Major General Rank (2004–2008) served as the Deputy Assistant Surgeon General, Health Care Operations then Assistant Air Force Surgeon General, Medical Force Development, and Assistant Air Force Surgeon General, Nursing Services, Office of the Surgeon General, Headquarters United States Air Force, Bolling Air Force Base, D.C. As Assistant Air Force Surgeon General, Medical Force Development, she established new and appraised existing personnel policy and enhancement actions for more than 34,000 active-duty officer and enlisted medical personnel. As Assistant Air Force Surgeon General, Nursing Services (14th Chief, Air Force Nurse Corps), she created and evaluated nursing policies and programs for 19,000 active-duty, Guard and Reserve nursing personnel. She interacted with major commands, the Air Staff, other military services and the Joint Staff on nursing services matters to ensure the highest caliber of nursing care and personnel (U. S. Air Force Biographies) (Fig. 1). Figure 1. View largeDownload slide Major General Melissa Rank loading a patient during her last A/E flying mission while serving as Chief, Air Force Nurse Corps. Shortly after takeoff from Balad, the ambuses and ambulances were destroyed by an incoming enemy missile. Figure 1. View largeDownload slide Major General Melissa Rank loading a patient during her last A/E flying mission while serving as Chief, Air Force Nurse Corps. Shortly after takeoff from Balad, the ambuses and ambulances were destroyed by an incoming enemy missile. Major General Rank had nearly 32 years of healthcare leadership experience while serving in roles such as flight nurse, chief nurse, squadron commander, and twice as a group commander. During several assignments, she provided trauma care to wounded military services members and civilians from the USA and other countries. She continued to practice clinical nursing, even as the Nurse Corps Chief. She flew patient care missions and joined nurses at deployed locations in Balad and Balgram. Major General Rank believes that every leader should be able to “take the test”: to personally provide the same clinically competent, quality patient care that he or she expects out of subordinates. The interview content provided in this paper was gathered as part of a larger, Institutional Review Board approved study, to describe the careers, leadership experiences, and leadership lessons of the former Chiefs, Air Force Nurse Corps. The original survey was developed by Dr Lucinda McCray, Professor of History at Appalachian State University. An expert panel of executive nurses suggested modifications to the questions for appropriate use with Air Force executive level nurses, resulting in a total of 78 questions being included in the survey. Specific questions and responses that contribute to the purpose of this paper are pulled from the verbatim transcribed interview and written correspondence with Major General Rank to provide rich content about her experiences and her leadership recommendations through her own words. VH: “How did you see Air Force nursing developing clinically during your career?” Maj Gen Rank: “In-depth clinical expertise became more specialized, intricate and sophisticated over my 32 years as a military nurse. Care, 32 years ago, involved large bays or wards with a multitude of patients as far as the eye could see with only one nurse and an aide to care for all of them or 4–5 very critical intensive care unit patients with only 1 registered nurse and one nurse’s aide to care for them. Over the years, our expertise has resulted in the development and implementation of evidence-based practice guidelines. We have shown that we can measure the outcomes of our patient care, manage high-risk populations, and provide case management services. We functioned in increasingly complex and demanding nursing roles in the nation’s evolving health care delivery system. The research literature at the time was abundant with data supporting improved patient outcomes, shorter hospitalization, greater patient satisfaction, and reduced patient mortality because of our nursing care. In addition, the medical team moved closer to the front lines of the battle. The injuries that we encountered in two major theater wars were devastating wounds delivered from explosive devices. Yet, the mortality rate from these combat injuries was less than in any previous war, from 23% in Vietnam to 10% or less today. At the Air Force Theater Hospital in Balad, Iraq, we had a 98% survival rate. This success is due to dramatic improvement in trauma care, but is mostly due to the fact that our critically injured receive one-on-one, around-the-clock care from highly trained and dedicated medics.” VH: “What has not changed during your career?” Maj Gen Rank: “What hasn’t changed over my military career is the extraordinary dedication, courage, and skill of those we call “Airmen” which has remained constant. Airmen deliver for the nation every minute of every day. Nursing’s value in the federal services and to the nation is that it is a clinical discipline that is also a 24/7 operation delivering minute-by-minute care.” VH: “How did you see nurse leadership developing throughout your career?” Maj Gen Rank: “Leadership roles have evolved over the past 30 years from being the charge nurse of a busy inpatient unit, nurse manager of a bustling outpatient clinic or chief nurse of a medical treatment facility to become a squadron and group commander in peace and in war settings. Nurse leaders operate in settings that require greater independence, flexibility, critical thinking, creative problem-solving, and reasoned decision-making than we ever had been faced with in the past. Over the years, we became even more cognizant of anticipating an impending crisis and taking actions to end the crisis or minimize the damage.” VH: “What were some of the most painful lessons that you learned during your military career?” Maj Gen Rank: “It was very difficult to witness the carnage of war and the serious wounds our troops suffered and had to endure the rest of