Interview: Major General Barbara R. Holcomb

Veterans Affairs and Military Medicine Outlook: What motivated you to begin a career in Army medicine?

Major General Barbara Holcomb: I realized at the end of my first year of nursing school that I couldn’t afford the next three years. I had a workstudy job as a clerk typist in the Army Reserve Officer Training Corps (ROTC)/ military science department. During the summer, a 3-year scholarship opportunity opened up. I applied, was accepted and joined ROTC. I planned to do my four-year commitment and then get out. About two years in I realized I liked what I was doing and I’ve been here ever since.

How many different specialties are there within Army nursing?

We currently have nine specialty nursing areas beyond Medical-Surgical nursing: Public Health, Psychiatric, Peri-operative, Certified Registered Nurse Anesthetist (CRNA), Emergency/ Trauma, Critical Care, Family Nurse Practitioner (FNP), Psychiatric Nurse Practitioner (PNP), and Nurse Midwife (NMW). We have some sub-specialties, called additional skill identifiers that any of the specialties can earn. These include en route critical care nurse, nursing informatics, nurse methods analyst, infection control, research, and case management.

Are there any particular specialty areas experiencing nursing shortages?

We have a shortage of CRNAs and PNPs in the active component. The reserve component also has these shortages as well as critical care and emergency/trauma. While we have many specialties, we also have to be generalists so we can assist in areas where there are shortages or if a specific area in the hospital has a high volume of work.

Do you find you are sometimes competing with the Department of Veterans Affairs and civilian hospitals when seeking out new nurses for Army Medicine?

Not really for our military nurses. We bring new nurse officers in through either ROTC, OCS (through the Army Enlisted Commissioning Program), or through a direct appointment. Nurses coming in with a direct appointment work through a recruiter and need to have a year of experience in nursing or already have a specialty as mentioned above. Where we compete with the VA and civilian hospitals is with our Department of the Army civilian nurses. Nearly 60% of our nursing staff is civilian. Although we are both federal nursing entities, the VA has a different pay scale than the DoD and has not faced sequestration. We are challenged in some parts of the country to retain our civilian nurses especially if there is a VA or a large civilian hospital nearby.

On the other hand, many Army nurses and other medical professionals transition to the VA at the end of their military career. It provides an opportunity for them to continue to serve. We have many great partnerships with the VA and are continuously developing partnerships with our civilian counterparts as well.

How does the Army incentivize prospective nurses to choose a nursing career in the Army?

ROTC scholarships, recruiting and retention bonuses, specialty pay for advanced practice nurses (CRNA, PNP, FNP, and NMW). We offer a program to pay for an advanced degree at the Master and Doctorate levels. Other incentives include leadership opportunities, medical and dental care, housing and food allowances, along with salary and promotion opportunities.

What sort of balance does the Army maintain between military nurses, civilian nurses, and contractors?

We rely heavily on our civilian and contract staff; they are essential to our success as a healthcare system. Our military nurses must maintain specific skills to provide essential nursing care in an operational field environment, so they have certain training requirements. Our military nurses also relocate every 2-4 years to gain experience. Our civilians provide continuity for our patients. Many of our civilians are military spouses, so they also relocate. During high periods of transition, we use contracted nursing staff to help fill our gaps.

What are some of the key medical technologies that have been developed during your career, and how have they changed Army medicine, both on the battlefield and in care facilities?

There have been many changes in technology over the past 30 plus years. To start with, healthcare itself has changed from an inpatient based practice to outpatient with many surgical procedures changing to laparoscopic as opposed to open incisions. Radiologic diagnostic tools such as the digital X-ray, CT scan, PET Scan, and MRI as well as diagnostic ultrasound have improved immensely. Other medical devices such as IV pumps, pain injection pumps, diabetic monitors, instant lab results with point of care testing, needleless IVs, infrared vein scanners to help insert IVs are new during my career. Patient documentation has also changed, from paper charting to electronic charting and we are experiencing advances in telemedicine and virtual health care.

During the last 18 years of war in Iraq and Afghanistan, we’ve developed many medical devices and products to stop extremity, axillary and intra-abdominal bleeding. In addition to changing the response procedures to trauma, we’ve developed blood products, burn treatments, regenerative tissue, extremity prosthetics, and many other products; many of which are now also in use in civilian healthcare settings.

Do you ever have concerns that, because of the tremendous advances in such technologies, that nurses and other health care professionals might become too dependent upon them?

Yes – my concern is that we may not maintain the sensing skills we need such as listening, seeing, smelling, touching, and be able to assess a casualty to determine a plan because we rely on machines to do the work for us. If we are in an environment where we don’t have electricity, communication networks, or high tech equipment we will need to rely on basic skills, our senses professional knowledge and experience to get through difficult situations.

What are some of the opportunities available to Army nurses for them to continue their educations and growth in their careers?

