Cerner Millennium's Care Pathways for Specialty Care Referrals: Provider and Nurse Experiences, Perceptions, and Recommendations for Improvements.

BACKGROUND: Using structured templates to guide providers in communicating key information in electronic referrals is an evidence-based practice for improving care quality. To facilitate referrals in Veterans Health Administration's (VA) Cerner Millennium electronic health record, VA and Cerner have created "Care Pathways"-templated electronic forms, capturing needed information and prompting ordering of appropriate pre-referral tests. OBJECTIVE: To inform their iterative improvement, we sought to elicit experiences, perceptions, and recommendations regarding Care Pathways from frontline clinicians and staff in the first VA site to deploy Cerner Millennium. DESIGN: Qualitative interviews, conducted 12-20 months after Cerner Millennium deployment. PARTICIPANTS: We conducted interviews with primary care providers, primary care registered nurses, and specialty providers requesting and/or receiving referrals. APPROACH: We used rapid qualitative analysis. Two researchers independently summarized interview transcripts with bullet points; summaries were merged by consensus. Constant comparison was used to sort bullet points into themes. A matrix was used to view bullet points by theme and participant. RESULTS: Some interviewees liked aspects of the Care Pathways, expressing appreciation of their premise and logic. However, interviewees commonly expressed frustration with their poor usability across multiple attributes. Care Pathways were reported as being inefficient; lacking simplicity, naturalness, consistency, and effective use of language; imposing an unacceptable cognitive load; and not employing forgiveness and feedback for errors. Specialists reported not receiving the information needed for referral triaging. CONCLUSIONS: Cerner Millennium's Care Pathways, and their associated organizational policies and processes, need substantial revision across several usability attributes. Problems with design and technical limitations are compounding challenges in using standardized templates nationally, across VA sites having diverse organizational and contextual characteristics. VA is actively working to make improvements; however, significant additional investments are needed for Care Pathways to achieve their intended purpose of optimizing specialty care referrals for Veterans.

Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth?

The U.S. Veterans Administration (VA) is a large publicly financed health system that has long struggled with provider shortages. Shortages may arise at the VA because it offers different compensation than private sector employment options or because of differences in the way that labor is supplied to public versus private employers. In the mid-2000s, the VA adopted a more generous and flexible pay schedule for its dentists. We exploit this salary schedule change to study the impact of a positive wage shock on dental labor supplied to the VA, within a difference-in-differences framework. We find limited effects on VA separation and new hire rates overall-though early career dentists appear more sensitive to the wage change. More generous pay has its clearest effects on employment type for VA dentists, reducing the likelihood of being part-time by roughly 10%.

The VA Caregiver Support Line: A Gateway of Support for Caregivers of Veterans.

In passing the Caregivers and Veterans Omnibus Health Services Act of 2010, Congress created a legislative mandate for the Veterans Administration (VA) to strengthen its program of support services for caregivers of veterans. As part of this expansion, the VA implemented a nationwide toll-free telephone Caregiver Support Line (CSL). The CSL is a single point of entry system to link caregivers to national and local services to support care of a veteran. This article describes the CSL and its role in supporting aging veterans and their caregivers, discusses social workers' contributions to its development and implementation, and reports utilization data.

Military healthcare professionals' experience of transitioning into civilian employment: A heuristic inquiry.

BACKGROUND: Armed forces are reinventive institutions that shape the identity of their members. Leaving the military involves an adjustment to civilian employment that may be turbulent at times. OBJECTIVE: The aim is to understand the experiences of self and other military healthcare professionals' midlife career transitions. METHODS: This qualitative study applied heuristic inquiry research methods. This included a thematic analysis of the researcher's personal experience (diary and reflections) combined with data from interviews or communication with other veterans (n = 10) within a creative synthesis. RESULTS: The themes identified within the study were: The tipping point for leaving; adjustment as a veteran; progression within a new workplace. We experienced a divergence in values away from military service leading to a tipping point for leaving that was followed by a triple whammy of uncertainty about leaving, insecurity in a new job, and loss of identity that impacted mental wellbeing and needed to be overcome. CONCLUSION: This study has revealed new insights about being a military veteran and transitioning to civilian employment. These insights could lead to changes in how veterans prepare for a midlife career change, retention of personnel within military forces, and how civilian employers support veterans.

