Nursing in a TriService Environment


Name: Matthew Rivera

Rank: ENS, USN

Organization: Henry M. Jackson Foundation

Performance Site: Walter Reed Army Medical Center, Washington, DC; National Naval Medical Center, Bethesda, MD; Malcolm Grow Medical Center, Andrews AFB, MD

Year Published: 1997

Abstract Status: Final


ABSTRACTNursing in a Triservice EnvironmentPURPOSE: The purpose of this study was to describe qualitatively how nursing personnel experience working in an environment where more than one branch of military service is represented, i.e., Army, Navy, Air Force (Triservice). Subquestions addressed the experience for middle managers; the specific nursing unit; the military service; and the rank/status of staff.POPULATION/SAMPLE STUDIED: Participants included active duty military and civilian nursing personnel (n=77) purposively selected from one of four Triservice inpatient nursing specialty units (Psychiatry, Neurology, Pediatrics, and Maternal Child), at military medical treatment facilities representing each of the three services. Data collection began in September of 1997 and was completed in June 1999.DATA COLLECTION METHOD(S): This study used a descriptive exploratory design combining rounds of focused individual and group interviews of nursing personnel describing their experiences of working in a Triservice environment.METHODS: A semi-structured individual interview organized around group development was administered to 3 participants from each specialty unit, followed by a focused group interview of participants (3-8) representing their respective specialty units. Middle level officer and enlisted manager's (10) from each area participated in individual interviews. A subsequent focused individual interview was administered to 3 participants from each specialty unit and three additional focus groups were conducted with officer, civilian, and enlisted nursing personnel. Using an iterative approach, data were transcribed, coded, and pre-analyzed following each round of interviews and then used to add probes into subsequent interviews. Ethnograph 5 software program was used for coding, clustering, and identification of emerging themes. Descriptive statistics described the sample.FINDINGS: A contextual factor of cultural differences between each of the three military services is the major theme. Analysis shows a high frequency of sub-themes identifying differences between each military system's professional and paraprofessional specialty knowledge, experience, education, and training. Service comparisons are made about the differences in uniforms, rank, communication, leadership, management, problem solving, roles, evaluations, forms, rules, and policies.IMPLICATIONS: Emphasis on cost containment, reduction in personnel and the duplication of medical services has led military hospitals, like their civilian counterparts, to restructure the way they conduct business through mergers. The results of this study provided a beginning understanding of the issues accompanying mergers at a micro level.CONCLUSIONS/RECOMMENDATIONS: Organizational cultural differences must be identified early and a shared understanding about objects, talk, behavior, and emotions must be achieved to gain a collective commitment by Triservice personnel to reach a common goal.