The Science of Military Nursing (With Dr. Jacqueline Killian)
Joe Gaccione 0:08
Hello, and welcome to Vital Views, UNLV School of Nursing podcast. I'm Joe Gaccione, Communications Director for the School of Nursing. There are only a handful of nurse scientists in the United States Air Force, but as of June 30th 2022, there was one fewer. Now retired Colonel Jacqueline Killian officially stepped away from the Air Force to join UNLV School of Nursing as a full time professor. She served for 31 years leading numerous grant supported research. Her expertise includes resiliency, military nursing practice, and mental health. She also spearheaded an enormous COVID-19 surveillance testing program of the US Air Force workforce. Dr. Killian joins us in the booth today to share tales from a remarkable career and what she plans to bring to UNLV nursing. Dr. Killian, thanks for stopping in.
Jacqueline Killian 0:55
It's my pleasure.
Joe Gaccione 0:57
At your retirement ceremony, you mentioned a very small percentage of nurse scientists are in the Air Force. And I knew that nurse scientists were like a niche group in general in nursing, but I had no idea how small it was actually in the Air Force.
Jacqueline Killian 1:11
It's very true there, there were only 11 of us. Now there's 10. And we only have a couple go through the pipeline, or go through the school program, which takes three years. So it takes at least three years to grow a new nurse scientist, so we try to keep the pipeline full, but sometimes, some years we don't have any candidates apply for the program. So that can be kind of problematic when we have retirements such as mine come along,
Joe Gaccione 1:39
What separates a nurse scientist from your average nurse researcher?
Jacqueline Killian 1:45
So I think that there's always a, there's always a question about nursing research and what is a nurse researcher, so nurse scientist has their, has to have their PhD. Nursing research is conducted at many different levels by nurses across the profession. But the scientist has to have her PhD. There are nurses in hospitals that are helping with research studies. There are nurses in, in other advanced academic degree programs that are involved with research, but the nurse scientist has to have completed her PhD in nursing science.
Joe Gaccione 2:26
Okay. Out of that 31 years you served, that wasn't entirely Airforce, correct?
Jacqueline Killian 2:30
No, it was not. So originally, I joined the military in the army. I had an Army ROTC scholarship to obtain my Bachelor's in Nursing at the University of Florida. And so I finished my two years of nursing school while also going through ROTC. And when I graduated, I then entered the Army Nurse Corps. I worked in the army for four years, in the neonatal ICU setting, which I loved.
Joe Gaccione 2:59
What interest came first for you? Was it nursing? Or was it military service?
Jacqueline Killian 3:05
It was nursing. It was definitely nursing. And as soon as I started thinking about nursing and thinking about how I was going to pay for school, my father was in the Navy for 23 years. So I was familiar with the military setting. And so I naturally pursued or looked into ROTC scholarships. And at that time, I wanted to attend the University of Florida, and the Army ROTC program there was offering nursing ROTC scholarships.
Joe Gaccione 3:33
How does military nursing differ from traditional civilian nursing? Are there any major differences? Are there more like nuances?
Jacqueline Killian 3:40
I will say there are nuances. In the military setting healthcare setting, we have a team, team nursing approach. So in the military setting, we have RNs, who have their bachelor's degree in nursing. And then we work with, part of our nursing staff, our medical technicians, who are basically trained to the level of, or the equivalent to a licensed practical nurse in the civilian side of the house. And that is throughout all of our facilities, whether it's an inpatient setting or an outpatient setting, the nursing staff is made up of, of RNs and these medical technicians. So we work together to provide the nursing care that's needed for whatever area we're in. In the civilian sector, I don't think most facilities have the, have both RNs that are BSN prepared as well as two year degree nurses. I think some facilities do but I would say the majority don't. This team nursing concept that's in the military allows us to, we have to work very closely together. I think also part of military life is the fact that many times you live far away from your extended family. And so your work group becomes kind of your family and so one thing that I enjoyed about military nursing and about the military is this concept of military family, of giving each other the support needed because you're, you're far away from your loved ones.
