Preface
Students take NURS 801 Roles and Responsibilities for Transforming Practice as part of Old Dominion University’s Doctor of Nursing Practice program. The course’s major assignment is developing one’s Strategic Plan. My submission has been adapted to fit this portfolio’s Five-Year Plan.
Personal Philosophy
Growing up as a first generation Filipino-American to immigrant parents, I did not have health care insurance as a child. If there was a service I needed, my family either had to save for it or I only accessed the health system in an emergency. My parents owned a small business and any time I was not in school, I helped them with their daily operations. As I entered high school and observed my older brother traverse collegiate studies while working a full-time job and helping my parents at the business, it was apparent that I needed a scholarship or sponsor of some kind to study.
Enter the Air Force. I was offered an Air Force Reserve Officer Training Corps (AFROTC) high school scholarship which covered full tuition and provided a monthly stipend for living expenses. Including the grants and other scholarships I received, I was able to afford my undergraduate nursing degree at the University of Florida. After graduating, I entered active duty and have serve nearly 12 years thus far. My service has consisted of two overseas tours and one contingency deployment to Afghanistan where I had a near death experience.
Collectively, as one needing to work for everything that I have, I have been described as a hard charging, dedicated, and innovative individual. My nontraditional childhood taught me a good work ethic and the Air Force further enforced integrity, selfless service, and excellence as its Core Values (United States Air Force, 2022). As mentioned earlier, I was almost killed by indirect fire (a mortar round) walking to dinner. It left me with some post-traumatic stress disorder symptoms, but I have learned to manage them better with the birth of my first son being the catalyst for my change in thinking.
The last component influencing my personal philosophy is my current unit, the Defense Health Agency (DHA). The 2017 National Defense Authorization Act authorized the DHA was Charged with overseeing health care delivery in the Army, Navy, an Air Force, I have observed incessant bureaucracy and ignorance impede transition efforts affecting 9.6 million beneficiaries with my family being some of them. With the unique working conditions and occupational hazards military members face, I consider those in uniform a vulnerable population.
Therefore, my personal, professional philosophy is to be a decisive steward for those entrusted to my care. To get at it, I will use my education and training as a clinical nurse specialist (CNS) to usher in evidence-based practice (EBP) and execute sound project management skills to facilitate practice changes. I strive to conduct myself with poise and confidence, treating my patients and peers with respect and taking time to encourage their self-worth.
Legacy Statement
I want to be remembered as “that guy” that clarified the Disease Manager’s role in the Military Health System (MHS), and effectively tied it to readiness. Traditional patient education techniques are not controlling chronic medical problems and the Disease Manager is the misunderstood, incorrectly utilized solution that is already embedded in the facilities. In optimizing disease management programs across the MHS, we can decrease the number of military members suffering from chronic medical problems and their associated symptomology. One doesn’t sacrifice 20+ years for their country to spend their retirement in and out of the hospital. This is preventable and the Disease Manager is a key to that. The legacy I leave behind will pave the way for holistic, integrative medicine to become more commonplace in the MHS. There are already success stories outside our gates. Why not bring these benefits within?
Vision Statements
My 5-year vision has me as a Chief Nurse or Squadron Commander (COO-equivalent) at one of the military medical treatment facilities (MTFs). In this influential position, I want to lead nursing services or my department in delivering quality health care to our empanelment emphasizing patient safety, quality, and staff satisfaction. This requires considerable risk and growth as the number of personnel I’d be responsible for would near the 70s at a smaller facility and into the hundreds at a medium to large facility. It is this opportunity where I can mentor my staff, nurture their strengths, and improve on the weaknesses to improve outcomes.
My 10-year vision has me either still on active duty as 1) a Command Nurse, the Chief Nurse Officer (CNO) for several MTFs analogous to a regional CNO, 2) the Medical Education and Training Campus (METC)’s Commandant (University President-equivalent), or 3) retired from active duty pursuing a career in academia. I anticipate my passion for chronic care management may take a backseat if I assume more senior military positions, but either way, I want to support our next generation of nurses as they start their careers and provide that introduction to holistic nursing sooner. COVID-19 has taught us the importance of resilience and by taking care of ourselves, we can continue taking care of our patients.
