Veterans in Your Emergency Department: Serving a Hidden Population
One in 14 American adults is a veteran*, but for various reasons, most veterans seek medical care outside of Veterans Affairs (VA) hospitals and clinics.1 Add in the fact that most cities don’t have VA emergency departments, and you may be caring for veterans more often than you realize. I’d like to offer a veteran’s perspective on why it’s important for all caregivers to know if a patient has served, and I’ll suggest some steps that can help you provide even better care to the veterans that enter your emergency department.
The Importance of Identifying Veterans
As service members, we encounter different scenarios in our jobs than civilians do, and these scenarios can cause injuries seldom suffered by American civilians. As a result, veterans often present with unique medical needs.
Due to the impactful experiences of war, combat veterans suffer from post-traumatic stress and traumatic brain injury at disproportionate rates compared to our civilian counterparts. Veterans also suffer a higher rate of mental health issues,2 with veterans accounting for 1 in 7 American suicides.3
Veterans also experience a higher rate of substance use disorders than civilians.2 Homeless veterans in particular tend to visit the emergency department for alcohol-related disorders, substance use, suicidal behaviors, and mental health issues.4,5
But also bear in mind that not all veteran-specific health concerns are combat related. To train the greatest forces in the world, the service branches regularly push the physical limits of their members. As a result, chronic pain is a common complaint among the veteran population.
Barriers to Identifying Veterans’ Needs
Identifying those who have served and acknowledging their unique medical needs is important, but there are several barriers to accomplishing this:
- Often, veterans don’t associate their medical problems with events that occurred when they served, potentially making it difficult for their nurses and physicians to connect the dots.
- Military culture can ingrain a “just suck-it-up” attitude and a feeling that discussing mental health shows weakness. On top of that, veterans can feel misunderstood by non-veterans (both within and outside of health care settings). As a result, they may not seek the care they need, and when they do, they may not be the most open communicators.
- Many of the wounds associated with military service are invisible, so identifying them as a root cause can take some investigation.
- We all suffer from bias, and caregivers are no exception. Keep in mind that today’s veterans are more diverse than ever, so there’s no such thing as a “typical veteran.
What Can I Do for Patients Who Are Veterans?
Screen for Past or Present Military Service. At some point during your nursing career, you may have inferred a military connection when you saw a “Korean War Veteran” baseball cap or a Navy tattoo, but the best way to determine if your patients are veterans is to ask directly if they have ever served. If they have, follow up by asking about any service-related or combat-related injuries or illnesses. If possible, incorporate the information you gather into their patient history and pass along knowledge of veteran status to case workers--future caregivers may find this information helpful, and they may have more time to ask follow-up questions and screen for certain conditions.
If asking every patient if they have served is just not feasible, consider doing one of the following:
- Post a sign in the waiting room to let patients know that their veteran status is an important aspect of their medical care.
- Add veteran status as a follow-up question to aid in identifying pertinent resources for the most vulnerable populations. For example, homeless veterans represent 11% of the adult homeless population, so if you encounter someone with nowhere to turn, consider that they could be a veteran.
- Keep this blog article in the back of your mind. While a veteran’s broken ankle may have no connection to their 2008 deployment to Afghanistan, determining veteran status may be useful if diagnosis is difficult or if underlying causes need to be investigated.
Share Resources. As an emergency nurse, you often have the opportunity to guide veterans to better resources, but you have to balance that opportunity with the 1 million other things on your plate. If possible, try 1 of the following in your emergency department:
- Remember (or keep handy, perhaps electronically) 1 or 2 critical veterans resources (such as va.gov or the Veterans Crisis Line) that you can suggest to those who need it most.
- Have available a flyer with local and national veterans resources and hand it out as necessary, or keep some available in the waiting room. You can copy-and-paste the resource list below and edit it to reflect local contact info.
- Refer veterans to the closest VA when appropriate. For prior service members, the VA is often the best source for veteran-specific care. However, many veterans choose to avoid VA facilities, and others don’t even know they are eligible for VA benefits for various reasons:
- VA eligibility is not black and white. Even if a veteran is not eligible for full VA health care benefits, they may still be able to receive care for certain conditions such as post-traumatic stress disorder (PTSD), depression, and substance abuse.
- VA eligibility rules change. Even if a veteran was denied VA benefits in the past, they may be eligible today, so encourage them to apply.
- The Mission Act of 2018 expanded community care options for VA-eligible veterans, opening up a large network of civilian primary care and urgent care providers. This is especially helpful to those who live a significant distance from a VA medical facility.
Educate Yourself and Your Team. Expanding your knowledge about veterans not only increases awareness and empathy but may also make you more confident about speaking with those who have served.
- Nursing program coordinators, consider incorporating veteran awareness into your program. Example curriculums and simulations are posted by the American Association of Colleges of Nursing (AACN).
- Managers and nurse educators, consider integrating veteran-centric training, and encourage nurses to inquire about previous service and ask pertinent follow-up questions. AACN posts PowerPoints and other educational resources.
- Individual nurses, consider dedicating at least one continuing education credit per year to a veteran-centric topic such as military culture, veterans’ health care needs, PTSD, or advocacy for veterans. Several organizations, such as Center for Deployment Psychology, AACN, and Medscape, as well as many CE websites, offer veteran-related content for credit.
Guest Contributor
Whitney Hawknuff, MPH, MLS(ASCP), is a retired Army Chief Warrant Officer 3 who completed 4 overseas tours during her military service. Whitney has experience as a medical laboratory scientist, and she currently works as a freelance editor and writer. Whitney is pursuing a master of science in strategic brand communication with a goal of helping start-ups and veteran-owned businesses find success.
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