Joe Gaccione 5:10
I feel like you're automatically travel nurses because you're never in one spot consistently. You're never in one facility consistently. So you're constantly meeting new people, picking up new skills along the way.
Jacqueline Killian 5:21
Yes, that is true. We do, we do move a lot. But generally, we're in place about three years, sometimes longer, it depends on the needs of the, of the military branch that you're in. But yes, we do move quite a bit. So we get to see different places, live in different environments, and work in different environments as well. That's one of the things that I, I think I enjoyed most about my military career was almost every time I moved, I worked in an entirely different area of nursing.
Joe Gaccione 5:54
We mentioned your research earlier, talking about mental health, we talked about resiliency, can you explain where you got started in that? What drew you to those topics?
Jacqueline Killian 6:03
So I've always had an avid interest in positive psychology, I've read a lot about positive psychology, I believe in a lot of its tenants. Resilience is one of those. And so when I showed up for my PhD program, right from the get go, they start asking you, “Okay, what is your research question?” Like, “What do you want to formulate your dissertation work on,” because right from the beginning, they want you to kind of be building and working towards that, you know, cumulative kind of effort. So, resilience is a huge topic. And so I really had to hone that down. And so as a nurse educator, which I, the job I came, I came from when I entered my PhD program was, I was the director of education and training here at Nellis. And so I was interested to know if there was a way that we could provide an intervention, whether it be through education, or some kind of activity that would promote resilience and decrease stress for our military members. And I would argue that, you know, this is a problem, even in the civilian sector, you know, with, especially in the nursing profession, with our nursing shortage, staffing shortages, the workloads that nurses have to manage. And, you know, resilience is important for nurses across the board, I think, and stress management is important as well. So, my interest came from, from that background, I had always done a lot of reading on, on positive psychology, always in the realm of like hardiness and resilience and, and reading about individuals that show great resilience, and what do they have in common? What are those factors? And, you know, how can we promote that for people?
Joe Gaccione 7:49
I feel like it's easy, a lot of times to tell someone who might be struggling with stress management or resiliency to just, for lack of a better phrase, “Suck it up,” or, “It's going to be okay, you'll get through it,” like you're trying to motivate but it's easier said than done. What are the biggest things you've learned for either nurses, or service men and women to do? What can they do to really increase that resiliency? Is there one thing? Is there one or two things?
Jacqueline Killian 8:20
That's a really tough question. I think self awareness is important. So I think we're each responsible for knowing kind of where we're at. And you know, whether our cup is empty. And there isn't one thing that's going to fill everyone's cup, right? But probably one of the easiest things that people can do is deep breathing. And, you know, there's that phrase, you know, “Take a beat, take a breath,” right? There's some wisdom in that. When you take a deep breath, like you literally fill your lungs and even your abdomen with air, pause and then exhale. What that does is it innervates our, our vagus nerve that, that lives basically, in our diaphragm. And that innervates our parasympathetic nervous system, which is the, the cause of our rest or relaxation response, it’s the opposite of our stress response. So if you can take a few deep breaths, four or five, just take a moment, even close your eyes so that you don't have that external stimulus. It will cause a relaxation, biological relaxation response in your body and kind of create a reset for you, if you will. That's probably the easiest thing for people to do. They can do it anywhere, at any time. And it also kind of gives you a little bit of a brain break, which can also help with focus because A lot of times when we are under a tremendous amount of stress, it's very difficult to focus.
Joe Gaccione 10:05
And it probably helps too to have more external support as well, I'm sure the environment that you're in, if it's not supportive or it's not cohesive, then that breathing can only do so much, correct? Like it's got to be, it can't just be one thing and that's it.