Why
The whys that fuel my vision statements are love of learning, community, and zest for life. I was/am not the best student, but I do enjoy learning something new and different methodologies because not each patient (or aspect of life) is different. There are typical treatments but thinking ahead or differently can help that person who may feel unheard. I believe patients with chronic medical problems sometimes feel like they are a burden, but it’s the system that perpetuates this feeling, i.e., 20-minute appointments, patient quotas, etc.
I am so happy I got into nursing. I did not know if I’d like it. I just declared it as my major because my parents told me to. Even after getting into nursing school, I wasn’t sure. But after that first clinical day, I knew nursing was for me. As I retire from active duty service, I plan to pay it forward by becoming a nursing instructor. I find it so rewarding to share my experiences and give the youngsters the confidence that I didn’t have.
Lastly, my zest for life releases any restrictions or inhibitions. I set my mind on something and I’ll achieve it – one way or another. I think therefore I am not ashamed nor intimidated to speak up or voice my opinions. Learning to advocate for oneself is important not just in nursing but in life. Nobody is going to care more about one’s career or personal life then themself. Not to be construed as careless, but this zest is the energy to embrace whatever’s thrown my way with optimism.
Mission Statement
My mission is to become a holistic nursing pioneer in the MHS to impact the lives of our uniformed service members and their families, and our retirees and their families by elevating disease management to be a pinnacle partner in the Patient-Centered Medical Home.
Core Values
My core values are family, integrity, helping others. My family motivates me to do better. Any accomplishments and achievements I make ultimately benefit them while I am serving in the military. Extending from the Air Force Core Values, I prioritize integrity because it’s essential. To do the right thing when nobody is looking, it drives work ethic, honesty, meaningful work, trust, and equality. Lastly, in executing my mission statement, it helps people. Nursing, along with the entire health care system, works to help people. I find this a cornerstone to our profession.
Transition to Strategic Plan Introduction
As I contemplate how to execute my strategic plan, I reflect on my mission and vision statements. My mission is to elevate disease management (DM), or nurse coaching, to a recognized and trusted nursing specialty within the Air Force Medical Service (AFMS). In order to achieve this, I have several visions in the next 5-year and 10-year increments. These include becoming a Chief Nurse or Squadron Commander (COO-equivalent) at one of the military medical treatment facilities (MTFs), and serving as a Command Nurse or METC Commandant.
Goal 1
By 2028, I will be selected for Chief Nurse or Squadron Commander (Sq/CC). This is a milestone position that will provide critical experience for future positions in the military and outside. To oversee nursing services requires leadership, interpersonal communication, and emotional intelligence skills that are beneficial in positions of increasing responsibility, therefore, it’s on the timeline for personal and professional development. This addresses AACN Essentials Domains I, II, III, IV, V, VI, VII, VIII, IX, and X and Interprofessional Education Collaborative (IPEC) Competencies 1, 2, 3, and 4.
Objective 2a. By January 2027, I will be prepared for the Lieutenant Colonel (Lt Col) board. For AF Nurse Corps officers to retire from active duty service who did not have prior nursing experience before joining the military, selection for Lt Col is a mandatory requirement. Since retirement and all the accompanying benefits are vital for my family and life after the military, this objective is a must-do.
Strategy 1. By May 2024, I will earn my Doctor of Nursing Practice (DNP) degree. Interestingly enough, the Chief Nurse and Deputy Chief Nurse of the AF Nurse Corps do not hold DNPs or commensurate doctoral degrees. I think it’s important for our representatives to be academically prepared and role models for the junior and subordinate staff to follow. The Army and Navy places significant value in holding the doctoral degree, therefore, to be on par with them, I think it’s important to have the DNP. Since few there are not that many DNPs within the enterprise, it will differentiate me from my peers and increase my competitiveness.
Strategy 2. By July 2025, I will complete my Flight Commander tour successfully. One of the expectations to promote to Lt Col is to serve as a Flight Commander at least once to demonstrate the ability to lead people. This is analogous to being the nurse manager or head nurse for an inpatient unit, department, or clinic in the civilian health systems. Success is subjective, but the AF expects process improvements, improved metrics, and staff achievement, such as promotions, awards, and other recognitions. I will start at the Pentagon as the Fight Medicine/Special Missions and Auxiliary Clinic Flight Commander where I will oversee clinic operations, five providers, eight nursing staff, and four ancillary staff. My focus will be on increasing efficiency, capability, and staff satisfaction.
