Pulse
'We serve America's heroes'The Department of Veterans Affairs operates the largest integrated health care system in the nation — with 1,400 hospitals, clinics and nursing homes — and it's growing. Veterans returning from active duty in Iraq and Afghanistan are swelling the VA's patient ranks, which illustrates the importance of caring for those who have served overseas.
"We are seeing increasing demand for our services from veterans. We believe it is because they have heard good things about us from our clients," said Sandy Leake, MSN, RN, associate director for nursing/patient services at the Atlanta VA Medical Center in Decatur.
 Photos by BARRY WILLIAMS/Special |
| Mary Walker, a nurse case manager at the Atlanta VA Medical Center, talks with former Marine Cpl. Louis Washington about the Department of Veterans Affairs health care system. |
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| Physical therapist Judy Bickett works with Army Cpl. Hector Griego on an exercise to improve his functional mobility and range of motion. Griego was injured in an auto accident. |
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| Sandy Leake is associate director for nursing/patient services at the Atlanta VA Medical Center. |
"For a lot of years, the VA's system didn't work as well as it should have, but we have put changes in place, and we are increasingly recognized for delivering extraordinary quality care and at a more affordable price. Much of the increased demand comes from the perception of that quality. We are a system that has been radically transformed."
While the VA system made progress in the 1990s, recently it has come under fire for providing slow and inadequate care to returning troops at some facilities. Army Lt. Gen. James Peake, the new head of the Veterans Affairs Department, is in charge enacting 35 recommended changes made by a presidential commission last year. Some of the changes, such as aggressively improving programs for traumatic brain injuries and post-traumatic stress disorder, already are in place in Atlanta.
"I am most proud of the professional practice environment we have created," Leake said. "We have strengthened, evolved and elevated nursing practice here. We have the most talented team of professionals, and it's an honor to work with them."
A VA scholarship for health professionals — which came with a two-year service commitment — helped fund Leake's master's degree in nursing administration from Vanderbilt University, which she earned in 1989.
"I thought I'd meet that commitment and move on, but I was very surprised and incredibly overwhelmed by the tremendous satisfaction I found in working with veterans," she said. "We serve America's heroes, and that is the most satisfying career I could have ever wanted."
Since 1993, Leake has worked at the Atlanta VA Medical Center, one of the VA's largest and most complex hospitals. With 172 inpatient beds and 100 nursing-home beds, it provides primary, tertiary and long-term health care for veterans.
The Atlanta VA Medical Center also is a teaching hospital for Emory University, Morehouse School of Medicine and it collaborates on training programs with 33 other colleges and universities. Its research program is ranked 10th out of 120 VA research facilities.
Leake manages more than 600 nurses, who work in the main hospital and in community-based outpatient clinics in Athens, Lawrenceville, Oakwood, Smyrna and East Point. A new clinic is opening in Stockbridge.
Since Sept. 11, 2001, the Atlanta VA Medical Center has enrolled 5,900 veterans from the wars in Iraq and Afghanistan. Severely wounded soldiers first go to a polytrauma rehabilitation center. Then Atlanta's facility provides follow-up care or specialty services.
"We have been fortunate to have adequate financial resources to meet our growth, and despite the nursing shortage, our vacancy rates consistently outperform other hospitals," Leake said. "Our biggest challenge in Atlanta is space. There is no buildable space near the hospital."
Outpatient clinics work well with the holistic model of care, which the system has embraced. Primary care is the point of entry for most veterans, with doctors or nurse practitioners referring patients to specialty care.
"We strive to give the best-quality care anywhere, to maintain and expand services, and to make sure every veteran is satisfied," Leake said.
She has helped establish an outreach program that educates troops who are being deployed about services and checks on veterans who haven't come in for health care services. The hospital has enlarged its traumatic brain-injury services, Leake said.
For 15 years, the hospital also has been adding health care services for female veterans, including gynecology and mammograms.
"We don't normally deliver babies, but twice we had to rise to the occasion," she said.
"We treat the whole patient here. Many are with us from the time of their discharge and remain with us throughout their lives," Leake added.
'Great opportunity'
What first attracted Doris Spruill to the VA 30 years ago were the many nursing opportunities.
"I looked at all the areas of nursing within the VA and saw a good program that offered the best of everything to staff and the best care for patients. I saw great opportunity here as a nurse," said Spruill, RN, BSN, MPH, nurse manager for the Atlanta VA Medical Center's physical medicine and rehabilitation unit.
Spruill was impressed that her supervisors encouraged education and upward mobility for nurses, but she almost left in the first year.
She missed caring for women and children, "but then I found a family atmosphere in the staff and patients who needed us. I loved that. The patients kept me here," she said.
The physical medicine and rehabilitation unit's mission is to help veterans return to civilian life.
The unit includes programs for pain management, traumatic brain injuries, physiatry, physical therapy and occupational therapy.
Since April 2007, the Atlanta VA Medical Center has screened soldiers returning from active duty in Iraq and Afghanistan for traumatic brain injuries, which can be difficult to diagnose and treat.
"We take a team approach to treating TBI [traumatic brain injury] patients and offer one-stop shopping to provide all the services a patient needs," Spruill said.
Physical wounds aren't the only source of suffering for combat veterans. Short-term memory loss, exposure to shock waves, behavioral issues and problems reintegrating into their families can affect many soldiers returning from war.
Spruill's role is different from that of nurses who work in acute-care settings, but she loves talking with patients and seeing them progress.
"I think I'm good at winning them over," Spruill said.
'A special rapport'
So is Mary Walker, BSN, RN-BC, a nurse case manager at the Atlanta VA Medical Center. A veteran of the Navy Nurse Corps who served three tours during Operations Desert Shield and Desert Storm, she brings an insider's perspective to her clients.
"Our goal is to provide a seamless transition for these veterans back into society, and I feel a special rapport with my patients," Walker said. "We want to meet their psycho/social, medical and social needs, which can include helping the homeless [veterans] find employment or helping veterans learn about all the benefits and resources [that are] available."
Walker's team manages follow-up care for injured veterans and uses a fully integrated electronic medical-record system, which has significantly improved efficiency and care at VA medical centers.
Within 48 hours of a name's addition to her caseload, Walker begins calling to schedule an initial assessment.
She manages a client's services for two years.
"I had trouble contacting one young man and placed so many calls that his mother told him he better come see me," she said.
The man was exhibiting bipolar and paranoid/schizophrenic symptoms.
"He wouldn't make eye contact, but I just kept talking and listening," Walker said. "I spent eight hours with him, walking him to see people in other departments, and, before the day ended, he made eye contact and smiled.
"When I see him now, he talks with me. I know he trusts me, and that means a lot."