Caring for Post-9/11 Veterans in the Civilian Sector: Knowledge and Readiness of Registered and Advance Practice Nurse Providers.

Importance: Since 2001, 3.5 million United States service members deployed overseas in support of the post-9711 Global War on Terror. While healthy and fit upon deployment, veterans have experienced many complex and often unexplainable illnesses and chronic diseases, with more than 520 000 being diagnosed with cancer. With the implementation of the VA MISSION and PACT Acts, post-911 veterans are increasingly being seen in non-VHA healthcare facilities by non-physician providers. Objective: To assess the readiness of registered and advanced practice nurses to provide knowledgeable and competent healthcare for post-9/11 veterans in the civilian healthcare system. Design setting and participants: A web-based survey was administered by the HunterSeven Foundation (a Veteran-founded non-profit organisation), with 541 nurse respondents. Primary outcomes and measures: Questions were designed to assess military knowledge, comfort level caring for veterans, self-reported proficiency and prior training of participants. Mean differences were compared using a restricted maximum likelihood, fixed-effects model, with incidence between groups estimated as log-binomial relative risks. Results: Meaningful gaps in clinical knowledge of screening for and treatment of medically related conditions were identified. Our assessment also highlighted a sparseness of knowledge for making care recommendations based on apposite resources. Conclusions and relevance: Cognitive biases among healthcare providers in the civilian sector may lead to missed and/or delayed diagnoses, therefore emphasising the need for additional training focused on caring for post-9/11 veterans.