The AFMS’s Total Nursing Force (TNF) mission reads, “Develop an empowered, innovative, and ready [TNF], advancing [EBP] to optimize health and human performance” (United States Air Force, n.d.-c). Combining these two strategies, I can use my position of authority and education to promote that spirit of inquiry. Understanding that EBP is not exclusive to nursing, I plan to elucidate the benefits of EBP to my multi-disciplinary team I will oversee which includes medicine (physicians and physician assistants), emergency medical services (EMS), pharmacy, health care administration, and laboratory (National Association of Clinical Nurse Specialists, 2023; IPEC, 2016). Projected to lead Pentagon Flight Medicine, which is a primary care clinic, this is the perfect opportunity to identify areas and processes for improvement, and let the evidence to lead our clinical practice while incorporating expertise and patient preferences.
For example, access to care is always a hot item for leadership. Looking into some of the clinical practice guidelines, I plan to work with the interprofessional team to find alternative ways to open access. Approaches include working with the health care administrator to assess scheduling templates, possibly using group appointments to our advantage. Additionally, I am interested in identifying an acceptable list of over-the-counter medications our flyers can receive through the pharmacist versus booking an appointment. For standard coughs and colds that are self-limiting, providing symptom support in this manner will create more provider availability, maximize each team member’s skills, and increase patient satisfaction (IPEC, 2016).
Strategy 3. By December 2026, I will have attended Air University’s Leadership Development Course for Squadron Command at Maxwell Air Force Base (AFB), Alabama. Individuals that have been identified as high performers with potential to serve as a Sq/CC are recommended by the installation commander to attend this course (United States Air Force, n.d.-b). Given that my next assignment will play a crucial role in promotion, career advancement, and vectoring, if I am sent to the LDC, it sends a message that I am competitive for Lt Col.
Objective 2b. By January 2027, I will increase depth and breadth of my assignments by venturing into population health, global health, or legislative affairs. Medical Group Commanders (MDG/CCs) will hire a Chief Nurse and/or Sq/CC that has a diverse portfolio of assignments that adds to the Executive Committee, or C-Suite.
Strategy 1. By December 2024, I will submit an application to become a Defense Institute for Medical Operations (DIMO) Instructor. To support partner nations (PNs) to develop their internal capabilities and capacity, DIMO can provide didactic and hands-on training to foreign militaries. Instructors are not permanently assigned to the DIMO, therefore, they rely on subject matter experts from the Services to provide the instruction. This will increase my experience providing formal education and training to diverse populations, which is an important skillset the Chief Nurse or Sq/CC to lead and oversee. This will challenge my teambuilding skills as I will have cultural considerations to be mindful of.
One of the benefits of being a DIMO Instructor is that my subject matter expertise can be shared with the various health care professional that are attending. Furthermore, the students are from PNs, so roles may change despite being in the same profession. For example, nursing capabilities in the United States are quite advanced comparatively. Nurses in other countries may serve a more subservient role to physician, whereas interprofessional collaboration is emphasized in the United States; each professional has their role to play. This role delineation is not intended to demean or downplay one’s contributions, but rather highlight them. This increases mutual trust and respect between professionals, ultimately benefitting the patient (IPEC, 2016).
Strategy 2. By July 2025, I will be competitively selected by the developmental team for a professional development opportunity. I am currently in my career timeline where I am eligible for another fellowship, advanced academic degree program, or professional military education program. This may translate to a Global Health Engagement Fellowship, Legislative Affairs Fellowship, Master of Public Health program at the Uniformed Service University for the Health Sciences, or attending Air Command and Staff College for a year at Maxwell AFB, Alabama. Selection for any of these positions will increase my marketability and competitiveness for Chief Nurse or Sq/CC as I will have yet another perspective I can bring to the MTF. One of the limiting factors will be where my children are at in their development. Since both have special needs, I may not be able to compete for some assignments due to the local area not being able to support my family’s educational and medical needs. My family is important to me, so to mitigate, I will only apply for those opportunities that are supportive of special needs families.
