#29 Navy L&D Nursing with Joshua Womack

Same.

And I didn’t even know… It just kind of blew my mind a little bit and I was like, “We have to learn more.” The session wasn’t even about that at all, but that little piece, I was like, “I need more.”

We both looked at each other and we were like, “Wait, we got to get, get him on the podcast.” So I am excited to introduce Josh Womack, who works in the Navy as a labor and delivery nurse, and he is going to give us all the ins and outs of what it’s like to work for the military and teach us all the abbreviations. Because I know there was an abbreviation that I just missed right there. And I’m excited to learn with all the listeners here. So if, Josh, if you want to introduce yourself and we’ll just get going.

Yeah, thank you for having me on. I’m Josh Womack. I’ve been in the Navy since 2012 now, so a little over 11 years. It’s all been in perinatal, some form or fashion. Mostly LDRPs, for the most part, is what we have in the Navy. We do have a couple of medical centers where we have a labor and delivery and postpartum. I’m originally from Alabama. I’m married to my husband, Michael, for eight years. We met at my first duty station, was in Pensacola. We’ve been to Spain, lived in Spain for three years, lived in San Diego, Virginia, Florida. I’m currently a clinical nurse specialist on labor and delivery, and we’re currently stationed in Portsmouth, Virginia, which is in Hampton Roads, kind of where most people know Virginia Beach. So that’s kind of where we live right now. Been here about two and a half years and I’m headed to Cuba in September. So that’s the next thing.

Well, that is so cool. And I already see a huge advantage of working in the military, which we’ll talk about soon, but I got to-

Seriously.

Right. I got to say that when you said 2012, I was like, “Oh, okay, five years,” and then you said 11 and I was like, oh my gosh.

I know, right?

So time is running away from me, first of all. But okay, so thank you for that introduction. You have lived around a lot of places. Cuba, that’s exciting. Are you excited about Cuba? Did you get to choose Cuba?

Sort of. Every place that we go, it’s considered a tour. If I were single and it was an overseas tour, those for the Navy, and again, every service is a little bit different, so I can only kind of talk, I can talk some about the Armed Forces, a lot about the Navy. And so two years would be normally what you do if you’re married or you have kids, it’s three years when you go overseas. So we normally will call our detailer, is what they’re referred to. They’re headquartered in Tennessee and they kind of have a whole repository of like, we have subspecialty codes for labor and delivery or ICU or peri-op. So my name is attached and I’m a 1920, which means I’m an L&D nurse. So they look and they see where do we need 1920s a year from now? And based on whatever my skillset is, so what my rank is and what my skillset is, then they’ll say like, “Hey, here are the three places where we need somebody.”

And Cuba was, because it is remote and you really just pretty much have to stay on base, you don’t really get to travel around in Cuba, that’s just 12 month orders. So my husband is also a nurse, he’s civilian, is what we would say. So he works in a civilian hospital nearby, he’s peri-op. So he kind of just got started and we just wanted a kind of shorter assignment to figure out what was going to be next, so Cuba was the best fit for me because it’s just a 12-month assignment. So I’ll be down there by myself, but he’ll get to come and-

I know you have a hundred questions prepared, Justine, but I am itching at my … every inch of me. I have so many questions. I have to know, because I didn’t know you could … I know, obviously we know about military. I grew up with military kids because I grew up overseas and a lot of them went to my school. That’s pretty much my only frame of reference. So I am dumb when it comes to this world and I’m sure I’m not alone in that. I hope I’m not alone in that. Somehow I missed it along the way. How the heck do you get into this and decide, to me, it’s like you either decide to go into the Armed Forces, we’ll say the Navy in this case, first of all, how did you decide the Navy and then how do you also, then you’re like, “But I also want to be a nurse and then I want to do that to get,” like what … how? Tell us how. I am dying.

Yeah, so everybody’s a little bit different. A lot of the time, somebody, they might have had a family member, so they knew it. I was in nursing school already, and to be honest, I just needed the career stability. Plus you would get, there’s different programs on how you can commission as an officer to get into there. And I needed the money for school and I kind of got this stipend while I was in nursing school and a bonus. And then you’re kind of contracted for four years or something like that afterwards.

So that’s kind of how I got into it. I had family that was in the Navy, I was already in nursing school, and the Navy had a program for it. And there’s different programs that you can do in the Armed Forces. So for the Navy, you can direct a session, you can already be a nurse and then join. You can do nurse candidate program, which is what I did. Or you could be prior enlisted. And so those are people who are already enlisted in the military. It’s like an enlisted officer program, where then the Navy pays for your nursing school. And then there are people who go to gen nursing school and are a part of, you might have heard of ROTC, like that different colleges will have. And so they get into the nurse corps via ROTC.