their lives. In addition, realizing that mistakes will happen that cause the loss of life. It is difficult to guide a unit though such mistakes without laying blame. But it is most important to find solutions to prevent the mistake from happening again and to help the unit bounce back from failure. It is important for a leader to accept criticism with poise, calmness and grace. It is important to maintain balance in my life when the stress was overwhelming. The pillars of balance in my life include: Faith, Family Fun, Friendships, Fitness, My Profession, and Nutrition. Abandoning these pillars cause stress to rise and physical health to decline.” VH: “What did you consider your best leadership attributes?” Maj Gen Rank: “I always realized that nursing’s value is as a clinical discipline. Clinical practice is what we do and who we are. I felt compelled and had a sense of urgency for us to reclaim our clinical domain in nursing. I desired all nurses to be able to “take the test” and demonstrate their clinical competence. I encouraged nurses to not lose touch on nursing issues or the latest in nursing technology. I did not want our nurses to loose contact with the nursing staff or forsake our patient contact with the emergence of computers in the patient rooms and in the nursing station. As I took on greater roles, I willingly accepted the blame for the entire organization although I may have had only a tiny part in the failure. I did not blame subordinates knowing there would be no way to regain and re-earn their respect. I did not serve my own ambitions or my own ego. I served others and devoted my time to serving them.” VH: “What words of wisdom or lessons would you like to communicate to the next generation of nurses?” Maj Gen Rank: “It is vital that nurses demonstrate caring. Care for the emotional, spiritual, psychological and medical needs of the patients. The nurse who invests his or her intellect, expertise, and emotion into the patient creates a therapeutic, welcoming environment. Actively engage with the patient and family in decision making while appreciating their uniqueness to foster trust, respect, caring and enthusiasm from the patient about his or her health. Be an advocate for the patient. Verbalize the patients’ needs and feelings to the rest of the multidisciplinary team. Build patient trust by being the staff member whose duty it is to ensure the patients get the best available nursing care. Be the patient’s liaison and link them to other staff members. Glean valuable and critical information from patients in a caring fashion and pass it on to staff who need to know this information. Partner with patients, relatives, and significant others. Nurses, as an equally important component of the health care delivery, need to engage in greater dialogue and promote understanding within the multidisciplinary team partnership. The multidisciplinary team roles complement each other. The team should attend continuing education together and conduct more grand rounds together. Nurses need to lead patients to health with compassion, intelligence, and competence. Everyday nurses lead a multitude of patients to well-being. Inspire young officers and technicians to maximize their abilities. Senior nurses are in position of knowledge and experiences in life that young nursing staff need to learn and emulate. Spark the ethos of caring. Pass on the passion for nursing and serving in the military. Share experiences that exemplify the essence of nursing and the art of compassion. There has been an incredible emphasis on nurses as leaders in administration, education or policy. Clinical leaders are vital to the advancement of the profession. Wise senior clinical nurses should strive to guide novice nurse officers, which is the essence of mentoring. Push them on to perform and live at a higher level. Help them understand the big picture. Identify, attract and support talent as it is essential to our survival. Senior nurses need to acknowledge our responsibility to encourage not discourage young nurses. Demonstrate the ability to practice safely and effectively. Fulfill your professional responsibilities within our scope of practice. A sound underpinning of theoretical knowledge is paramount. Obtain certifications as a hallmark of your clinical competence. Follow clinical guidelines as they guide patient care, patient outcomes, protocols, and clinical supervision. Stay up-to-date on research that focuses on patient outcomes, patient compliance, family involvement in patient care, interdisciplinary team building, improved efficiencies, and cost containment. Search for different and better ways to practice nursing. Hold a vision for the organization that is intellectually rich, stimulating, and rings true. Continue the journey to nursing excellence.” VH: “What do you consider the most valuable leadership skills for any nurse leader?” Maj Gen Rank: “Showing and teaching how to competently care for patients and each other by a clinician guiding a novice. Helping others maximize their abilities and understanding who they are. Helping them see the big picture. Expand and validate nursing’s values and skills. Mentoring promising candidates for leadership or face the chance that we will lose them to disappointment and exhaustion. I strongly believe effective mentors made the difference between those who decided to leave military nursing or stay and build a satisfying career. For nurses alone, I also strongly believed that as our recruitment and retention crisis loomed across the nation and in the federal services, strengthening our mentoring connection at every level of the profession was the linchpin. Identify, support and keep talents. Guiding, encouraging and mentoring were paramount. Have a backbone and exercise strength of character by taking a positon on important issues. Don’t postpone joy. Congratulate publicly those who have accomplished the extraordinary. Watch over those vital intangibles called morale and esprit de corps. Do not spend too much time with malcontents. Devote time to those seriously