Strategy 3. By December 2026, I will upgrade my current Familiarized International Health Specialist (IHS) SEI to an Enabled IHS SEI. I am interested in global health engagement and since we will rely on our PNs for support and assistance during the next “fight,” manmade or natural, it is imperative we build partner capacity. This will require attending more Formal Training Courses to increase my cross-cultural competencies and supporting boots-on-ground activities, such as training events, humanitarian assistance, exercises, and disaster response. Not many Service members can offer this capability, so to provide this to my hiring authority will be another feather in the cap for consideration. I have taken the Defense Language Proficiency Test in both Spanish and Tagalog, but I could improve. I will have to practice speaking these languages more to grow these skills so I can work with those PNs.
Goal 3
By 2033, I will serve as a Chief Nurse or Sq/CC at a larger facility, an MDG/CC, or even a Major Command (MAJCOM) Nurse. Alternatively, by 2031, I will be retired from military service and embarking on a new journey. This addresses AACN Essentials Domains I, IV, V, VI, VII, IX, and X and IPEC Competencies 1, 2, 3, and 4.
Objective 3a. By 2033, I will promote to the rank of Colonel (Col). The rank required to serve as a Chief Nurse or Sq/CC at a larger facility, MDG/CC, or MAJCOM Nurse is Col. No exceptions will be made so it is critical steps are taken to increase chances for promotion to Col.
Strategy 1. By December 2028, I will complete Air War College (AWC) via distance learning. AWC is described below:
The [AWC] distance learning [(DL)] program is a senior developmental education (SDE) program. The AWC DL curriculum is based on the five core areas central to all levels of professional military education—leadership, profession of arms, warfighting, national/international security, and communication studies. As an Air Force SDE program, AWC DL provides a strategic, “air-minded” curriculum that prepares graduates to provide strategic leadership, appropriate expertise and critical thinking in support of national security objectives. (United States Air Force, n.d.-a)
For those selected for Lt Col, it is expected that AWC will be completed prior to meeting the Col Promotion Board. Without AWC completion, selection for promotion to Col is statistically highly unlikely. Anecdotally, I have heard AFMS officers have difficulties with the content because it includes Line of the Air Force content that we do not routinely address, such as command and control and rapid global mobility; we are traditionally concerned with delivering the healthcare benefit. Identifying a study buddy will be helpful to keep on track with course deadlines and motivation. One of the suggestions I have received from my mentors is to consider having a study buddy from a different profession, such as physician, dentist, health care administrator, or allied health professional. This is to challenge the status quo and approach the coursework’s problems with different perspectives. Nurses are traditionally direct-patient care providers, but when faced with multi-domain operations or tasked to develop a joint task force course of action, we can be short sighted. This is a perfect chance to network with our medical planners, logisticians, and other health care administrators to provide the operational perspective to complement our clinical skills (IPEC, 2016). The end goal remains the same, but my fostering a cooperative, collaborative environment, we can achieve our mission. The policies and requirements we establish will be comprehensive and all-encompassing, versus short-sighted, garnering the buy-in from stakeholders on the front lines.
Strategy 2. By August 2030, I will complete Duke University School of Nursing’s Post-DNP Executive Leadership Specialty (ELS) Certificate. I decided to enroll in Old Dominion University’s Advanced Practice DNP concentration versus their Nurse Executive because I was completing the Adult-Gerontology Clinical Nurse Specialist Post Graduate Certificate. As a new APRN, I wanted to enhance my clinician skills to support my professional growth. I felt somewhat vulnerable to hold an APRN license when after graduation, I would not be in a CNS position. To compensate, doctoral studies focusing on advanced practice was my countermeasure. At the end of my career where I will serve as the Chief Nurse or Sq/CC of a larger facility. MDG/CC, MAJCOM Nurse overseeing nursing practice for several MTFs, or METC Commandant, I think it’s imperative to get formal Nurse Executive education. The AFMS is a dynamic health system and balancing civilian and military perspectives is challenging. This program will help bridge any gaps.