So there’s lots of different ways. So mine was the nurse candidate program. I was already in there. It really, really wasn’t on my radar until I had just had conversations with people that were in the Navy and met a Nurse Corps officer. They come to the school and I chose Navy because of the duty stations. There’s really nothing amazing about how I chose it. I always love to be around water. And so I was like, “Well, this makes the most sense.”

Okay, I have two questions. One, is it true that you’re an officer automatically because you’re a nurse?

So whenever you’re in the Nurse corps? Nurse Corps is an Officer corps. So we’re considered Staff Corps, so we support the fleet. The fleet would be the Navy. So we’re kind of a support corps. And when I started, when I took my oath and my active duty service started, I was considered commission at that point in time and then started off as officer.

And then did you have to go through a bootcamp? Did you learn how to use a gun?

That’s my question.

I have so many questions.

Do you have to go through the physical training and die? That would really freak me out. It’s good for being in shape, but …

No, no, no.

Okay, good.

Yeah, so-

Well, I mean maybe good.

Yeah, yeah. Well, I guess it depends on what, but so whenever you’re enlisted is really kind of that bootcamp that we all think of with pop culture. And so whether you’re an Army, Marine, Navy, they all have different places where they do their bootcamp. So bootcamp is an enlisted thing. So when it comes to officer, there’s two different, there’s officer candidate school and there’s officer development school. And so officer candidate’s school is kind of when you think of somebody, and again, I can only really talk about Navy, but surface warfare, or if you wanted to be a pilot and that kind of stuff, you go through the candidate school and that is going to be, it’s longer. And then at the very end, you commission as an officer because you’ve gone through it. So you’re an officer candidate.

Officer development school is a lot of that support corps that I was telling you. So if you’re a lawyer, if you’re a doctor, a physical therapist, a pharmacist, all of these things where you’ve already gone to your professional school and you’re going to be in the military in that capacity, you commission first and then you go to ODS, is what we call it, it’s in Newport, Rhode Island. And it’s shorter, it’s just a little over a month. And we jokingly call it knife and fork school because it’s really just meant to tell you, it’s like how to be an officer, how to wear a uniform. There’s definitely physical stuff in there. You do firefighting and you can do fun things like that. But a lot of it’s really just to get you acclimated to what it is to be in the military and to be an officer. For the most part, that’s kind of what it is. It’s an abbreviated …

So do you learn how to shoot a gun? And I’m also wondering, do you learn, I’m thinking, this is so silly, I’m thinking of …

Naive.

Cadet Kelly on Disney Channel. So am I going to learn how to put a gun together? This is where my level …

No. No. They will do … There are definitely other, depending on, after you’re done and you go to wherever you’re stationed, and depending on whatever your specialty is, there’s additional trainings that you can do depending on where you’re going to be, like a Torah, and as a nurse, and those kind of things. So if there is additional training that is required to include those kind of things, that’s done kind of separately, if that makes sense.

You can see that, it totally makes sense, and you can see that the military needs better marketing strategists because we know nothing here.

Yeah, literally nothing.

So military, if you are listening,

I know.

Well, and it’s a part of the reason why you’re here, which is such good exposure for us too, because I think we get boxed in and this may be something that somebody has been interested in and they just don’t know enough about it. So then you go to your, I’m going to call it bootcamp just because that’s like you went to bootcamp and then you did your nursing school, you’re commissioned, and then the idea though is that then you would go work in a military hospital, wherever there are military hospitals everywhere for the US?

Correct. So become military treatment facilities. And so Navy’s got all of their MTFs, so we love our abbreviations. And so Navy’s got theirs, Air Force has theirs, and Army. And so your services will staff those specific places and it can be within the United States or CONUS, the continental United States, or OCONUS, overseas.

And so depending on where it is, and we have hospitals everywhere around the world, and the hospital’s resources might vary. There might be places where you can be an L&D nurse as an Air Force only, there may be places where you could be Air Force and Navy and work at that MTF. So it just kind of varies. So yes, we help staff that, but there are also civilians that work at the MTFs who get hired on by the government because they really are our glue because we’re constantly rotating every two to three years. And they’re the ones that are supposed to stay there for the continuity and to help train us and tell us like, “Oh, that doesn’t work. We tried that 10 years ago,” and so we can’t just be good idea fairies everywhere we go.

So they kind of keep us grounded and then we have a duality of mission. We should be able to leave on a moment’s notice and you don’t want to gut a hospital.

Yeah, for sure.

That makes sense.

I remember talking to you when we met in person that civilians also get to go to different bases once you’re in that role.

Yeah. Yeah, once you’re in that system, and you’ll see this a lot if somebody has a spouse who’s a military, who’s in the military in any capacity. And so I’ve had somebody here where I’m working, this is her fourth MTF that she’s worked at, and she’s always been L&D everywhere she’s gone. And she’s done different services, so she was able to be at a Army MTF, and now she’s here at a Navy one. So I mean you can. Just like anything, it depends on what the availability is. But once you’re in the system, it’s a little bit easier to move around. And we have a nurse who’s returning back and she had, she’s been to Germany and that’s where she worked for a little while.

