|Author: Julia Elliott|
|Caring for Kids in an Overseas Naval Hospital|
|"Every day is a challenge," says CDR Sandra Mitchell, NC, USN, of her work at the U.S. Naval Hospital in Okinawa, Japan. "You do not know what surprises are waiting for you as you enter your office!"
As a Naval Nurse Corps officer in pediatric medicine, she serves her young patients and their families in a variety of capacities. "I am a teacher, mentor, counselor, advisor and supporter to my children and to their parents and guardians."
Mitchell works in a clinic staffed by five pediatricians, two other PNPs and six corps staff who provide assistance. "The pediatric nurse practitioner sees a child just as a pediatrician does," explains Mitchell. "We focus on wellness and preventative care, so that the children coming in for regular checkups have the most comprehensive examinations possible."
The clinic is part of the U.S. Naval Hospital, Camp Lester, Okinawa, Japan, the Navy's largest overseas hospital. It consists of 141 physicians and 172 nurses who provide a broad range of medical services. The hospital has 81 (expandable to 154) beds, five operating rooms, an ER, four labor and delivery rooms (averaging 1100 births a year), a mixed ICU (ICU/SICU/CCU) and a 14-bed NICU. Some 25,000 outpatients per month visit six branch medical clinics and four annexes at various outlying bases in Okinawa. Special services include the Japanese Physicians Medical Education Program, which acquaints graduates of Japanese medical schools with Western medical practice: this helps improve medical care for Japanese beneficiaries and enhance overall patient care through liaisons between USNH Okinawa and local Japanese hospitals.
Mitchell cares for the children of the Army, Air Force, Navy and Marine personnel, and of the teachers employed by the Department of Defense School System. The pediatric department and all USNH Okinawa primary care clinics provide well-baby care and outpatient treatment of childhood illnesses and injuries. To help treat the volume of patients encountered daily, Mitchell's clinic as has two civilian RNs for phone consultations and walk-in triage care and a medical receptionist for scheduling future appointments. The pace is brisk and the hours cover evenings, weekends and holidays.
Commander Mitchell's job includes evaluating children for age-appropriate physical, psychosocial and developmental growth. In addition, she treats minor acute illnesses and monitors chronic conditions. "I see mostly patients with asthma, dermatology issues and other non-life-threatening conditions. My [appointments] start at 7:30 am, and [patients include] newborns scheduled every 15 minutes, teen clinic [patients] every 30 minutes. We [also] see a full range of children, involving patients up to 19 years. We treat acute problems, [perform] standard physicals and [see] well babies and adolescents."
As an active Naval officer, Mitchell has multiple duties. "I am the hospital's Command Equal Opportunity Officer and am one of several medical representatives for child and spouse abuse committees." It all makes for very busy days, but Mitchell is undaunted. "That is OK," she explains, "because I am doing what I like. You have good days and bad days, yet I still would not change my occupation."
To overcome the English/Japanese language barrier, she cultivates mutual respect and carries a digital translator. "Also, knowing basic sign language is very helpful," she notes.
Mitchell is very proud of USNH Okinawa's Comprehensive Adolescent Preventive Health Service Clinic (CAPHS), a branch of the pediatric clinic that offers 13- to 18-year-olds physical examinations, health screening and education about adolescent development. She helps them learn how to deal with peer pressure and teaches them to consider the consequences of risky behaviors. "By providing a dedicated adolescent clinic, young adults can learn the importance of being responsible for their well-being," says Mitchell. "I don't believe teens take preventive medicine seriously enough, so this is our way of reaching out to them." She developed the clinic to help teens cope with the rapid physical and psychological changes they experience.
During each clinic session, providers meet with teens and their parents to discuss health issues, medical history, social problems, drugs and immunizations. "The clinic helps bridge a gap between parents and children, because they don't view health issues the same [way]," Mitchell explains. "I'm hoping this program will reach out to adolescents on health issues that need discussion during these critical years of their lives."
She has been striving to improve healthcare since graduating from nursing school in 1972, when she took part in an effort to improve inner-city healthcare. "I was born and raised in New York City, and am of Puerto Rican descent," she explains. "I am proud to be a 'Nuyorican,' which is [a combination of] New York and Puerto Rican. It defines Latino men and women who are born or raised in the city." Her affinity for her fellow Nuyoricans and urban citizens inspired her to improve nursing care in her own community.
Mitchell says she always knew that she would one day become a nurse, but she needed to finance her education. She applied to the National Health Corps and qualified for federal grants and scholarships to pursue her degree in preparation for work in an urban setting. "I was in the right place at the right time," she recalls. "They were looking for a new breed of provider, which was a midlevel nurse, and being a minority, speaking Spanish gave me the edge."
