The VA health care system located in San Antonio recently celebrated the graduation of the second cohort of Advanced Practice Registered Nurses (APRN) residency program.

Registered Nurses (RN’s) and Nurse Practitioners (NP’s) were listed among the top Veteran Health Administration mission critical occupations.

Dr. Valerie Rodriguez-Yu, Associate Director for Patient Care Services, told the audience at the graduation ceremony how COVID-19 painted a clear picture on the need for providers. “As our nation has learned throughout the pandemic, medical professionals are in short supply, especially in nursing,” Rodriguez-Yu said. “In academic year 2021-2022, VA’s Office of Academic Affiliations added 28 new nurse residency programs in response to one of the nation’s most critical healthcare occupation shortages.”

The graduating cohort had four nurses. Two primary care, Dr. Angelica Romasko, and Rebecca Ebert, FNP. Joining them were two mental health residents, Nurse Practitioners Olivia Yeargain and Tracy Senterfitt.

According to the director of the Primary Care Nurse Practitioner Residency Program, Dr. Rebecca Santomassimo, the residents must be fully licensed as a nurse practitioner and board certified in their chosen specialty.

What makes this residency unique is its Veteran focus.

“The program develops leaders in advocacy, clinical care and research while servicing diverse socioeconomic backgrounds in a supportive environment dedicated to teaching, mentorship and Veteran-centric care,” Santomassimo said.

Romasko said the program was critical for her understanding of the specialized needs of Veterans, and even teaching her things she didn’t know about this population.

“I was surprised to learn about the high prevalence of military sexual trauma among female Veterans,” Romasko said. “Hearing their experiences about feeling powerless makes me want to empower them and make them feel as comfortable as possible during uncomfortable situations, like a woman’s health exam,” Romasko added.

A national call out for proposals was answered by Veterans Integrated Service Network (VISN) 17 and were awarded grants to support four residents. The year-long residencies are affiliated with the University of Texas Health Science Center School of Nursing.

Rodriguez-Yu, summed up what the residents will bring to the table. “No doubt throughout this residency, you have developed and grown into prepared providers through didactic and inter-professional clinical experiences,” Rodriguez-Yu said. “You did this all while improving access to care for Veterans with complex primary care and mental health needs.”

Santomassimo said each graduating nurse was offered a position, and that all the graduates accepted positions throughout the network from the new Northwest Health Care Center to Victoria. They will now have full patient panels.

Even if they don’t continue their practice at the VA system, this program’s impact will be felt throughout many communities across the country.  

“Our NP residents will continue to reach outside the VA to enhance Veteran well-being,” said Margit Gerardi, who is the Mental health Nurse Practitioner Residency Program Director at South Texas.

Gerardi went on to say it is important to remember that there are Veterans who aren’t getting their care at the VA, and their care should be individualized for Veterans.

Santomassimo added that this second cohort is just the beginning, as Veterans continue to choose VA, the program, just like the healthcare needs of the Veterans will expand. The next cohort has already been planned to double in size to eight nurses.

Nurse Tracy Senterfitt is appreciative of the opportunity to train at the VA because she says these opportunities are rare. “Residency is not as common as you may think among nurse practitioners,” Senterfitt said. “The residency program at the VA strengthens and matures providers through continued education opportunities and hands-on experiences with other providers in the psychiatric mental health field,” Senterfitt said.

Senterfitt says the exposure to new groups has benefitted her practice. “Having the opportunity to rotate through several specialties within psychiatric mental healthcare offered at the VA, like the community living center and emergency room triage has allowed me to see Veterans in various dimensions of mental health,” Senterfitt said. “This has added layers of perspective, knowledge and facets to the care I am able to provide our Veterans.”

Romasko also gained a bit of perspective while serving a Vietnam Veteran.

“I was having a pleasant appointment with a man in his 70’s. We were joking and laughing, but when I asked him if he wanted to speak to mental health about anything, his demeaner changed,” Romasko said. “He became quiet after recounting some of the regrettable things he was ordered to do in Vietnam. He shared with me the guilt that he’s felt his whole life and he began to cry,” Romasko explained.

Romasko was able to convince him to see mental health for his PTSD and he agreed and learned that things on the surface might not paint the whole picture.

“I almost didn’t ask him about mental health because he was so jovial. That encounter really impressed upon me the notion that we all carry some sort of burden, no matter how happy some of us may appear,” Romasko said. “It broke my heart that he was crying about something he did over 50 years ago and that he was carrying that burden all this time,”

Senterfitt was also exposed to challenges see had not seen prior to her residency, working with many suicidal and homeless Veterans with some of the most acute mental health conditions.

Both nurses said their residency was a positive experience.

To stay current and relevant, Gerardi says the curriculum is constantly changing.

As new treatments are offered for mental health care and are offered at the VA such as Ketamine therapy, rTMS (Transcranial Magnetic Stimulation) , the curriculum and residents’ training experiences will continue to develop,” Gerardi said.

Senterfitt says her practicing at the VA has been very rewarding.

“Serving those who have served this country is truly my greatest honor,” Senterfitt said. “I have a family of Veterans as well as active service members and it is my passion to support, honor and give back to the community.”

“I was familiar with healthcare from an active-duty perspective since I was a Navy nurse,” Romasko said. “Coming to the VA felt like home.”