That’s cool.

Came back.

What are the perks? Why would I not just be a civilian versus joining the Army directly? What are the different perks that you get versus a civilian?

The perks of being in the military?

Mm-hmm.

So I would say if you … this is something that me and my husband, Michael, talk about a lot, that keeps us kind of in it, has been if you really just enjoy that adventure of like you don’t want to settle down in one place, that for somebody can be also the reason why they’re like, “This is not for me. I have small kids and I don’t want to have to,” or if anything, I have high schoolers and they’re already adjusted to this place. So for me, that’s part of what I enjoy about it, is that I get to do all that. Plus you get a lot of different training opportunities because you’re operational. And so doing a tactical combat course, that’s not something, and you do it as a nurse. You’re learning what you’re doing on the battlefield. And so as an L&D nurse outside of the military, that opportunity wouldn’t necessarily be there.

Wait, so you’re like simulating delivering a baby in a battlefield?

No, no, no, no.

Oh.

Like I would be …

I was like, “Wow.”

No, that would be ideal. But no, that would be more, it’s more of a like, “Hey, you’re going to go with these folks and you’re there as a nurse.

Gotcha.

Even though your background is L&D. And so there’s lots of different training opportunities, plus the opportunities of like my grad school was paid for.

Yeah, that’s super cool.

When I went and got my clinical nurse specialist, that was just my full-time job for two years, was just to be a student and I was getting paid the whole time. So I would say those are-

Oh, wow.

Those are some of my biggest, like right off the top of my head, perks.

Yeah.

Sarah, do you have any other questions about that specifically because I have a question about L&D.

I have something.

Yeah, say … what do you have?

Well, I want to know about the whole military hospital. What’s the difference between the military hospital and a regular hospital, whatever your abbreviation is? Is it just serving people in the military as a resource to them or what’s that about?

So the military hospitals, for the most part, when you walk in here, you would think this, we have everything, well, depending on what the resources are. Is it a medical center? Is it someplace a hospital that’s just in Spain, but we’re here to serve the beneficiaries. And so that is the active duty personnel, their families, retirees, and so we’re their hospital. And so you have a full pharmacy, we got a NICU and L&D because I mean, if you think about it, most of your active duty folks are people who are starting their families. And so that’s really what we’re trying to be here for so that they can get their whole care within that military system.

Other than that, not very big differences as far as what the composition of the hospital is. You might have one of the clinics, called a deployed clinic or something like that, something that sounds really weird, but really it’s just a primary care clinic for the active duty folks only, not just the beneficiaries. So those are some small nuances, but for the most part it looks like anything that you would see out in the civilian world.

I’m like, I’m just envisioning the world. That basically what I’m hearing is that, and I’ve known this because I also, I’ve worked with military clients, where they have active, they are in one of the Armed Forces or they’re spouse is, or they’re stationed overseas. I’ve had Japan and Germany and Spain as one of them off the top of my head. So my context is from the client side more than anything, and so I’m thinking about how many active duty military are there around the world? I don’t know if you know those numbers off the top of your head, but it sounds like there’s this whole subset culture of hundreds of thousands of people all over the world, we’ll say from the US because that’s where we are and where we’re from, that basically it’s like this own little world where they have these resources at their fingertips, one of them being obviously medical. Is that, am I getting it right?

Yeah. No, no, no, you’re completely, you’re very right. So when I go to Cuba or when we were in Spain, you have your base and your base has a school on it and it’s got a hospital, I’m going to Cuba and I’m going to Cuba as an L&D nurse. I’m not going there for detainees or doing anything like that. So it is just there because there are families there and there’s the possibility that somebody could get pregnant and just depending on what her pregnancy is, if she’s very low risk and stuff, we could deliver them there. So there’s an OBGYN and three nurses.

And so depending on how big that base is and what the demand is and what the resources are, we’ll tell us how many L&D nurses do I need? How many OBGYNs do I need? Do we offer MFM here? Can you go overseas? Because everybody who does get stationed overseas, both active duty person and their family gets screened, they kind of say everything is good for us to go over there if we wanted to start a family. And so-

This is so cool. Sarah, I’m putting in my two weeks, I got to go to the military.

Stop it right now. You should have told her she has to do a very intense boot camp.

Right. Then I would be out. You told me I didn’t, so …

I know.

You do-

I’m stressed about running a mile. Don’t make me do that in front of anyone. I avoid that at all costs.

It’s funny that you’re talking about that because we get, I mean annually it used to be twice a year, but right now COVID kind of changed some stuff, but you got to do your weigh in once a year and be within a certain body composition, and then we do physical fitness tests. And so I have to do at least 50 pushups in two minutes and hold a plank for two minutes and …

All right, I’m out.

Run a mile

Thank you for that. Oh my gosh. That’s like elementary PE trauma for me. That’s what they were preparing us for.

