Nursing and the Air Force

It is no secret that nursing is having a crisis in retention of qualified nurses.  Perhaps other professions who have successfully resolved their retention problems can teach us something.  As an Air Force wife for fourteen years, I have had many occasions to witness the military way of doing business. 

While casual observers may disagree, the Air Force way is efficient at accomplishing its goal – our country’s defense.  Defense is  delegated to many missions, but for this illustration I will use the mission of the tactical fighter wings for my example.  Their mission is to supply fighter jets and pilots for defense.

As a registered nurse for six years, I have had many occasions to witness nursing’s way of doing things.  Nursing professes its main goal is delivery of quality patient care.  The delivery of that care is divided into many different specialties.  In each system, the Air Force fighter wing and the hospital nursing staff, the success in meeting goals is directly related to the performance of the leadership structure.

In correlating the fighter wing to the hospital nursing staff, the comparisons are simply stated:

Air Force                                              Nursing

Wing Commander                                 VP/Administrator of Nursing Services

Director of Operations                           Director of Nursing

Squadron Commanders                        Nurse Managers

OPS Officers (Operations)                     Assistant Nurse Managers

Standardization and Evals                   Staff Development

Fighter Pilots                                        Staff Nurses

Air Force and Nursing hierarchy and rank structures are similar.  In the Air Force however, from fighter pilots to Wing Commanders there is a fundamental and driving force that provides a common ground and mutual respect.  That force is the love of flying. 

They all fly, fly as much as they can, covet jets and flying time, manipulate schedules, leave families, stay up all hours and constantly test themselves for the sake of a few hours of jet time.  They are bureaucrats, administrators and educators, as well as pilots who innately crave to get back to what called them to duty in the very beginning – the need to serve, to fly, to defend their country.  And they succeed.

And what does nursing do?  Nursing promotes its best and brightest in a direction away from the bedside and keeps them in positions that do not always require them to provide clinical care.  It appears to diminish and undermine that which called nurses to duty in the very beginning.  That call to duty is to serve, to nurse at the bedside, to delivery the highest quality of patient care.  Nursing must now be careful not to take its best and brightest away from the bedside, but strive to keep them in a cockpit, at the bedside where they are most needed. 

Nursing leaders should guard against forgetting the basics and losing credibility with the nurses at the bedside.  And it is not enough to say, “I’ve paid my dues.”  or “I keep in touch.”  A true leader will nurse, will fly again, at the bedside no matter which shift, weekend or holiday, needs to be staffed.  Without this leadership we may lose sight of nursing’s goal and mission of delivering the highest quality of care.

The Air Force has learned its lesson.  It now offers incentives to its young pilots.  Huge sign-on bonuses, choice of assignments, more time to fly and less demand for paperwork have increased pilot retention.  These incentives encourage the best and brightest to stay in the cockpit where they want to be.  The Wing Commander, however, still flies, still experiences what his young pilots do and transfuses that fighter pilot spirit into his administrative mind.

Where’s the lesson for nursing?  Let’s glorify the bedside nurse again.  Compensate the nurse for the work that’s done, offer incentives to stay at the bedside, and decrease the paperwork so a nurse can increase the time with patients.  Nursing leaders should fly with their nurses at the bedside to give followers and leaders a common ground and mutual respect.  No nurse should be “beneath” direct patient care at the bedside.  It’s where every nurse began and every nurse belongs.

Ann Marie Land, MSN, RN, CRRN

Rehabilitation Educator, Riverside Rehabilitation Institute