As I mentioned earlier as part of the incentives, there are opportunities for advanced degrees. Additionally, Army nurses take national certification exams to demonstrate their specialty expertise. There are other opportunities for nurses to develop their leadership skills. They attend the same military courses as all other Army officers. There are opportunities to work in both field and garrison clinical settings, serve in roles to recruit nurses, support ROTC, command units, and work as staff officers at headquarters levels, among other opportunities such as Congressional Fellows and Training with Industry. We have just started a program to assign Army nurses and doctors to civilian trauma centers to help them develop their skills and to serve as a conduit to rotate surgical teams through those facilities before deployment to ensure they have the highest possible skill set to take care of wounded Warfighters.

What do you see as the greatest future challenges in ensuring the health and safety of Army Soldiers?

We have become accustomed to being able to evacuate casualties from the point of injury to surgical care very rapidly. Battlefields in the future may not allow us to have rapid air evacuation. We’ve trained our medics to treat a casualty and get them evacuated within a “golden hour.” We have to teach them how to provide care beyond that hour. It may be 24, 72 or 96 hours before they can evacuate casualties. They need to have the nursing skills to manage pain, minimize infections, toilet, feed, and position casualties. We can look to the past, to the lessons available from WWI and WWII and learn from those lessons to prepare for the future. We are also working efforts on how to maximize Soldier fitness, so they are fighting at their optimal level, regardless of climate or elevation. The most important thing is helping Soldiers understand why they are doing whatever skill they are learning, so they can troubleshoot if it doesn’t work. We have to grow from a mindset of “do as you’re told” to “this is the objective and these are ways you can achieve the objective.” Soldiers must understand the intent of the task or mission.

MAJOR GENERAL BARBARA R. HOLCOMB is a 1987 Distinguished Military Graduate of Seattle University Army ROTC where she earned a Bachelor of Science degree in Nursing. She earned a Master’s degree in Nursing Administration from the University of Kansas, a Master’s level Certification in Emergency and Disaster Management from American Military University and a Master’s in Military Strategic Studies from the U.S. Army War College, Carlisle, Pennsylvania.

Major General Holcomb’s military education includes the AMEDD Officer Basic Course, AMEDD Officer Advanced Course, Faculty Development Course, Combined Arms Services and Staff School, resident Command and General Staff College, AMEDD Executive Skills Course, Interagency Institute for Federal Health Care Executives, Medical Strategic Leadership Program, Army War College, Army Strategic Leader Basic, Intermediate, and Advanced Courses, and CAPSTONE.

Her previous assignments include Clinical Staff Nurse, Post Anesthesia Care Unit and Department of Emergency Medicine, Madigan Army Medical Center; EMT Section, 47th Combat Support Hospital, Fort Lewis, Washington and deployment to Desert Shield/Desert Storm; Staff Nurse and Clinical Head Nurse, Mixed Med/Surg Ward and Head Nurse, Troop Medical Clinic and 111th MI Brigade Family Clinic, Fort Huachuca, Arizona; Officer Basic Course Nurse Advisor, Department of Nursing Science and Commander, A/187th Medical Battalion, Fort Sam Houston, Texas; Chief Nurse, Department of Outlying Health Clinics, 67th CSH/ Wuerzburg MEDDAC, Germany; Medical Detachment Commander (Provisional), Camp Able Sentry, Macedonia; Chief Nurse/XO, 14th CSH, Fort Benning, Georgia; Commander, Special Troops Battalion; Chief, Base Transformation Office, U. S. Army Garrison, Fort Sam Houston, Texas; Chief, Ambulatory Nursing, Brooke Army Medical Center; Chief, Nursing Administration, Carl R. Darnall Army Medical Center and Commander, 21st CSH, Fort Hood, Texas; Commander, Medical Task Force 21, Operations Iraqi Freedom and New Dawn; Chief, Army Nurse Corps Branch at Human Resources Command, Fort Knox, Kentucky; Commander, Landstuhl Regional Medical Center, Landstuhl, Germany; Command Surgeon, FORSCOM HQs, Fort Bragg, North Carolina; Army Action Officer for the Military Health System Review; Commanding General, Regional Health Command – Central (Provisional), Fort Sam Houston, Texas and prior to becoming Commanding General, Medical Research Materiel Command and Fort Detrick, she served as the Deputy Commanding General for Operations, U.S. Army Medical Command. She was designated as Chief, Army Nurse Corps on 2 November 2015. Major General Holcomb’s awards and decorations include the Distinguished Service Medal (1OLC), Legion of Merit (2OLC), Bronze Star, Meritorious Service Medal (5OLC), Army Commendation Medal (3OLC), Army Achievement Medal (1OLC), National Defense Service Ribbon, Iraq Campaign Medal (2 campaign stars), Kosovo Campaign Medal, NATO Service Ribbon (Kosovo), Southwest Asia Service Medal (3 campaign stars), Kuwait Liberation Medal (Saudi Arabia and Kuwait), the Meritorious Unit Commendation Ribbon (1OLC), and the Expert Field Medical Badge. She is a member of the Order of Military Medical Merit.

This interview originally appears in the Veterans Affairs & Military Medicine Outlook 2019 Spring Edition