Yep. Yeah, well-

In elementary school, was this.

It’s so nice though because this year I go up an age bracket, so that means my requirement for X amount of pushups or planks or whatever kind of goes down. So you’re grouped in 30 to 34, 35 and whether or not you’re a male or a female.

Okay, I’m assuming your husband doesn’t have to do these though, so that’s an advantage to be a civilian.

Correct. He does not have to any of that.

He doesn’t have to weigh in. I feel like that’s pretty traumatic.

You get a 10-week notice. So that’s what I was saying. I just got my 10-week notice today. Because a lot of people are-

Okay. So it starts today.

Yeah, I’m going to Orange Theory after I get off.

That’s great.

That’s part of my training.

I mean, it’s a good way to stay healthy. I think nurses need that.

Yeah, it is.

For sure. I’ve been thinking about, so we have a few mentees that have taken our mentorship program that are married to military nurses. I don’t think they were ever active military themselves, but they work as L&D nurses on the bases. And one of the unique challenges that I didn’t realize, and maybe listeners too, is a lot of times, and maybe it’s only sometimes you have a lot of patients that are delivering alone, where their significant other is deployed. And so I was curious if that’s common, how you guys handle that, what’s the emotional support that you have to give specifically as that’s good person for them?

I’ve seen that on the client side as well, and that’s why they’ve brought me in because they’re totally alone.

Yeah. We definitely … it’s dependent upon where I have been stationed, to be honest, because a lot of it, for example, like in Spain there were a lot of spouses who their active duty member was a part of something that was going to be deploying a whole lot, versus where I was in Florida, that wasn’t as common. So I tended to always have the family there for the most part. And when you’re in the states, a lot of the times family can come to you. So overseas was where I saw it the most. And we’ve done everything from FaceTiming to hooking up, like figuring out how do we get in touch with the command that they’re at to try to make sure that they can watch this with them.

So there is a lot of stuff. And then of course it just makes it a little bit difficult whenever you are military and government because they’re privacy and security and doing those kind of things. So there is a lot of extra support that you end up doing. I’ll say we probably, in those places, and this again has just been my experience, it’s a slower unit and so you could give way more time to them at the bedside. It felt a little more manageable to not only be their L&D nurse, but really be there to support them and give them that. And I’ve seen over my 11 years just the use of doulas within the hospital and on bases, even overseas, other spouses that were getting that training so that they could become a part of like … a resource for that hospital’s unit.

How open is the military? And it probably just depends on the assignment for the support person or spouse to just drop what they’re doing and flyback? Like I’ve seen that in TOS recently. What’s the realistic logistics of that?

The experience that I’ve had, and this was a lot, whenever I was overseas, was having an American Red Cross message if there was something to do with your family member. And so there is a very specific way that we can go through that to get in touch with that service member’s command, depending on the severity of the situation, to get them to their family member. That is a very real thing.

Of course, the mission that they’re doing and the logistics of just getting back would probably be one of the biggest barriers, but there is a specific way that everybody knows, including all the way up the chain of command in the hospital to try to remove those barriers if that situation was so dire that they need to be right there as soon as possible. So they have definitely tried to do that.

And then we’ve just increased our parental leave. It used to be that even your support person, if they’re a service member, specifically men would get X amount of days, but now they get a full three months after they have a baby.

Nice. Wow, that’s great.

The support is there for that.

Yeah. That’s awesome.

Okay, another naive question, forgive me. And also forgive me, all the listeners that are in the military, I’m just learning.

Yeah, so sorry. Sorry we’re here.

I have zero family members in the military, not one. Okay, so Navy Seals, is that a part of, do you care for Navy Seal family members or is that a different branch altogether?

We can carry, regardless of whatever your service is.

Gotcha.

Maybe Air Force or Army, because you might be stationed somewhere as an Navy person, but the closest MTF to take care of you as Air Force or something like that.

Okay, so you’re all specialties can go to you

Come one, come all. Yeah.

Come one, come all. Okay. All right.

We support each other, but for the most part you do feel like you end up primarily serving the, I always want to say the fleet, but that’s very Navy specific, but the people who are doing the military stuff, when you think of military.

Interesting.

Have you ever you noticed any unique needs of the laboring person in this environment that you think maybe are unique to a military environment?

I think we hit on it when it comes to just the reality of the mission comes first with the service member kind of thing. That’s kind of getting away from completely invalidating somebody’s work/life balance. That was very historical military to be like, “Oh, you didn’t pack your family and your C bag,” kind of thing. So mission comes first, but we know that that is so important. It’s a part of everybody’s wellbeing, is to know that your family member is going to be taken care of. And so whereas we do try to remove the barriers if somebody isn’t there, I would say that’s probably one of the things that’s very unique. And then just if you are a service member, I don’t believe this is something only the service is struggling with, as far as staffing and those kind of things, but we’re still having the same access to care issues that everybody else, the demand is there, but sometimes the staff isn’t there.