RE-AIM applied to a primary care workforce training for rural providers and nurses: the Department of Veterans Affairs' Rural Women's Health Mini-Residency.

Introduction: Application of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate workforce education and training programs targeting clinical health care staff has received relatively little attention. This paper aims to contribute to this area with RE-AIM findings from a women's health-focused workforce training program implemented by the U.S. Department of Veterans Affairs (VA). Over the past two decades, the rapid expansion of the women Veteran population in VA has necessitated a quick response to meet clinical demand. To address this health care need, the VA Offices of Rural Health (ORH) and Women's Health (OWH) partnered to deploy a primary care workforce development initiative for Rural Providers and Nurses-the Rural Women's Health Mini-Residency (Rural WH-MR)-to train VA clinicians in rural locations in skills for the care of women Veterans. Here we assess the applicability of RE-AIM as an evaluation framework in this context. Methods: We evaluated the Rural WH-MR, relying on a primarily quantitative approach, rooted in RE-AIM. It included longitudinal and cross-sectional measurements from multiple quantitative and qualitative data sources to develop selected metrics. Data collection instruments consisted of pre-, post-, and follow-up training surveys, course evaluations, existing VA databases, and implementation reports. We developed metrics for and assessed each RE-AIM component by combining data from multiple instruments and then triangulating findings. Results: Results from the Rural WH-MR program for fiscal years 2018-2020 indicate that RE-AIM provides an instructive evaluation framework for a rural workforce training program, particularly in eliciting clarity between measures of Reach vs. Adoption and focusing attention on both provider- and patient-level outcomes. Discussion: We describe evaluation metric development and barriers to and facilitators of utilizing RE-AIM as an evaluation framework for a provider- and nurse-facing intervention such as this workforce training program. We also reflect upon RE-AIM benefits for highlighting process and outcomes indicators of a training program's success and lessons learned for evaluating rural workforce development innovations. Several of our observations have implications for training and evaluation approaches in rural areas with more limited access to health care services.

Female Family Physicians Are More Racially Diverse Than Their Male Counterparts in Federal Sites.

Supporting a diverse family physician workforce is an integral component of achieving health equity. This study compared the racial/ethnic composition of Federal family physicians (Military, Veterans Administration/Department of Defense) to the entire cohort of family physicians and stratified by gender. Female family physicians serving at Federal sites were more diverse than the overall population of female family physicians and, also than their male Federal counterparts. This gendered trend among Federal physicians needs further exploration.

Informal Caregiver Support Policies Change Use of Vocational Assistance Services for Individuals With Disabilities.

Support policies for caregivers improves care-recipient access to care and effects may generalize to nonhealth services. Using administrative data from the U.S. Department of Veterans Affairs (VA) for veterans <55 years, we assessed the association between enrollment in a VA caregiver support program and veteran use of vocational assistance services: the post-9/11 GI Bill, VA vocational rehabilitation and employment (VR&E), and supported employment. We applied instrumental variables to Cox proportional hazards models. Caregiver enrollment in the program increased veteran supported employment use (hazard ratio = 1.35, 95% confidence interval [1.14, 1.53]), decreased VR&E use (hazard ratio = 0.84, 95% confidence interval [0.76, 0.92]), and had no effect on the post-9/11 GI Bill. Caregiver support policies could increase access to some vocational assistance for individuals with disabilities, particularly supported employment, which is integrated into health care. Limited coordination between health and employment sectors and misaligned incentives may have inhibited effects for the post-9/11 GI Bill and VR&E.

US Department of Veterans Affairs Post-Baccalaureate Registered Nurse Residency: Developing Nurses Equipped with Knowledge and Skills to Care for Nation's Veterans.

Nurse residency programs were developed to improve novice nurse competencies, mitigate burnout, lower recruitment costs and nurse attrition, and the quality of patient care. The Office of Academic Affiliations (OAA), US Department of Veterans Affairs (VA), established a 12-month postbaccalaureate nurse residency (PB-RNR) program at 49 sites to develop competent, confident, practice-ready registered nurses equipped with the knowledge and skills to care for veterans. The OAA evaluation of the PB-RNR program demonstrated improved new nurse graduate competence, confidence, recruitment, and retention rates after completion of training at participating VA medical facilities.