Jacqueline Killian 10:19
No, no, absolutely not. And that's what I was saying. There's not like, one catch-all, fix-all thing that people can do to be more resilient or to decrease their stress. So this would be just like one tool that you would want to have in your toolbox, so to speak. You know, the other thing that deep breathing does is it also hyper oxygenates. And when we bring more oxygen into our system, it kind of gives us a little bit more energy as well. So that's another good thing about just taking a moment to take a few deep breaths, can really help to kind of reset your biology, so to speak.
Joe Gaccione 10:53
What was the biggest lesson you learned in the Nurse Corps?
Jacqueline Killian 10:57
That's, that too is a tricky question. So many lessons that I've learned throughout my military career, probably the biggest one is the importance of blooming where you're planted, being flexible and open minded. I have to be honest, I wasn't thrilled with every assignment that I received. But what I learned was that you kind of have to take the bull by the horns, and show up and do your best every day. And before you know it, you're loving what you're doing. So I think that is probably, throughout my military career has served me very well, is to just focus on, “Okay, what do I have to do right now? Let me do it to the best of my ability.” And in the end, you know, it ends up breeding success.
Joe Gaccione 11:49
One assignment that they mentioned at your retirement ceremony, and we touched on it at the beginning, was this COVID surveillance testing program, which, based on what they said at the ceremony, was incredibly extensive, and it started out small, and then it just grew. Can you talk a little bit about your involvement in that?
Jacqueline Killian 12:06
Yes, I can. So as a nurse scientist, I was asked to lead that effort, it was an Air Force wide effort. We were looking at figuring out how to test our asymptomatic Air Force personnel to determine whether we were having a problem with asymptomatic COVID spread. Now we have hundreds of thousands of personnel. And at the time, in the height of COVID, testing materials were at a premium, you couldn't get them. And if you had them, you wanted to use them sparingly. So we started out, it involved five research labs across the Air Force, at the Air Force Academy, at Wright Patterson Air Force Base, Keesler Air Force Base, down at Lackland in San Antonio, as well as out at, in California, we had a research lab there as well. And so we, I utilized those subject matter experts that work in the labs, because I'm not a lab officer, I've never worked in a lab. But I, I basically gathered those groups together so we could discuss, “How can we do this?” And so there was evidence that pooled testing would work and essentially, what you do is you put eight samples together, and do, and test them. That's the pooled sample. If it tests negative, then you save seven tests. If it tests positive, then we would test those individuals to see which individuals were positive. So over the course, across these five different labs, we saved a great number of test materials conducting the testing in this manner. It was a huge effort, involved making certain that all of the labs had the right equipment, they have the right supplies, they have the right personnel to take on this new additional duty that, you know, previously, the labs weren't having to do. Also, we were able to use approved testing materials that were non-clinical. So we didn't have to tap into the testing materials that were needed for symptomatic patients. So that, that was a huge effort. Weekly, we met weekly to discuss what was going on, how each lab kind of did it a different way. So we had a lot of lessons learned about what worked and what didn't work, what worked better. And, again, then weekly, reporting up to Air Force headquarters level, the results of that effort, as we had, we, we did that effort for a year and saved a tremendous amount of money with testing supplies and also tested different mechanisms for accomplishing that testing should we, in the future, have another kind of pandemic scenario that we need to do testing for, testing a large number of people for.
Joe Gaccione 14:56
Gotcha. When did you realize you wanted to be an educator?
