the realm of primary care. That’s why the program is focused on nursing in a community setting—in a health care center or clinic, say. “We tend to think of nurses in a hospital setting,” says Emmons, but that’s not where most of us get the vast percentage of our health and wellness care.  

Veterans Serving Veterans aims to do more than just train veteran nurses. Emmons notes that it has three pillars, the first of which is to recruit, train, and support veteran students and encourage them to treat other vets in the community. The second, he says, is to update and improve the nursing curriculum as a whole to include the care of veterans so that all students are exposed to the needs of veteran populations. The final pillar is to educate a wide range of community- based providers on the best practices to apply to those populations, through educational programs, webinars, and other special events throughout the year.

Students in the program will also do their clinical rotations in the community. Emmons and Nickitas are working on partnerships with groups that treat veterans in an outpatient setting, among them Project H.O.P.E., which offers health care to the homeless; Home for the Brave, a transitional housing program for vets run by the Volunteers of America; Samaritan Healthcare & Hospice, which provides palliative and hospice care for veterans; and the Pennsylvania Veterans Affairs. “We’ll be one of the first nursing programs to work with the VHA in an outpatient setting,” Emmons notes.

The program has also been designed with special consideration for the sensibility of veteran students, who may face a variety of barriers to enrolling, and succeeding, in a nursing program. Some may have faltered in college before joining the military, and even though they excelled during their service, the problems they had in school could keep them from being accepted into other nursing programs. Some may have already used up their educational support through the GI Bill. And some will face difficulties adjusting to the relative lack of structure on a college campus. To deal with those potential hurdles, the program will consider military success along with academic success when deciding whether to accept a candidate. It will provide financial assistance when needed.

It will also offer more structure than the typical nursing program. Throughout the academic year, veteran students will receive mentoring and, if necessary, tutoring, including face-to-face time with Nickitas, Emmons, and Sandi Blood McKay SNC’18, who is the program coordinator and a veteran of the U.S. Coast Guard. At the end of the year, students will participate in a bridge program to help ascertain what assistance they need emotionally, academically, and, when applicable, physically.

Part of the support provided will be communicating to students how much they’re valued, to let them know, explains Emmons, “that we  appreciate their veteran contributions,” as well as the qualities they honed in the military, like tenacity, drive, and the will to overcome adversity. “We’re going to have to earn their trust so that they feel safe.” 

Although all students at the nursing school, veterans or not, go through the same curriculum, those enrolled in Veterans Serving Veterans will be required to spend a minimum of 150 hours working with vets in the community. It’s a way, Emmons says, “to leverage the bond that exists among all veterans.” Nickitas explains: “One of the things you get when you become active military is a sense of belonging, the sense that you’re part of something greater than yourself, that you’re part of a team and no one can step out. Because when you step out alone, you are alone.”

When that bond exists between caregiver and patient, Emmons says, it improves health outcomes “because it motivates a patient to improve his or her own personal health.” It also motivates the caregiver. As Jackson stresses, “I know no better group of people who can meet and exceed the standard the way my fellow veterans can.”