Strategy 3. By May 2031, I will successfully serve as both a Chief Nurse and Sq/CC. In the context of military promotions, promotion is potential to serve at the next rank. Therefore, to determine fitness and readiness to serve as a Col, has the member served in senior leadership positions that warrant the promotion? Although there are several, other opportunities for Lt Cols, members that have served as a Chief Nurse and/or Sq/CC, particularly Sq/CC, have increased likelihood for promotion to Col. Commanding is the epitome of military service, therefore, heading into the Col Promotion Board, these milestones will facilitate selection and ultimately vectoring into higher leadership positions.
As mentioned previously under Flight Commander, Chief Nurse and Sq/CC success is determined by objective and subjective measures. At the end of each year, a climate survey is administered to determine the health of the unit. Commanders oversee several units or work centers, therefore, the responses are from the multi-disciplinary staff. Additionally, some of the questions can be personalized to the command team. This gives us the chance to reassess some of our interventions, such as morale, team building, an atmosphere of inclusiveness, etc. Often times, a question about staff satisfaction is included so we can improve empowerment, raise autonomy and self-worth, and decrease attrition. It is these emotional intelligence items that if focused on can positively influence patient outcomes (IPEC, 2016). If I can create the ideal workplace, then the staff will enjoy coming to work versus feeling obligated.
Objective 3b. By 2031, I will retire from active duty military service and prepare for transition into civilian life.
Strategy 1. By January 2031, I will apply for and be accepted for a Department of Defense (DoD) Skillbridge Program. To allow transitioning Service members acquire civilian work experience, companies will sponsor a veteran to receive industry training, an apprenticeship, or internship (DoD, 2023). I will seek a program through a college, university, or health and wellness center to grant me academic or clinical experience. This will provide me with recent work experience that can be exported to a full-time, part-time, or as needed nursing faculty position. If academia is not possible, the health and wellness center will posture me for clinical practice. Multiple options will be considered because it is unknown what companies will be available in 2031. Depending on the economy and/or global environment, e.g., COVID-19, opportunities may be limited so I need to be flexible.
Strategy 2. By August 2031, I will earn my Certified Nurse Educator (CNE) credentials to further position myself for academia. I think health care providers make for excellent clinicians, but sometimes these skills do not translate to academia. Educator competencies are not inherent in medical school, nursing school, etc., therefore, delivery of instructional materials can fall flat if the instructor does not have the personality to facilitate learning. By going through a formal program, such as ODU’s Nurse Educator Certificate, one will receive the didactic instructions and hands-on practice to be a better instructor and faculty member.
Health professions education is multi-disciplinary and requires formal education and training to be executed effectively. There are excellent clinicians, however, they lack can lack the temperament to share their expertise for others’ educational benefit. Although specific to nursing, nurse educators can be force multipliers. Curriculum development, facilitation basics, and classroom instruction is universal, therefore, having this additional credential is a benefit for the health professions, not just nursing. Nurse educators can bridge training gaps affecting the multi-disciplinary team. Professional development topics are a perfect example where nurse educators can facilitate discussions, open circles of dialogue, and reflection so that the team better understands each other (IPEC, 2016). Clinical topics delivered as a commercial-off-the-shelf product, such as Advanced Cardiac Life Support, are an excellent way to work with others from various departments to validate competency and network.
Outro
As with any plan, things can change. The above goals, objectives, and strategies can shift depending on current work/life balance, personal circumstances, and my family. At the end of the day, the next five years look bright and I look forward to meeting the goals I’ve set for myself.
References
Department of Defense. (2023). What is Skillsbridge? https://skillbridge.osd.mil/program-overview.htm
National Association of Clinical Nurse Specialists. (2023). Core competencies. https://nacns.org/resources/practice-and-cns-role/cns-competencies/core-competencies/
United States Air Force. (n.d.-a). Air War College (SDE) distance learning program. Air University. https://www.airuniversity.af.edu/GCPME/AWC/
United States Air Force. (n.d.-b). Leadership development course for squadron command. Air University. https://www.airuniversity.af.edu/Eaker-Center/CPDS/LDC/
United States Air Force. (n.d.-c). Total nursing force. Air Force Medical Service. https://www.airforcemedicine.af.mil/Media-Center/Fact-Sheets/Article/2972844/total-nursing-force/
United States Air Force. (2022). A profession of arms: Our core values. https://www.doctrine.af.mil/Portals/61/documents/Airman_Development/BlueBook.pdf