Jacqueline Killian 15:00
So, I always enjoyed education throughout my nursing career. So early on, I was always volunteering to be like, on the patient education committee. And, you know, with staff development and education on the unit, so doing unit and services and so forth. I just always truly love that. Even in the NICU, I sought out opportunities like to become a lactation consultant, and I got certified as a lactation consultant for the moms that had preemies and became a grief counselor. So always involved in education, even at the clinical staff nurse kind of level. And then when I went to seek my master's degree in nursing education at Hampton University, I actually had the opportunity to do some lectures for the undergraduate students and really loved it. I love the engagement. The questions they had were amazing. Preparing the lectures was, I found that to be really fun, you know, doing the research to support the content. And then my position here at Nellis, when I was stationed here at Nellis, from 2008 to 2012, I was the flight commander, or the director for education and training for the Federal hospital out at the base. So we did, we were responsible for all of the training programs for all of the health care personnel. So all the BLS, ACLS, you know, newcomers orientation, you know, the Joint Commission requirements, regarding any kind of patient care, we did all of that. And so I had the opportunity, again, to develop training and education materials, provide that education and training and just really loved doing that in the hospital setting. So that's when I decided to pursue my PhD because I figured when I retired eventually, which I'm at now, my retirement point, that I would want to seek a job in academia.
Joe Gaccione 16:57
What classes are you currently teaching now or will teach?
Jacqueline Killian 17:00
So I'm currently teaching NUR 427, which is the nursing leadership and transition to practice for the level for nursing students, which I think is a really great class for me to teach with my leadership, leadership experience in the military, as well as the research that I've conducted in transition to practice for nurse practitioners. So I, I just finished an internship here over the spring term, and co-taught that with Dr. Silvestri-Elmore, really enjoyed that, it seemed to be a good fit, so they're gonna allow me to continue teaching that course.
Joe Gaccione 17:35
That was a unique transition, because even though you had started earlier this year, you were still with the Air Force, so you were officially an intern.
Jacqueline Killian 17:45
Joe Gaccione 17:46
Even though you're essentially faculty.
Jacqueline Killian 17:48
Yes. It was a great opportunity for me to learn about academia and to meet a lot of the faculty and work with some of the faculty to figure out how they, you know, how they manage their role as faculty.
Joe Gaccione 18:06
We're talking about nursing leadership, there are a lot of intangibles that a nurse can have, or really anyone can have. But when it comes to nursing, what to you is the biggest leadership skill a nurse can have if they want to take the next step forward?
Jacqueline Killian 18:24
Wow, that's a tough question. So many right answers to that question, I think as an–
Joe Gaccione 18:33
Let's say clinical practice first to kind of narrow it down.
Jacqueline Killian 18:35
For clinical practice, I think it has to be having a team focus. You know, with the workload that nurses have today, I think you really need to have an understanding of not only everything involved in the care that you need to provide, but what are the, what are the aspects of that care that you can delegate? What are the resources available to you on the unit that you can take advantage of so that you can make that workload more manageable? And you know, a lot of times that that takes experience that takes some time in the role to figure that out. That's not something that you're going to have as a brand-new graduate. So, it's important to realize that. I think the other thing is to be willing to always ask questions, to be a lifelong learner. Even today, with several degrees, I still consider myself to be a lifelong learner. I don't know everything. I'm right now starting a new career, which is, you know, brand new to me, you know, the page is blank right now. I'm taking a lot of notes. I'm asking a lot of questions. So in the clinical setting, it's the same way as you have new patients with new disease processes that you don't have experience with. You know, ask those nurses that are on your team that perhaps have seen this before or had patients like this before, you know, never be afraid to ask a question, because it's just going to work, make your work easier, instead of harder.
Joe Gaccione 20:08
And I think that's important for our students to understand, especially the undergrads, because they have a heavy workload, they feel like perhaps it's just academic life and “That's it, I have to cram all this knowledge into four semesters, and then I'm done.” But really, if they embrace the fact that, “Yes, I have to learn this now, but I don't have to know everything right now,” it's almost like a breath of fresh air.
Jacqueline Killian 20:32
I think it takes some of the, the weight off of your shoulders, when you give yourself the grace to know that it's okay to not know everything. It's okay to ask a question. It's okay to, to say, “You know, I don't know much about this, can you tell me more?” That really does, I think, take a weight off of your shoulders, and really opens the door to some really wonderful experiences and knowledge that you need and you, you can gain if you just ask the question.