'The face of the programme': How local clinicians shape decisions about eligibility for a national caregiver support programme in the USA.

OBJECTIVE: To examine the causes of variation for determining clinical eligibility for a national caregiver programme in the US Veterans Health Administration (VHA) and so help inform standardization of clinical eligibility assessment for support and establish conditions for more consistent caregiver experiences across the USA. METHODS: We used mixed methods, including a national survey of caregiver support coordinators (CSCs) across VHA medical centres, semi-structured interviews with a purposive sample of 53 CSCs and interdisciplinary team members, and observations of four VHA medical centre sites. RESULTS: A majority (70%) of CSCs across VHA medical centres reported that they used interdisciplinary teams to conduct assessments. Interdisciplinary teams were seen to help mitigate potential harm to therapeutic relationships from eligibility decisions. Survey respondents reported using a range of assessment tools provided by the national VHA Caregiver Support Program office, but participants expressed concerns that the tools did not necessarily effectively assess clinical need. Some local sites had developed innovative person-centered approaches, in which the assessment process provided an opportunity to assess veterans' holistic clinical needs, in contrast to a programme-centered approach, which focused on assessing whether veterans/their caregivers meet eligibility criteria. CONCLUSION: Discretion by those involved in making decisions on programme eligiblity is important for implementing a national social services programme based on clinical need. Interdisciplinary teams can help mitigate potential harm to therapeutic relationships. Discretion allows for innovation. This work has implications for setting policy in other programme contexts in which applying eligibility criteria requires clinical judgement.

Facilitators and challenges to military undergraduate nursing student success.

BACKGROUND: Understanding the broader community of educators and programs involved in the education of military nursing students (MNSs) is needed to develop best practices that support their academic success. PURPOSE: The purpose of this study was to 1) identify factors nursing faculty perceived would facilitate and/or challenge the success of MNSs when transitioning to and progressing through baccalaureate nursing programs, and 2) ascertain successful strategies used in teaching and working with these students. METHODS: A descriptive survey research design was used to collect data from faculty at 26 schools of nursing that received federal funding to support the transition of veterans to a career in nursing. Quantitative and qualitative data were collected, analyzed, and integrated via descriptive statistics and content analysis. RESULTS: The survey was completed by 88 faculty from 19 of the 26 schools. The top four categories for both the facilitators and challenges, based on Jeffreys' (2015) NURS Model, were student affective characteristics, student profile characteristics, professional integration factors, and environmental factors. Programmatic factors were the most commonly cited success strategies, including having culturally competent, knowledgeable, and designated faculty and staff for MNSs. CONCLUSION: Developing evidence-based strategies to use in teaching and advising MNSs ideally will ensure their academic success.

Determinants of Workforce Preparedness during Pandemics Among Healthcare Workers at the U.S. Department of Veterans Affairs.

OBJECTIVE: An infectious disease outbreak can place a significant burden on healthcare systems, however, our understanding of the broader healthcare workforce's preparedness during a pandemic is limited. This study examines factors that influence perceived workforce preparedness at the U.S. Department of Veterans Affairs (VA) during a pandemic. METHODS: The VA Preparedness Survey was a random, anonymous, web-based survey fielded nationwide October to December 2018. Multivariate statistical analyses examined the effects of study relevant factors (sociodemographic, work-related, general health, and household-related characteristics of VA employees) on perceptions of workforce preparedness, including institutional readiness and understanding of individual roles during a pandemic. RESULTS: Four thousand and twenty-six VA employees responded. Overall, 55% were confident in their VA medical facility's ability to respond; 49% understood their role; and 68% reported their role to be important during a pandemic. After controlling for study-relevant factors, household preparedness, having plans that address the health care needs of family members, and higher self-reported health status were associated with all 3 workforce preparedness variables. Clinical staff (compared to non-clinical staff) were less likely (OR:0.80, 95% CI:0.68-0.94, P < .01) to have confidence in their medical facility's ability to respond but more likely (OR:1.77, 95% CI:1.49-2.10, P < .001) to believe their role was important. Employees who have been at the VA longer (OR:1.07, 95% CI:1.01-1.14, P < .05) or have experienced a disaster while working at the VA (OR:1.29, 95% CI:1.04-1.59, P < .05) were more likely to understand their role during a pandemic. CONCLUSION: The findings from this study suggest the need for identifying ways to increase VA employees' confidence in their medical facility's ability to respond to a pandemic; develop trainings to improve understanding of their different yet critical roles, for both clinical and non-clinical staff, during a pandemic; create different workforce trainings for newly hired employees; and identify ways to improve household preparedness for a pandemic outbreak.

