Where does a nurse who's spent her career teaching nursing go to learn more? If you're Army Maj. Patricia Patrician, back to school.
Until recently chief of nursing education at the Army Medical Center and School at Fort Sam Houston, Texas, the 37-year-old Patrician has begun doctoral studies at University of Pennsylvania. She is focusing her studies on reorganizing nursing to address the military's adoption of managed-care techniques with its Tricare program for military healthcare beneficiaries.
As in the civilian system, nurses in the military are taking a greater role in managing the healthcare of others (in this case, active-duty personnel, family members and military retirees).
But military nurses aren't necessarily prepared for that duty, Patrician says.
It's been five years since she first confronted the changing role of nurses in the military. After briefing the chief of the Army Nurse Corps on some patient-care issues, Patrician and her colleagues were asked to demonstrate the cost-effectiveness of their work.
"I realized we were not trained as nurses . . . in anything but providing nursing care," Patrician says. "That provided the impetus for me to help nursing quantify the value it provides to the healthcare system."
And like many in civilian healthcare, she sees both the advantages and disadvantages of managed care. Among the downsides Patrician sees are beneficiaries' confusion about their benefits and the exclusion of Medicare-eligible retirees from military healthcare under Tricare, although they can be treated at military hospitals and clinics when space is available.
But Patrician says she also believes managed care does good work by forcing healthcare providers to come to grips with utilization issues.
"I believe managed care is sort of opening eyes . . . pushing us to figure out who is the best provider for a given situation," Patrician says. "Not all patients need to see a physician for care."
A senior officer says she is accustomed to such insight from Patrician. Col. Susan McCall, assistant chief of the Army Nurse Corps, says Patrician has zeal and passion for teaching patients and fellow clinicians about medical conditions.
"She is very much driven to ensure that patients, in particular, have enough information to make the most informed decision about their healthcare," McCall says. "Her interest in education has not just been focused on patient education but also the education of other clinical practitioners."
"My philosophy is patients know best what they need," Patrician says. "If you treat the patient well and with the utmost respect of their needs, instead of the healthcare system's needs, they do better."
Indeed, even early in her career, Patrician showed her dedication to quality improvement and education. She helped develop a multidisciplinary heart-attack rehabilitation and education program at Kenner Army Community Hospital, an 11-bed facility at Fort Lee, Va.
Subsequent training and experience moved her up the ranks of the Army's nursing corps to instructing other clinicians. She has served as a leader and instructor within the military healthcare system and for civilian schools and providers.
Along the way, Patrician earned certifications as a cardiac and critical-care nurse, as well as a master's degree in nursing from the University of Texas. She began passing on her experience and knowledge as she trained nurses within the military healthcare system and as an adjunct faculty member at Austin Peay State University in Clarksville, Tenn.
As a nurse, Patrician frequently played a leading role in developing quality improvement and assurance programs. She even helped to found a chapter of the American Association of Critical Care Nurses while at 155-bed Blanchfield Army Community Hospital at Fort Campbell, Ky.
As chief of nursing education at the Army medical school from 1994 through this year, Patrician managed a $1 million master's and doctoral program for 75 Army nurses.
She says she will return to nursing education or become a researcher after completing her doctorate.