Joe Gaccione 21:05
I know you quickly transitioned from retirement, from Air Force to full time faculty, but what's the adjustment been like now that you're officially retired from the Air Force? Has there been an adjustment?
Jacqueline Killian 21:18
Well, I think doing the internship really helped with my adjustment, to be honest. And I think, in the military, we have this phrase, it says that, you know, people tell you, “Oh, you'll know when you're ready to retire.” And it's very true. Like, you know, last year when I put in my request to retire, I felt it was the right time, you know. And so, I've had a year to kind of prepare, you know, for last week when I had my retirement ceremony and my last day on active duty. So I think that the transition for me has been pretty easy. Because I've been ready, I've been preparing for it. And I've been looking forward to it. I know that's not always the case with everyone that retires from the military. People retire under a lot of different circumstances and so I feel pretty fortunate that you know, everything kind of lined up well for me.
Joe Gaccione 22:15
Do you mind me asking when that moment was when you realized, “You know what, I think it's time to move into something else?”
Jacqueline Killian 22:22
So I think, so I was assigned to Wright Patterson, an Air Force Base in Ohio for this last assignment, I spent two years there. And it was my third assignment separated from my family. And I moved in May of 2020, in the height of COVID. So it was not optimal circumstances to be moving at that time. And so that last assignment for me was, was quite different due to the pandemic and the work circumstances that the pandemic posed. A lot more people were teleworking, we were doing meetings over, over teams, or over the phone, and very few people were meeting face to face. And so that was really, really different. And you know, everyone across the world experienced this, right? Through the pandemic. So when it came time for me to decide whether I was going to put in for my retirement, that truly was a factor. And the fact that it was my third assignment separated from my family. I have three grandbabies here locally. It was just time for me to retire and move back home and, and, be, be reunited with my family again.
Joe Gaccione 23:37
That's an interesting point, that brings us to our last question that really connects to it, one of the defining things from your retirement ceremony that I took away was that reliance on family support. Seeing you with your parents, and your children, and your grandchildren, and your extended family. And I think that's true, not just for military life, but for nursing life. You, as a nurse, you directly deal with life and death, you deal with long hours, and miss social time. But the families also experience that too. For nurses out there, for servicemen and women, especially the younger ones, what advice do you have for them to, to manage that experience when it comes to not being around family?
Jacqueline Killian 24:21
That's really an important question. So, you know, social support is linked to resilience. So if you have a stronger social support network, you're going to be more resilient. Building and maintaining relationships can be effortful, right? But it's worth that effort because you will get paid back tenfold. Whether that, those relationships are with your family, with your parents, your children, your siblings, extended family, or whether it's with your chosen family, you know, your friends, your peers. It's important, despite having a large workload, to commit some time to maintaining those relationships because when we face challenges, and we all face challenges, you know, sometimes those challenges are sporadically and sometimes they seem to come one right after the other, you need that social support to help you kind of weather those storms, right? So my, my advice would be, it's easy to not reach out because you're tired or what have you. And I'm not saying you have to reach out every day. But it is so important to maintain the relationships in your life, because they help you through the most difficult times in your life. I'm very fortunate that I'm, I'm very, I guess, open with my children, with my parents. We communicate, you know, weekly, we FaceTime, we call, we email, we text, and, and sometimes it's a little bit challenging, because I may have a suspense or a deadline and I'm working on something and I'm, you know, I'm in a group text and my, my phone keeps pinging. But, you know, I don't let that be a negative because I realize the importance of maintaining those relationships, because those are the people that will stand by you, will support you when you need it the most.
Joe Gaccione 26:42
That is all I have, Dr. Killian, thank you so much for joining us. Best of luck in the next phase of your career. For everyone out there, thanks for listening. Hope you have a great day.
Jacqueline Killian 26:52
Transcribed by https://otter.ai