From flight nurse to chief of medical doctrine, Air Force major’s career soars Published April 2, 2015 Military Health System Communications Office WASHINGTON -- As an Air Force flight nurse, Maj. Julie Skinner found adventure and rewards she never could have imagined as a civilian registered nurse on the ground. She calls flight nursing the best job she's ever had in a military career that has included improving medical processes and tending warriors wounded in Iraq. Last year Skinner was named chief of medical doctrine, an Air Force leadership position focusing on the Air Force's guiding principles, at the Defense Health Agency Headquarters in Falls Church, Virginia. She has traveled a long way from life as a New York state college student who had a dream of becoming a flight nurse. "The best part of flight nursing and my service in Iraq was the privilege of caring for our wounded warriors. I tried my best to keep them comfortable as we moved them to a safe place where they could recover," she said. "Those injured were suddenly put in a system foreign to them, shuttled to a temporary medical facility, moved from helicopters to ambulances to planes and buses. I helped them relax and eased their pain and confusion." During her flight missions at the patient bedside, Skinner noticed opportunities for change, ways to do things better and more cost effectively. While she didn't feel she could voice those views at the time, as her career progressed, she gained the education and authority to improve care. Skinner's unfolding career path Following college graduation and two years as a medical/surgical registered nurse at a civilian hospital in upstate New York, Skinner entered the U.S. Air Force through direct commission, starting basic officer training in 2000. She spent the next three and a half years as a medical/surgical nurse at Wilford Hall Medical Center in San Antonio. After completing a flight nurse course on "how to turn the back of an aircraft into a hospital suite," she was off to Ramstein Air Base, Germany, on medical air evacuation missions with patients who suffered mostly from burns, blast injuries or service-related mental health issues. They flew on several different types of aircraft - from small Lear jets (C-21s) to large cargo planes (C-17s). "As head nurse, I was in charge of what my patients needed. While some of them were unable to communicate, others were amazed that we got them quickly from the war zone to the U.S. hospital in Germany with compassion, caring and smiles," she said. Most of the air evacuation missions she flew from 2003 to 2006 were from Joint Base Balad in Iraq to Ramstein or from Germany back to the U.S. During 2004, she flew 14 flights in a three-month period, a particularly busy time. On the larger planes, she set up metal frames that hooked into the floor and allowed her to stack patients three racks high. "Often, in the fog of war, our patient load changed significantly from the time we prepped for the mission to the time the patients actually loaded the plane. We sorted through paperwork after we took off to pull together the story of a patient and determine what we needed to do for him or her during the flight. Sometimes we'd have a really critical patient, but we couldn't find a summary of his operation report or an X-ray report. Problems with documentation during flight led me to pursue a master's degree in nursing informatics so I could be part of the solution," she said. Skinner completed a two-year program offered by the Air Force Institute of Technology that allowed her to study full-time and earn a double master's in business administration and in nursing administration and informatics from the University of Maryland. Despite the challenges of flight nursing, Skinner said, "I loved that job. It was very different from civilian nursing. The patients were so appreciative. They couldn't believe the level of medical care provided on the plane and all our efforts to make sure we got them home safely." Working to improve medical processes Skinner returned to Germany for two years and worked in an outpatient medical group, managing nurse advice telephone lines. She noticed the nurses were spending a lot of time doing documentation and charting notes. Skinner contacted the company that provided the references guides the nurses used and asked for electronic versions so the nurses could cut and paste information into the patient's chart, one of the measures she instituted that saved time and money. She also worked in utilization management, finding ways to institute better care and reduce costs at the U.S. Air Force Medical Group in Colorado Springs. In 2013 she was chosen for a special Air Force education program at Air Command and Staff College Maxwell Air Force Base, Alabama, a 10-month program for selected majors from across the Air Force. This program taught her more about Air Force doctrine - "how we train, fight and equip as the Air Force. The theory evolves slowly, it's not a directive or a rule set, but an authoritative source on how to accomplish military goals and objectives," she said. From there, she has applied Air Force principles specifically to medical doctrine, which includes how health care is provided and how professionals are trained.