Mitchell then went to school for a year of didactics and attended Columbia-Presbyterian Medical Center, earning her pediatric nurse practitioner certification. She spent three of the six years she owed the National Health Corps working in the neighborhood in which she grew up. During this time, she also returned to school and earned a master's degree in psychiatric nursing in 1979. That same year, Mitchell was commissioned into the U.S. Naval Reserve.
"As part of reserve duty, I did my two weeks per year duty to fulfill my reserve obligations in Fort Skyler, Staten Island, and in the late 1970s and early 1980s, I energetically participated with the New York State Nurse Practitioner Coalition in an attempt to get professional recognition from the [New York] State Nurses Association," says Mitchell. Her phone calls, letters and advocacy eventually helped the NPs prevail. In September 1988, she was part of a rudimentary Pediatric Nursing Grand Rounds using teleconferencing. During the next two years, Mitchell's group linked major hospitals such as Queens General and Long Island Jewish Hospital, developing a monthly united forum to share knowledge and experience and provide an opportunity to network, enhancing nursing practice in all of the participating facilities.
In 1989, Mitchell was recalled into the regular Navy, reporting to the USNH Orlando, FL, where she worked as a PNP for five years. During her tour in Florida, she completed two master's degree programs, one in counseling and one in educational leadership at Troy State University, Fort Walton Beach, FL. While in Florida, Mitchell was a preceptor to four student family nurse practitioners from Florida State University during their pediatric rotation. She also found time for involvement in numerous community volunteer activities.
Her next tour of duty took Mitchell to USNH Sigonella, Italy, from 1995 to 1997, where she was department head of pediatrics. She completed the Department of Navy Total Quality Leadership training while in Sigonella and taught classes to the military community and facilitated several groups. From 1997 to 2000, Mitchell's tour brought her to USNH Camp Lejeune, NC, where she was acting department head and division head, facilitated a health promotion group, and helped establish the Reach through Sharing (RTS) bereavement program. Throughout her naval career, Mitchell has also worked with child abuse prevention and victim advocacy programs -- two causes she holds in high regard.
While many healthcare providers enjoy the continuity of staying in one place for years at a time, Mitchell thrives on travel. "I cannot understand how some people can be at the same place for 10 to 20 years!" she exclaims. "Every three to four years, I change places and look forward to each new assignment."
She also actually finds it easier to keep tabs on her young patients in the military setting. "Working in the private sector, I found that I would lose a family and that I would not be able to find them. If a child needed an immunization or needed follow-up care, they had the option of coming back or not. In the military, I am provided a better grasp of where that family is, regarding their child's health issues. Follow-ups and rechecking is a lot more consistent in the military."
While Mitchell encourages other NPs to consider practicing in the military, she advises that they should be up for a challenge, willing to travel and continue their education, ready to immerse themselves in different languages and cultures. As she enters her fourth year stationed in Japan, Mitchell acknowledges that although she has developed a taste for sushi and other Japanese culinary delights, one of the things she enjoys about returning to the U.S. every six months is indulging in old favorites like hot dogs and quiche.
Until her next tour of duty begins, Mitchell feels at home in Okinawa. "My next tour of duty will be either Pensacola, Florida, or Port Smith, Virginia," she says, "and either one is OK with me because it is the East Coast, and that is where my family is."
Whether they choose to practice in the military or in civilian settings, Mitchell encourages new NPs to maintain high professional standards, rather than being intimidated by the pace of change in the field. She says, "The nurse practitioner role is changing with the change of society's ideals. One person can make a difference in how the practitioner programs are evolving from the political arenas, licensing procedures, national certifications, policy-making issues, who is governing whom, reimbursement issues regarding the federal, state, city and local organizations."
Despite the challenges of keeping abreast of new developments in the NP field and meeting the demands of the U.S. Navy, Mitchell is devoted to her career. "I find my job a challenging one, and I dedicate myself to it fully. Children are the hopes and dreams of our future, and if I can pave the way to a healthier existence in even the smallest way in their lives, then I am doing my job. In the simplicity of that insight, I do find fulfillment. I have earned Navy awards of which I am very proud. For 24 years now, my commitment to my profession has been resolute and unyielding."
CDR Sandra Mitchell, NC, USN, obtained her B.S.N. from Hunter College, New York, NY, in 1972, her PNP from Columbia Presbyterian Medical Center in 1976, and her M.S.N. in Psychiatric Nursing from Hunter College in 1979. She obtained her certification as a Women's Health Practitioner, Planned Parenthood, in New York City in 1984, her M.S. in Counseling Leadership and M.S. in Human Development from Troy State University, Fort Walton Beach, FL, in 1994 and 1995, respectively, and her certificate in human resource management from La Salle University, Philadelphia, PA, in 1998.
Julia Elliott is a freelance writer from New York. She is on the editorial staff of NEWS-Line for Nurse Practitioners.