And so in order for them to be, maybe there’s four or five outlying clinics that’s near here, but it might be 45 minutes from my house, but that’s where I’ve got to go because that’s where the primary care clinic is for Tricare and they’re accepting patients. So that might be some nuanced things.

And then just our duality of mission, we’re a very mixed bunch of staff, and so if there’s a really big thing that’s happening and active duty aren’t there, it’s going to strain the system. And that could be something that could affect, it’s definitely taken into account and plans mitigated, that kind of stuff, back up. But that’s something that I feel like is very specific to the services that you wouldn’t normally just see at a civilian side.

Like they would pull resources in the case that they needed resources somewhere else.

Right, right.

From you. And then you’d be left even more strapped than you were in the first place. I can imagine. I mean, staffing, we know is an issue everywhere, but this is a unique situation. That’s why you need civilians for it.

Yeah. Exactly.

To help fill in those gaps likely, but especially because of all the extra training and it’s not just like, “Oh, I’ll help tomorrow and yeah, I’ll join the Navy.” That’s not easy. As easy as it would be for me to be like, “Eh, you need help, I’ll pop in over there at this hospital.”

Yes, the onboarding to come in either active duty or as a civil servant, as a GS, that’s what we’ll say civilians are GS, is months. You can’t just, because you have to go through a background check, you’ve got to get all of the accesses and all of those kind of things. So it isn’t. So we do depend, I mean there’s different stuff that we call on reservists or we do have contractors that work here, they’re kind of like our travel nurses. So that’s kind of what our mix is.

But yeah, back to your original question, I think probably y’all hit it when it came to just the support aspect of being kind of isolated, especially when it comes to being overseas and what if I deliver overseas, and again, my experience in Spain and there’s no NICU, but my baby needs the NICU, and so transferring out to a local hospital where I need a translator and all of these other things that would be very unique but not uncommon.

Well, and that becomes a cross-cultural situation. I think about giving birth in Ecuador, where I grew up. That’s a completely different situation. And would it be correct to assume that these military hospitals would have access to resources, in theory, from the states. In Ecuador, epidurals are unheard of. No one gets an epidural and their C-section rate’s like 60%. But let’s say there’s a military hospital there that you … what I remember from growing up with military is that they would always have access to the best pantry snacks and they’d have Dr. Pepper and there was imported stuff in their back, wherever that, and embassy also had … embassy probably even more had a better stash of all … like a Snickers. If I wanted a Snickers, I could go to one of my friends that had access to different resources.

So can you speak to that as far as resourcing from the states? Like maybe epidural wasn’t a thing in the country that you’re in, but would they have access to that given that that’s more commonplace here?

So when it comes to the actual hospital, any place overseas, it’s going to be just what it is here. The supply chain is going through the same thing, so they always had access. Now let’s assume that because maybe they’re 29 weeks and we don’t have a NICU, so we’re transferring out to another hospital, there was a complete separate department within our hospital that became your liaison and advocate while you were out there. So that was that complete resource thing. And your physician at your hospital and the physician that was there were constantly in contact with translators. So there was some advocacy on our part, even if they got transferred out to the local hospital.

Well, and what a benefit, if your living overseas, to have all of that.

Yep. And then all the-

Rather than be left alone.

… American stuff that you would want for comfort if you were out there was all on the base. So there was always a big group of people that were bringing all the things to you. So I had to, whenever I was over there, one of my friends, she went into preterm labor, so I was the nurse on and had to ride in the ambulance with her to the hospital and got to see inside it. But she was pretty well supported that whole time she was there, and we were always welcome staying there as long as we needed to.

And if she needed Cheetos postpartum, you could deliver.

Uh huh. And those host countries are very good. The hospitals are very good about getting in touch with those and going ahead and forming those bonds with those local hospitals, and talking about what is the normal American patient’s idea about what it is to be in the hospital because it might seem way more sterile in this hospital, which makes you look like you don’t know what you’re doing, when really the technology was all there and everything was good. And so that was something that we would even preempt them outpatient wise. Because I was L&D nurse for two years over there, and then the last year I was the clinic manager of the OBGYN clinic. So if somebody had a high risk pregnancy or we knew something was going to happen, you’re already talking about like, “Let me tell you what to expect whenever you go there. And you might see this, but here’s your resource and we’ll be there and here’s our number and all of those things.

Cool.

And again, it was manageable because it was a little bit smaller and so you could take on a pretty good load.

When you go to Cuba, are you going as a CNS or are you going as a labor and delivery nurse?

I am billeted, so that would be the job that the detailer sees to go as a CNS. It’s not a very big hospital, so it’s not going to be a lot of … I’m at the largest Navy L&D right now, so I’ll take a lot of stuff there whenever I go there just to make sure we’re tight as can be, but it’s definitely not very busy at all. But yeah, I’m considered that, but I’ll be honest, I’m going to be working the floor. It’s me and two other nurses.

