COVID-19: Military Nurses Leading Innovation Through Research, Clinical Care, Education, and Collaboration

ABSTRACT Military nurses have been placed in the forefront of clinical and leadership roles during the COVID-19 pandemic. Serving in critical roles, military nurses have spearheaded innovations in clinical practice, conducted research, and implemented evidence-based practice projects that have advanced the capabilities of the Armed Forces Nurse Corps. This collection captures and highlights many of these military nursing contributions combating the COVID-19 pandemic.


Military Nurses: Top Clinicians and Scientists
Military nurses comprise one of the largest percentages of military healthcare personnel and one of the most deployed military specialties. These highly educated professionals frequently hold advanced academic degrees and professional certifications (Table I). 1 One of the most important distinctions military nurses hold is their dual roles as clinical nurses and as commissioned officers in the Armed Forces. While military nurses' role within the Defense Health Agency healthcare systems is similar to civilian clinical practice, their operational practice environments are unique and diverse-from field and surgical hospitals in operational theaters, to hospital ships serving global health engagement missions abroad, to large populous healthcare systems in the United States. These clinical practice settings span the globe and provide a unique perspective that encompasses diseases and scenarios that are uncommon in the United States, but prevalent in worldwide locations. Military nurses make tremendous sacrifices on behalf of our country to care for our nation's wounded, injured, and sick service members. Military nurses are one of our country's greatest assets as they serve the nation anywhere, anyplace, any time.
One military nursing specialty is nurse scientist, professionals who bring their education and training in scientific writing and data analysis skills to mentor clinical nurses and encourage the dissemination of their important contributions to a wider audience. Though a small core group, military nurse scientists are prolific, productive, and essential to bringing research into military nursing practice settings. Military nurse scientists expand scientific knowledge related to the nursing care military nurses provide in austere and operation environments, but also inform military requirements, threats, and manning, identify new capabilities, and contribute to important healthcare policies. They also provide scientific mentorship to military nurses-to look for the best available science, to find gaps in military nursing care, to utilize data for clinical and leadership decisions, to use psychometrically sound instruments to capture meaningful data, and to implement evidence into all clinical settings. 2,3 They challenge nurses to advance the scholarship of their practice. Recently, military nurse scientists have also worked tirelessly with nurses of all specialties, ranks, and services to advance

COVID-19: Military Nursing Response
The current DoD's priorities for COVID-19 are to maintain mission readiness, support interagency government endeavors to address the pandemic, and protect the troops, DoD's civilian employees and contractors, and their families. 4  Equally important is the ability to effectively implement evidence-based nursing care when limited effective treatment options are available for new and emerging health threats. Because of the unique clinical position of nurses, they are optimally positioned to readily define, implement, and evaluate the best available practices that advance quality and safety in military health care. Areas important to address include: 1. Evidence-based practice projects that define, implement, and evaluate infection prevention and control practices during wartime, peacetime, and humanitarian and national response. 2. Evidence-based practice projects that define, implement, and evaluate communication tools, such as telehealth technology, to expand access to healthcare services for military service members and their families during the COVID-19 pandemic and beyond. 3. Evidence-based practice projects that assess readiness, gather evidence, set up training, promote staff safety, and bolster peer support to strengthen the military healthcare system. 4. Evidence-based practice projects that assess healthcare provider risk (both physical and mental), reduce harm, and apply workplace safety interventions and evaluate outcomes during COVID-19 and other emerging pandemic threats. 5. Evidence-based practice projects that define, implement, and evaluate leadership decisions, leveraging data analytics to drive time-sensitive decisions to improve patient outcomes in military health care.
Empowering military nurses in these areas is the key to reducing mortality and improving patient outcomes across the continuum of care.

TriService Nursing Research Program
The TriService Nursing Research Program (TSNRP) provides modest, but needed, infrastructure support for military nurses to conduct research and to collaborate across the Armed Services. Building professional relationships is a hallmark of the TSNRP and is evidenced by the collaboration between the frontline clinicians and military nurse scientists who created this supplement.
These identified research gaps and evidence-based implementation areas align with the TSNRP's long-standing funding priorities of (1) force health protection, (2) nursing competencies and practice, and (3) leadership, ethics, and mentoring.
This supplement is also aligned with the TSNRP's strategic goal of developing and strengthening the community of nurse scholars to generate new knowledge and translate it into practice.
It is hoped that this experience will serve as a future model to continue to develop the scholarship of military nurses and encourage the next generation of military nurses to disseminate important military nursing contributions through professional publication. Undeniably, the greatest strength of the TSNRP community are the military nurses-passionate, determined, resolute, and laser focused on readiness.
Ironically, the COVID-19 pandemic occurred during the International Year of the Nurse as declared by the World Health Organization. It seems appropriate that in 2020 military nurses continued the legacy of advancing nursing scholarship to advance the care our service members and beneficiaries receive. Working with this dedicated group of nurses has been an incredible experience and truly contributes to paving the way for advancing military nursing.

FUNDING
Publication of this supplement was funded by the TriService Nursing Research Program.