Can You Commit to the White House's Joining Forces Initiative?



Marilyn Stringer Associate Editor


Rose Horton


Karen Peddicord

Spearheaded by First Lady Michelle Obama and Dr. Jill Biden, Joining Forces is a national initiative to support our veterans and their families. This comprehensive initiative promises to engage all civilian sectors to provide support and opportunities for service members and their families through education, training, employment, and wellness programs. This support is especially needed when our service members have been discharged from the military. It is often necessary for military personnel and their families to postpone their goals related to job training, employment, and higher education. In addition, support to our military in attending wellness programs is critical.

Since 2001, approximately 2.4 million U.S. military personnel have served in Afghanistan and Iraq in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Of these military personnel, approximately 1.44 million individuals are eligible for Veterans Administration (VA) services and approximately 772,000 have used VA health care (Veterans’ Health Administration, 2011). Approximately 12% of these military personnel are women (Spelman, Hunt, Seal, & Burgo-Black, 2012). Women have served in combat zones and have been exposed to the same combat risks as their male counterparts (Veterans Health Administration). The most prevalent health conditions sustained by military personnel from serving in combat zones are musculoskeletal problems and mental health conditions including traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Combined TBI and PTSD have affected 1 in 6 of our veterans (White House, 2012).

In women deployed to combat zones, urinary infections are common because of dehydration and delayed micturition due to inadequate privacy (Wilson & Nelson, 2011). Female veterans have higher rates of depression than their male counterparts (Jacobson et al., 2009), more commonly report sexual trauma experienced during military service (Haskell et al., 2010), and have increased risk of disordered eating and weight loss (Jacobson et al.). To address these health concerns, the Department of Defense and the VA provide health care services for our veterans, but half of today's Iraq and Afghanistan veterans seek care from health care providers outside the VA system (White House, 2012). Although some of the members of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) provide care within federal health care facilities, most of AWHONN members will encounter our veterans and their families at non-federal health care sites.

Our legacy as nurses to serve the military personnel began during the Crimean War in 1854, when Florence Nightingale made a commitment to support military personnel by gathering nurses to serve soldiers. Those nurses were able to greatly decrease mortality rates for soldiers (Ellis, 2008). Today, we need nurses to commit to serving military personnel and their families during deployment and upon their return. Nurses, the largest group of health care providers, are often the first providers that veterans and their families contact when accessing health care. During this initial contact, nurses are ideally positioned to provide assessment screening for PTSD and TBI; however, we often do not have the skills to perform these assessments. To assist with providing current and future nurses with skills in assessing and caring for those suffering from TBI, PTSD, and other combat-related issues, more than 150 state and national nursing organizations and more than 500 schools of nursing have pledged to provide education on caring for our veterans and their families (White House, 2012). The anticipated reach of this initiative includes more than three million nurses in almost every care setting across America (White House).

AWHONN is one of the approximately 150 nursing organizations that has committed to support the Joining Forces initiative and has pledged to raise awareness for the need for screening and referrals for veterans and their families. AWHONN has a long-standing commitment to educating its members on how to recognize and care for veterans affected by PTSD, TBI, depression, and other combat-related issues. Recently, both of AWHONN's journals published manuscripts related to deployed women and health. The March/April 2012 issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing featured an In Focus series related to care for military families, and concomitantly Nursing for Women's Health featured an article on the challenges of providing breast milk infant nutrition during deployment.

AWHONN's annual national convention programs always include topics of high priority in caring for members of the military and their families. The most recent June convention in Washington, DC was no exception. Major Gwendolyn Foster, MSN, RN, CNM was the recipient of the 2012 Award of Excellence in Advocacy for her individual contribution to promote women and newborn's health. In addition, Major Foster presented on rape and sexual abuse and their impact on women in the military. AWHONN will continue to keep its members updated on the Joining Forces initiative by providing educational information to support nurses who care for women and their families during active or retired military service, including sharing resources on Facebook and providing weekly Smartbrief electronic publications.

In June 2012, Rose L. Horton, AWHONN's President, attended the Armed Forces Section meeting at the AWHONN annual convention to listen to and learn from women serving in the military. The purpose of this meeting was to explore future strategies to provide additional education to nurses in our specialty on this important topic. AWHONN Armed Forces members voiced their appreciation for the AWHONN website and the timely, evidence-based resources provided there. They also expressed appreciation to AWHONN for its commitment to participate in Joining Forces.

If you are interested in learning more and committing to the White House's Joining Forces Initiative, please visit these selected web resources:


  • Rose L. Horton, RNC, MSM, is the President, Association of Women's Health, Obstetric and Neonatal Nurses, Washington, DC and Director of Maternal Child Health, Saint Vincent Health Center, Erie, PA.

  • Karen Peddicord, PhD, RN, is the Chief Executive Officer, Association of Women's Health, Obstetric and Neonatal Nurses, Washington, DC.