Yeah, yeah. And do they have an idea of how many births you’re going to have that year?

Cuba’s not busy at all. I cannot remember what the number was, but it’s not very busy at all. It’s nothing we’re … probably what we do in a date here, I’ll do all year.

Wow.

That’s so interesting.

That is so interesting.

It’s a little-

And you can’t leave the base.

Yeah, I was going to say that’s a little unfortunate. You’re going to go a little stir-crazy. I would.

Everybody, I mean it’s your own little Caribbean island.

That’s true.

So everybody goes down there and learns how to … they get scuba certified …

Oh, that’s nice.

And the bases, especially in places like that, that are more remote and the idea of being like, “I’m going to go island crazy,” is big on, it’s called MWR, Morale, Welfare and Recreation. So they’ll have a lot of people come in and be like, let’s do those things. Or then you can rent a boat through MWR and go out with your friends on the boat, and they’re constantly doing events. And so I’ve always really enjoyed small to medium-sized tours and places that we’ve been because the camaraderie that you had was so tight.

Totally.

I mean, when we’re in Spain we couldn’t go to the commissary, which was the grocery store, and not see everybody that you had delivered. You lived in like North America.

Oh.

And so that that’ll be-

It’s like camp.

Exactly. Exactly. But yeah, but there MWR is very big about keeping it as fun as possible. They got a nice gym there so I can go work out a couple times a day if I needed to.

A couple times a day.

Wow.

Okay.

Your weight next year is going to be low.

That, and you’re going to blow them out the water with those pushups.

Yeah, I’ve got to undo being here. I got a big place and working and working.

Yeah, that is so great. MWR, you guys really do your acronyms and that would be a fun department to work for too. I’m assuming that person is also in the Navy that gets to work for that department.

Those are mostly civilian run, to be honest.

Oh.

They’re definitely … we have what are considered collateral, so your active duty. We love our collateral, so you have your primary duty and then you take on doing other stuff within the command or the base that you do. And so every department and unit has an MWR like representative. But really those people who are overseas doing those big things, these are people who that’s their job, to go and coordinate these big events and keep the morale up there.

I feel like I would love that job.

You would excel at that job. Bundle Birth is no more guys. Sorry.

Yeah, I’m going to go do MWR and you’re going to go …

Learn how to do a pushup.

Be a nurse. Right.

Oh.

That’s fun. Well that’s awesome. I had two more questions for you. One question, Josh, that I get often in my DMs, and this is not about military, but more specifically about being a male in labor and delivery. And I was curious if you could answer, maybe the question would be what’s your biggest challenge and then maybe what’s the biggest assumption you get? For example, do you need a chaperone for cervical exams? Do the doctors do cervical exams? That’s the biggest question everyone asks.

My experience, and this is maybe something a little different with the military. So my first duty station I showed up in Pensacola. It was me and another guy and another female. And we had all been to ODS together. We were all brand new, instants, which were like oh-one, so right out a nursing school and he said, “I’ve got one place for med-surg and I have two L&D. And so looked at my girlfriend and was like, you’re going to L&D. And then looked at me and the other guy and was like, “Which one of y’all wants to go to L&D?” And I knew on L&D you got to wear scrubs and on the med surg you got to wear a uniform for 12 hour and I was like, “I’m not doing that.” And so I got into L&D, that’s how I got into it.

That’s awesome.

And ended up loving it. Had a wonderful crew. I definitely did not expect to work on labor and delivery whenever I got out of nursing school. I, of course, like everybody else thought I was going to do critical care and become a CRNA. And so when I went up there, there were more male nurses than I had seen in my nursing career, because if you think about it, a lot of the nursing, even though the nurse course still mirrors what the profession is as a whole, demographically we do have a few more males and you become needs of the Navy and most of the needs in a lot of these places is labor and delivery nurses. It tends to be our biggest, busiest, highest security place in the hospital.

What?

Well, I mean you think about, you have a lot of younger people in the military, they’re married, a lot of, they’re having families. You don’t have a ton of sick people.

And they’re probably not sick because they are young.

Because you have to weigh in every year, you have to do a bunch of pushups.

It’s forcing them to do the pushups and mile run.

Right. So you don’t have-

Yes. So that tends to be one of our biggest units. So that’s always where your biggest needs are.

Interesting.

So it’s not uncommon to have three or four guys on one shift and that was my basis. To be honest, I walked around and didn’t really think, which I mean I guess in some ways is for sure a privilege not even be thinking like, “Oh my gosh, I’m a male up here and we’re in delivery.” But yes, we always get chaperones, but then we also have enlisted corpsmen and so they our … they do more than a tech or nursing assistant would do, they’re almost function as an LPN on the unit. And so they get trained up here and that’s definitely more men than anything. So I have worked on shifts where it’s been more men working than it has been women.

Wow.