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives.

BACKGROUND: With the restructuring of primary care into patient-centered medical homes (PCMH), researchers have described role transformations that accompany the formation of core primary care teamlets (eg, primary care provider, registered nurse care manager, licensed practical nurse, medical support assistant). However, few studies offer insight into how primary care teamlets, once established, integrate additional extended team members, and the factors that influence the quality of their integration. METHODS: We examine the process of integrating Clinical Pharmacy Specialists (CPS) into primary care teams in the Veterans Health Administration (VHA). We conducted semi-structured interviews with CPS (n = 6) and clinical team members (n = 16) and performed a thematic analysis of interview transcripts. RESULTS: We characterize 2 ways CPS are integrated into primary care teamlets: in consultative roles and collaborative roles. CPS may be limited to consultative roles by team members' misconceptions about their competencies (ie, if CPS are perceived to handle only medication-related issues like refills) and by primary care providers' opinions about distributing responsibilities for patient care. Over time, teams may correct misconceptions and integrate the CPS in a more collaborative role (ie, CPS helps manage disease states with comprehensive medication management). CONCLUSIONS: CPS integrated into collaborative roles may have more opportunities to optimize their contributions to primary care, underscoring the importance of clarifying roles as part of adequately integrating advanced practitioners in interprofessional teams.

An Innovative Approach for Graduate Education for Psychiatric Nurse Practitioners.

A major transformation in nurse practitioner (NP) education is the emergence of post graduate residencies; their foci include (a) educating NPs in population health; (b) increasing clinical proficiency; and (c) incorporating quality and safety into practice. We describe a psychiatric NP residency program supported by an academic-practice partnership, known as the Veterans Affairs Nursing Academic Partnership for Graduate Education (VANAP-GE) between the Birmingham Veterans Administration Medical Center (BVAMC) and the University of Alabama at Birmingham (UAB) School of Nursing (SON) for a population of Veterans with complex mental and physical health needs. Topics which are covered include risks of suicide among Veterans, post-traumatic stress disorder, depressive and anxiety disorders, and substance use disorders. During this one-year traineeship during the first year after NP certification, residents engage in development of crucial skills for improving the future of U.S. health care. All residents are newly licensed PMHNPs, but some are also pursuing DNP degrees. For residents who are simultaneously enrolled in BSN to DNP programs, the additional clinical training afforded by NP residency education provides a natural laboratory for their projects with foci of quality and safety, leadership, and clinical scholarship. Reduction in NP turnover as well as cost savings of orientation and recruitment are significant benefits for the practice partner with zero vacancies since the partnership's inception. These multiple successes predict increased establishment of residencies as viable post graduate pathways for NPs.

Mapping the reach of a rural Transitions Nurse Program for veterans with geographic information systems.

PURPOSE: Rural Veterans who receive inpatient care at a Veterans Health Administration (VA) tertiary facility can face significant barriers to a safe transition home. The VA rural Transitions Nurse Program (TNP) is a national, intensive care coordination quality improvement program for rural Veterans. To communicate the reach of TNP into rural communities, we developed geographic information system (GIS) maps. This study evaluated TNP transitions nurse and site champion perceptions of GIS as a communication tool for illustrating the reach of TNP into rural communities. METHODS: Using residence information for TNP enrollees, we built GIS maps using ArcGIS Enterprise, a mapping and analytics platform. Residential addresses were matched to Rural-Urban Commuting Area geographical categories. Transitions nurse and site champion perceptions of the local and national GIS maps were assessed through surveys and interviews. The data were analyzed using descriptive and content analytic methods to identify themes. RESULTS: Transitions nurses and site champions perceived GIS maps as a valuable, easy to understand, acceptable, and appropriate communication tool to illustrate the reach of TNP into rural communities. Interviews revealed three common themes: a picture is worth a thousand words, the GIS maps are an effective communication tool, and the GIS maps revealed surprising and promising information. CONCLUSIONS: GIS is a useful communication tool to support to illustrate the reach of an intervention. The GIS maps engaged transitions nurses and site champions in discussion. The availability of open access software programs and publicly available location data will increase access to GIS for researchers and practitioners.