contributing to the mission. Ask for exceptional performance and you will get it. Anticipate impending crisis-look around corners. Anticipate and take actions to end the crisis or minimize the damage. Protect innovators- well over 50% of their ideas may be awful but among the “non-starters” will be pearls of wisdom. Encourage them to present all of their ideas and put the great ones into action. Praise those effusively who moved from competition to cooperation. Encourage those who find solutions that reconcile the opposites. Thank the invisible people who are working so quietly and competently that they often go unnoticed.” VH: “What role model influenced your development as a leader?” Maj Gen Rank: “I served under Colonel William Rew, 20 FW/CC at Shaw AFB, SC. He knew how to administer discipline with compassion. He was committed to all of us as individuals and as a whole. He encouraged the heart by engaging fully and supported and encouraged all of us along the way. He set high standards not mediocre ones. He helped us to see how our role at the Medical Group contributed to the overall effectiveness of the Wing.” VH: “What were some of the lessons that you learned from your role model?” Maj Gen Rank: “I learned that daily communications made a difference in the overall daily operations of the unit, group, and wing. Knowing what is going on down within the units in an organization pulled everyone together. The leadership did not enforce rules and standards selectively. They did not look away to avoid facing a difficult problem. The leadership administered discipline fairly and avoided favoritism. He transformed the unit by teaching the real meaning of values of the organization and proclaimed the organization’s enduring values.” VH: “What was your greatest challenge during your tenure as Corps Chief?” Maj Gen Rank: “Clinical Skills Sustainment. Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, two major theater wars were occurring simultaneously. Thus, ensuring clinical competency of nurses and enlisted was paramount. Accepting fully our obligation to provide quality nursing care to our communities and to the patients entrusted to us. Recognizing completely the importance of maintaining clinical competencies and encouraging professional growth among our nursing staff, whether in, a medical center, a field hospital, humanitarian operations, or aeromedical evacuation setting. Learning how we provide our best evidenced-based nursing care to our countrymen in times of peace or disaster, to provide humanitarian aid to our friends and allies in need, and to provide humanitarian assistance to other countries caused by natural disasters. The best way for our nursing personnel to maintain currency and be effective in deployed or humanitarian settings is to have hands-on experience as inpatient nurses. In 2006, I released a policy mandating nurses working in outpatient and non-clinical roles complete 168 hours of annual training on inpatient units. This new policy ensured nurses had adequate opportunities to maintain operational clinical currency. Air Force Chief Nurses embraced bringing clinicians back to the bedside and we established over 50 training affiliation agreements with civilian and federal facilities to expand our training platforms.” VH: “What was your contribution to the flight path, the development of the clinical leader?” Maj Gen Rank: “It truly began with Brigadier General Sally Wells. It helped the nurse who was not the best nurse manager to stay at the bedside and still be an advocate for the patient. That was the clinical pathway.” “The overarching goal of the Flight Path was to guide more deliberate development for AFMS officers and senior enlisted, place the member in the right job at the right time, set them up for career success and personal satisfaction while maintaining expertise at the frontlines of patient care. Its intent was to develop a streamlined, consistent Medical Group structure from Clinic to Medical Center that provided a ready and fit force for the Air Expeditionary Force; reward military and functional competence; provide a medical power projection platform to deploy medics forward and provide high quality, cost effective care. The Flight Path fostered corps-specific force-development, requirements-driven leadership opportunities, balanced leadership teams with the Medical Treatment Facilities, compliance with military and civilian certification requirements, and cost-effective mission support at home and when deployed.” VH: “What do you consider the most valuable leadership skill for a successful Chief, Air Force Nurse Corps?” Maj Gen Rank: “The most important skill for leaders is listening. Listen to what’s being said rather than thinking about what should be said next. Do not get caught up in the credentials on the wall and in your biography because it may not mean that the Chief Nurse is a good, decent person. Be clinically competent yourself for why should others go where you wish to take them if the Chief Nurse is not clinically experienced. Hold the Air Force Core Values near and dear to your heart”. “Curtis Lemay, one of the Fathers of the United States Air Force said: “Saving lives is the most courageous form of heroism I know”. I have found Lemay’s words to be true after almost 32 years of serving my country. Serving and helping others in a cause that is greater than myself is what matters”. VH: Thank you Major General Rank for sharing some of the valuable leadership lessons that you have learned during an incredible 32-yr career as a Nurse Corps Officer and executive leader. We are grateful for your service to our nation and your continued service to our communities. Major General Melissa A. Rank Biography. Published on U.S. Air Force Biographies website: http://www.af.mil/About-Us/Biographies/Display/Article/104628/major-general-melissa-a-rank/Accessed February 25, 2018. © Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Military Medicine – Oxford University Press
Published: Jun 28, 2018
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