And I’ll be honest, I don’t know if it’s just because all of a sudden, and granted this was in smaller facilities, this isn’t at the place that I’m at right now. That’s a pretty large, isn’t one other male nurse on the floor and then I’m the other one. But at these places where it’s active duty heavy, you can have more men. And so I don’t know if just the patients in general kind of realize that or go in and kind of see it. There was never an issue for me. I’ve always been drawn more to women anyway, those are my best friends and girlfriends. So I know I’m okay with walking into a room and immediately establishing a rapport, so that’s never been anything. But I’ve always made sure that there was chaperones, and making sure that they felt comfortable, and especially if there was any previous trauma or anything like that to be cognitive of it.

I’ll say I was at, and the only time that I’ve ever had to explain myself has probably been to other L&D female nurse about having an issue with me being in there. And I’ve had one person say, this is a very like, “Oh, I assumed you were a postpartum or a NICU nurse. I didn’t think you would be an L&D nurse. Don’t you think that’s a really intimate environment?” And I was like, “Okay.” I have not had three or four patients that have had an issue with us being there. And they’re normally very vocal. If for some reason you wanted to have female only providers, then absolutely sign, we make sure that the team knows. And we take care of different nationalities. Sometimes there might be a foreign national that we are also taking care of in our hospital. And so culturally there may be issues with me in there, but the team always knows about it and that’s never … So that’s been my personal experience as being a male L&D.

Well, thanks for answering that and I’m so glad I asked because it’s fascinating that you showed up and you were like, “Okay, you’re L&D.” What? That’s another aspect of the military. Yeah.

Yes. Which I mean it can be good and can’t be bad because if you’re constantly, because there are people who’ve been put into L&D in the military and as soon as you’re done…

Shouldn’t be in L&D.

You’re like, “This is not what I want to do.” But active duty, we’re there to, again, you’re needs of the navy, so if the need is here, then we’re going to put you there. But we’ve had some, and that is where your nurse leaders matter so much to be like, “Look, I understand that this is not where you want to be.” L&D’s great because you get triage, you get OR, like where do you want to go next, and let’s make sure that we get you to that spot. It’s not uncommon for you to meet a Navy nurse and early on in their career, they weren’t in postpartum or in labor and delivery at some point, and they were like, “This is where I learned my foundational skills and my time management and …

That’s unique too.

That’s very unique. Yeah.

Yeah. So is it easy-

It’s the complete opposite.

Right. Is it easy to transfer to another specialty if there’s needs in the Navy come open to ER, could they transfer to the ER kind of thing?

Oh yes. Yeah, we have people here, even if our need might be really heavy labor and delivery, the nurse leaders who’ve grown up in the Navy understand that sometimes you might have that subspecialty, like I talked about earlier. You might be a 1920 and you’re like, “Look, I will do whatever I need to do,” But this is really my ultimate goal. And within the nurse core, you have your professional development as a nurse, but also your professional development as an officer and you are a leader and you are expected to be that.

And so you having short and long-term goals is something that you must understand and be able to speak to at any point in time. So if I was in L&D, because that was where I was needed, I’ve shown that I can be flexible and agile and grow in any area, but then my long-term goal might be I want to be a CNS in the ED, or I want to be a CRNA. And so you just let your leaders know that and then as soon as they can, they support you because that is part of your professional development as an officer, is to know where are you going?

Well, I love that. That’s cool. Now we’ve said CNS a couple times and we haven’t explained what that was. And so I wanted to explain that a little bit through you. And I want to know, as you answer what a CNS is, did you go to school … because I know that the perinatal CNS or labor and delivery CNS is like canceled, right? So you have to do regular CNS and then specialize a little bit. If you want to explain that what it is and what the process is for our listeners.

Yeah. So a clinical nurse specialist. So we have five … we’re an advanced practice nurse, we’re one of the advanced practice nurse, and we have five roles. So we’re an educator, we’re a clinical leader, researcher, a consultant, and then educator, did I say that? And so we operate within three spheres of influence. So we affect patient care by looking at nursing practice within a system. And so I’m very systems focused and I see how the system and policies and protocols and the current research, and all that stuff fits into the nursing practice that we are performing within that organization. And then try to transform what is happening and bringing it up to date to affect what the patient care is. And then of course you want to make sure that your clinical skills are still up-to-date. So you still go and work the bedside a little bit because that’s also going to inform you what’s happening in the system.

So within the perinatal world, just like you were saying, Justine, there’s no board certification for it. So adult gerontology, pediatrics, like those places, you go to school, you graduate and then you go and take this board certification and you’re board certified CNS. Perinatal, there’s nothing for that. I will say we are pushing for it again. Like AWHONN Armed Forces section, Armed Forces section in general, AWHONN in general has petitioned up to ACN to bring this back so that, because we don’t have a board certification, there’s not a lot of nursing schools, graduate schools that you can find that will do clinical nurse specialists and let you do a perinatal focus. I was lucky because I went to school in San Diego, at Point Loma Nazarene University, and they’re very good, and probably most of the Navy CNSs come up through there because San Diego has such a large different healthcare systems. They have perinatal CNSs, and of course the West Coast is really good about utilizing perinatal CNSs in their health systems.