Gender and compensation among surgical specialties in the Veterans Health Administration.

BACKGROUND: A gender pay gap has been reported across many professions, including medicine. METHODS: Surgeons employed at complex Veterans Affairs Medical Centers (VAMC) nationwide in 2016 were identified. Data on salary, gender, years since medical school graduation, professorship status, h-index, and geographic location were collected. RESULTS: Of 1993 surgeons nationwide, 23% were female. On average, female surgeons had significantly lower salaries compared to male surgeons ($268,429 ± 41,339 versus $287,717 ± 45,379, respectively; p < 0.001). Among each surgical specialty, there were no significant differences in salary on univariate analysis. Women were underrepresented in higher paying specialties and more heavily represented in lower paying specialties. On multivariate analysis, gender (p < 0.001), time since medical school graduation (p < 0.001), surgical specialty (p = 0.031), h-index (p < 0.001), and geographic location (p < 0.001) were significant predictors of salary. CONCLUSION: Female gender significantly predicted lower salary among VAMC surgeons, however within each surgical specialty, there was no significant gender pay gap. SENTENCE SUMMARY: Independent predictors of salary included gender, surgical specialty, experience, h-index, and geographic location. Although female surgeons had lower overall salaries compared to male surgeons in the Veterans Health Administration (VHA), there were no significant gender differences in salary among each surgical specialty. Pay transparency, unique to the VHA, along with the use of rational and objective criteria to establish and adjust salaries, may play a role in reducing the gender pay gap among VHA surgeons.

The Impact of Job Role on Health-Care Workers' Definitions of Patient-Centered Care.

While patient-centered care (PCC) is a widely accepted aspect of health-care quality, its definition is still the subject of debate. We investigated health-care workers' definitions of PCC by level of patient contact in job roles. Our qualitative study involved semi-structured interviews with key stakeholder employees (n = 66) at 6 Veterans' Affairs health-care locations in Southern California. Interviews were recorded, transcribed, coded for definitions of PCC, and analyzed by participants' self-described level of patient contact. Stakeholders whose role primarily involved patient contact tended to define PCC through: patient as a person, patient preferences, and shared decision-making. Stakeholders whose role did not primarily involve patient contact tended to define PCC through: patient-centered redesign, customer service, and access to services. Stakeholders with more patient contact emphasized patient-level and interpersonal concepts, while those with less patient contact emphasized system-level and business-oriented concepts. The focus on PCC-as-access may reflect influence of changing institutional climate on definitions of PCC for some stakeholders. To facilitate successful PCC efforts, health-care systems may need to leverage differing but complementary definitions of PCC within its workforce.

Daniel Ruge: the first neurosurgeon to serve as physician to the president.

The role of chief White House physician has traditionally been held by an individual with a background in a broad medical field, such as emergency medicine, family medicine, or internal medicine. Dr. Daniel Ruge, who served as the director of the Spinal Cord Injury Service for the Veterans Administration and was appointed during President Ronald Reagan's first term, was the first neurosurgeon to become the chief White House physician. Aside from being the first neurosurgeon to serve in this capacity, Dr. Ruge also stands apart from others who have held this esteemed position because of how he handled Reagan's care after an attempt was made on the then-president's life. Instead of calling upon leading medical authorities of the time to care for the president, Dr. Ruge instead decided that Reagan should be treated as any trauma patient would be treated. Dr. Ruge's actions after the assassination attempt on President Reagan resulted in the rapid, smooth recovery of the then-president. Daniel Ruge's background, his high-profile roles and heavy responsibilities, and his critical decision-making are characteristics that make his role in the history of medicine and of neurosurgery unique.

