Of our nation’s nearly 20 million veterans, 5.1 million live in rural America. Assisting rural ex-military who have served us, one of UCF’s veterans has a key role by sitting on the national Veterans Rural Health Advisory Committee that advises the U.S. Veterans Affairs Secretary.
Angeline Bushy, a UCF College of Nursing professor and the Bert Fish Eminent Scholar Endowed Chair in Community Health Nursing, has a career that spans more than four decades.
Bushy, a nationally and internationally recognized authority on rural healthcare scholarship, served more than 20 years with the U.S. Army Reserve Nurse Corps and achieved the rank of lieutenant colonel. She also lived with and worked to provide healthcare to Native Americans on reservations.
She earned her doctorate at the University of Texas and began teaching at UCF’s Daytona Beach campus in 1996.
In observance of Veterans Day on Nov. 11, we asked Bushy about her service to the country and UCF.
What did you do in the military?
Initially, as a nurse in the Army Reserve, I was assigned to an EVAC unit in North Dakota. After that I was assigned to the Army General Hospital in Utah; then, in an Army Combat Support Hospital in Jacksonville, Florida. I was mobilized for Desert Storm in 1991 with the Utah Hospital. Military reservists, along with attendance at monthly drills, have annual training exercises at various military installations both in in fixed facilities and in the field.
How/when did you become involved with the Veterans Rural Health Advisory Committee?
In 2017, I was invited by the Secretary of Veterans Affairs to serve on this committee associated with my activities in the National Rural Health Association and my veteran status. The board’s mission is providing advice to the Secretary of Veterans Affairs on healthcare issues that affect veterans residing in rural areas.
What can you tell us about rural veterans?
Of the 5.1 million veterans who live in rural American, 2.7 million are enrolled in the Veteran Affairs healthcare system. More than 57% of rural enrolled veterans are 65 or older; and 44% have a service-related condition. In Florida, veterans make up 9% of the population, about 1.5 million; of these, about 170,000 reside in regions designated as rural. It is important to note that the veteran population is not only young adults who recently served, rather a significant number are older veterans who served in World War II, the Korean Conflict and Vietnam. In other words, people we encounter everyday are veterans, such as grandfathers, fathers, uncles, aunts and perhaps even older siblings — often they are the quiet ones in our midst.
Did you grow up in a rural area? Is that why you were drawn to this?
I was raised on a farm-ranch near a small town in North Dakota. Upon graduating with a Bachelor of Science in Nursing, we (my husband and I) lived and worked in small hospitals and health departments in North Dakota towns with populations less than 1,500 for a decade. The following decade we lived in eastern Miles City, Montana, population under 10,000. I was employed as the program director of associate degree program and worked closely with various healthcare agencies in the county and region. I joined the faculty at the University of Utah’s College of Nursing, and received a grant to develop a master’s degree program in public health nursing to outreach sites in Utah, Idaho and Wyoming. Most of my rural experiences occurred in regions defined by the federal government as “frontier areas” – i.e., having a population of six persons or fewer per square mile that tend to be “medically underserved areas.” Essentially, rural and remote regions usually have fewer, if any, healthcare providers, and residents must travel great(er) distances to access health-related providers and services.
What differences in healthcare do rural veterans have compared with veterans who live in more urban areas?
Impaired access to healthcare is experienced by rural veterans, even more so if they rely on Veterans Administration providers or services. Veterans may need to travel several hundred miles to access a VA facility across challenging terrain and inclement weather conditions. The intent of the Veterans Choice Act (2014) was addressing impaired access to care especially for rural veterans. As with any government program there were a variety of challenges with the Choice Act. Subsequently, on June 6, 2018 the Veterans Mission Act was legislated to remedy some challenges in the original legislation. For eligible veterans, the Mission Act enables access to healthcare providers in their own community and promotes use of telehealth services. The Veteran Community Care Program is another option for rural veterans to receive care from a community provider. This is particularly relevant for older rural veterans and those with a military-related disability.
What are the top issues concerning veterans in rural areas?
It is important to stress veterans cross the lifespan — young, middle aged, older individuals — males as well as females. Common medical diagnoses for rural veterans receiving care in outpatient settings include high blood pressure, Type 2 diabetes, acid reflux, post-traumatic stress disorder, depressive disorder, as well as one or more service-connected disabilities. Service-related disabilities and other medical condition experienced by rural veterans can be exacerbated associated with impaired access to specialty care along with rural social determinants such as poverty, homelessness and substance abuse.
What work did you do with Native Americans?
The small town I was raised in is situated across the Missouri River from the Standing Rock Indian Reservation. This large reservation is located in the west-central region along the North and South Dakota boarder. During winter months a common practice involved locals driving across the frozen Missouri river to visit relatives on the opposite side; hence, my early exposure to Sioux tribal members. Later, my husband and I lived on that reservation and I was employed in a very small South Dakota hospital. As for veterans, Native American cultures traditionally honor their warriors. Even today, at a Native American powwow, attendees participate in a respectful dance, garbed in traditional attire, to show respect and honor tribal veterans. Since most Native Americans reside in rural areas, the Veterans Rural Health Advisory Committee includes ad hoc representatives from the Indian Health Service as well as one or more Native American veterans.
What classes are you teaching now at UCF?
I am assigned courses consistent with my scholarly and clinical focus, specifically, public health nursing, health promotion across the lifespan, and nursing research courses. I also serve on doctoral dissertation committees, DNP project committees, and Undergraduate Honors Thesis.
What advice would you give to nurses considering joining the military?
Serving in the military provided valuable nursing experiences for me that definitely differ from a civilian practice setting. For instance, in a field hospital one quickly learns to function with fewer resources, especially technology driven devices. Even when a situation seems to be dire and insurmountable in an austere environment, one can creatively approach the situation — albeit, not using the classic textbook approach. A military career is not for everyone. For those who choose this path, there are rewarding professional opportunities that support troops who serve our nation.