There was enough preceptors for the people who go into this program. So I was there in a cohort with a bunch of different CNSs, three of us were perinatal. And so as a CNS, you have to have 500 clinical hours and that needs to be with somebody who does that, who occupies the job as a perinatal CNS. So that was my experience, was in San Diego, being able to go do preceptorships with those people. Did I answer that question fully?

Yeah, you did. As I’m anticipating some questions that may be some new nurses are listening to this. So the difference between a CNS and an educator, would that be your educating too, but you’re also more involved in policy and change, involvement with manager. It’s almost like a mixture of management and education in one role. And do units usually have manager educator and CNS, or do they have one or the other? How does that work?

Some differences between nurse educator and a CNS, the nurse educator, so although that is a master’s prepared nurse is not considered one of the advanced practice nurses. So as the CNS, depending on what graduate school you go to, your curriculum as a nurse educator will be very focused on the education and very focused on the curriculum development. And you don’t have the clinical hours that are required of a CNS. So a CNS requires 500 and then they have to take the three Ps that every advanced practice nurse has to do. So advanced pharmacology, physical assessment, and patho. You don’t necessarily have to do that as a nurse educator. And I think most of your hours are really going to be in that curriculum development and actual teaching.

So as a CNS, I should know how to do education. My curriculum in graduate school was you need to go research this, become the expert in it, and then teach somebody on it and become that consultant. And so it’s trying to kind of enmesh all of your roles together and educator is a part of that, but it’s just a piece of it. So it’s more systems based.

Okay. Well thank you for answering that question. Sarah, do you have any last questions?

No. I think this was the highlight of my week of learning, and I’m sitting here with all sorts of articles around me. This was so new for me and so fascinating. I’m just so grateful that you were willing to give us your time and your expertise. I think if there was anybody tempted by the military, or just military curious, that they may walk away being like, “Wait a second.”

I could do this.

“Hold on, this might be something that I can do. I can do 50 pushups, I think.”

Yeah.

I definitely can’t.

Or they could get there.

I’ll tell you, adrenaline always … we always talk about this, everybody’s always nervous every year that you’re like, “This is going to be the year I fail my PRT. Even though you could be working out all year long, something about being evaluated on it, but then you’re adrenaline just gets you so much further. I’m like, “Oh, this is 15 more than I normally could ever do.” Because I’m so nervous.

What happens if you fail?

So if you fail, and this is more Navy, I’m not for sure about the other services. I mean, you could have a bad day. Maybe you were sick that day but you weren’t so sick. But then you started and you’re like, “This isn’t going to happen.” So you do get a by, but you have to redo it within a certain amount of time. And then if you do fail it does go into your … part of my evaluation and me promoting as an officer and going up in ranks is that I should be able to pass every PRT, and again, be ready to be physical at a moment’s notice. And so regardless if you gave me a 10-week notice, I should be able to do all the stuff right here, right now. And if you fail it and it becomes a thing, you fail it too many times, that could be the end of your career. So that definitely …

Wow.

… Is a part of our annual evaluations is did you pass your physical fitness test?

Wow.

Both of our mouths are gaping now, like, “Oh my God.” I love that that’s what we’re worried about. Of all the things. So if you are military curious, Josh, where can they start? Where would you send them to get more information and maybe start pursuing what it may look like to join the Armed Forces?

First step, if they wanted to see, if they knew, “Hey, I know I want Navy,” because of the duty stations or whatever, then go into just navy.com. That is where a lot of the recruiting stuff is. Most places have Armed Forces recruiting, so it might be something that’s very navy specific, like a Navy office where they can recruit there. Or it might just be an officer recruiting center and they kind of recruit everywhere. So that is where you would find who do you need to get in touch with at your local place because there’s going to be a local place somewhere and then they will get you all that information and get you started on that.

And then, honestly, that that’s the most formal place. And then I’ve seen other people just kind of going to Reddit and different places to kind of see what sub threads they are and those kind of things. There’s been a few people that are new to the Navy that I’ve recently worked with, and they just kind of went down a rabbit hole on the internet and finally found, “Hey, I want to join the Navy because I found the list of all the hospitals that you could work at within the services.” But yeah, navy.com, honestly.

Interesting. Okay. If you have any questions for Josh specifically, you can email me at bundlebirthnurses@gmail.com and I will send those over to him. But thank you again, Josh. This has been such an amazing episode and we are so … it was so fun.

Thank you for having me.

Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram or TikTok.

Now it’s your turn to go and think outside the box of all the ways that we can apply our skillset as labor and delivery nurses to our specialty. And then make sure you’re doing a few pushups tonight, I know I will be. See you next time.