Nursing Professionals within the Intergenerational Context during the 20th and 21st Centuries: an Integrative Review / Los profesionales de enfermería en el contexto intergeneracional durante los siglos XX y XXI: una revisión integradora / Profissionais de enfermagem no contexto intergeracional durante os séculos XX e XXI: uma revisão integrativa

Objective. To describe the generational differences and similarities existing among nursing professionals of the 20th and 21st centuries and how these have influenced on the evolution of the profession. Methods. Integrative review according to the methodology by Whittemore and Knafl. The key words used for the search were: nurses, intergenerational relations, Veterans, Baby Boom, X generation, and Millennials. Results. The electronic search process yielded 10 documents (eight articles and two theses), all within the Anglo-Saxon environment (4 in Canada, 5 in the United States, and 1 in Australia). The documents recovered determined three principal themes: the intergenerational nursing workforce (n = 7), recruiting and retention within an intergenerational workforce (n = 2), and tutoring within an intergenerational nursing workforce (n = 1). The four generations of nursing professionals (X, Y, Baby Boomers, and Veterans) have different aptitudes, social and cultural setting, that coexist within the same work staff. Conclusion. This study establishes the legitimacy of the intergenerational differences as an important variable of social categorization. The findings have the potential to improve generational comprehension and promote a more cohesive culture in clinical practice settings, besides conserving the legacy of the four generations of nursing professionals contributing to outline the identity of the nurses through the conservation of social, cultural, and professional experiences.

Objetivo. Describir las diferencias y similitudes generacionales existentes entre los profesionales de enfermería del siglo XX y XXI y cómo han influido en la evolución de la profesión. Métodos. Revisión integradora según la metodología de Whittemore y Knafl. Las palabras clave utilizadas para la búsqueda fueron: enfermeras, relaciones intergeneracionales, Veteranos, Baby Boom, generación X y Millennials. Resultados. El proceso de búsqueda electrónica dio como resultado un total de 10 documentos (8 artículos y dos tesis), todos ellos en el ámbito anglosajón (4 en Canadá, 5 en Estados Unidos y 1 en Australia). En los documentos recuperados se determinaron tres temas principales: la fuerza de trabajo de enfermería intergeneracional (n = 7), el reclutamiento y la retención dentro de una fuerza de trabajo intergeneracional (n = 2) y la tutoría dentro de una fuerza laboral de enfermería intergeneracional (n = 1). Las cuatro generaciones de profesionales de enfermería (X, Y, Baby Boomers y Veteranos) tienen diferentes aptitudes, entorno social y cultural, que conviven dentro de un mismo equipo de trabajo. Conclusión. Este estudio establece la legitimidad de las diferencias intergeneracionales como una importante variable de categorización social. Los hallazgos tienen el potencial de mejorar la comprensión generacional y fomentar una cultura más cohesiva en entornos de práctica clínica, además de conservar el legado de las cuatro generaciones de profesionales de enfermería lo que contribuye a perfilar las señas de identidad de las enfermeras mediante la conservación de experiencias sociales, culturales y profesionales.

Objetivo. Descreva as diferenças e semelhanças geracionais entre os profissionais de enfermagem dos séculos XX e XXI e como elas influenciaram a evolução da profissão. Métodos. Revisão integrativa segundo a metodologia Whittemore e Knafl. As palavras-chave utilizadas para a busca foram: Enfermeiros, relações intergeracionais, Veteranos, Baby Boom, Geração X e Millennials. Resultados. O processo de busca eletrônica resultou em um total de 10 documentos (8 artigos e duas teses), todos da área anglo-saxônica (4 no Canadá, 5 nos Estados Unidos e 1 na Austrália). Três temas principais foram identificados nos documentos recuperados: a força de trabalho de enfermagem intergeracional (n = 7), recrutamento e retenção dentro de uma força de trabalho intergeracional (n = 2) e tutoria dentro de uma força de trabalho de enfermagem intergeracional (n = 1). As quatro gerações de profissionais de enfermagem (X, Y, Baby Boomers e Veteranos) possuem diferentes aptidões, meio social e cultural, que convivem dentro de uma mesma equipe de trabalho. Conclusão. Este estudo estabelece a legitimidade das diferenças intergeracionais como uma importante variável de categorização social. Os resultados têm potencial para melhorar a compreensão geracional e fomentar uma cultura mais coesa no cenário da prática clínica, além de preservar o legado das quatro gerações de profissionais de enfermagem, ajudando a moldar a identidade do enfermeiro por meio da preservação de experiências sociais, culturais e profissional.

US veterans and their unique issues: enhancing health care professional awareness.

United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18-44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies, and utilizes veteran clinical faculty.