5 Questions with Richard Westphal

Dr. Richard Westphal – a long-time military nurse who oversaw the Navy’s $117 million psychological health and Traumatic Brain Injury programs from 2007 to 2010 – arrived at UVA in 2013 as a professor of nursing. Westphal’s interests include psychiatric/mental health services, stress injury, and palliative care, and he continues to be a sought-after speaker on the topic of identifying and coping with stress injuries to those who work in the military and in law enforcement.

• Talk about your route into nursing.

I was introduced to the fundamentals of nursing care early in life. My mother was the director of nursing in an elderly care facility. Many days, I would go where she worked after school, and hang out in the day room with the elders. By the time I was a teenager, I had a strong back and no winter job, so I started working in geriatrics as an orderly. I was quite familiar with elder care from my childhood and was comfortable working with frail elderly patients.

The start of my nursing work, however, began rather ominously. On my first shift, my first patient actually died while I was feeding him soup – and I assisted with cleaning up his body. I gave him a shave, helped change his clothes -- to prepare for his family who was just notified. This was an exceptional place that really provided high quality nursing care. Those experiences led me to enlist in the Navy.

My formal nursing training started when I enlisted in the Navy in 1974 … the Vietnam War was winding down and I volunteered, and was trained to be a hospital corpsman and an operating room technician for sailors and Marines. I spent five years doing that, including three years on a ship where I ran ‘sick-call’ – I was a 19 year old sailor responsible for immunizations, treating injuries, and meeting a wide range of acute health needs for over 600 sailors. Imagine a floating Office for Student Health.

After my enlisted service, I started my premed work on the GI Bill, and as I worked, I would interview nurses and doctors. ‘Why nursing?’ I’d ask, or, ‘Why medicine?’ For me, my passion was people and making a difference, so I changed my major to nursing in my second year. I completed my BSN at the University of Minnesota with a senior focus in thanatology and hospice. Four years of Minnesota winters and a tight nursing job market encouraged my wife and I to consider returning to Navy healthcare and travel.  My first assignment was in San Francisco where I worked in pediatric oncology and pediatrics, adult medicine and adult oncology.

• Sounds like a difficult job.

Many people have a lot of fear of death and chronic illness; one fact of life is that mortality is 100 percent. But I’ve always believed that it’s not how we die, it’s how we live until we get there. Most people can’t understand how I did pediatric oncology … but my passion was working with patients at the end of life. I could hang chemo but engaging with people and families with cancer about the end of life – that part was my calling.
My sign that it was time to change roles, though, was when I was crying while I administered chemotherapy to a child, feeling as though I was causing more harm than good. I was burned out. But I think for me, burnout became a good thing – it’s a sign that you need to do something else in life and reconnect with your passion.

• So what did you do?

Supporting people in crisis around end of life issues was a part of my work that I found most rewarding. I did an undergraduate clinical rotation in a locked diagnostic psychiatric ward … the patients were individuals that nobody could figure out, and for many students this seemed like environment of “lions, tigers, and bears; oh my.”
But I absolutely loved it. The therapeutic use of self – who I am as a person and as an instrument of healing – was something I used both in oncology and in mental health care. In both, people are coming to grips with tremendous loss. They were fundamentally redefining who they were as a person.

• How do you think working with a geriatric population early on influenced your nursing career?

The thing I do remember them saying to me, there in the elder care facility where my mother worked, is live with “no regrets.” As an adolescent, with hair below my collar, they urged me to make good choices and not to be afraid of rolling the dice of life. I took from that that if you’re making active choices, which is part of what I hope to pass on to my students and a big part of my passion for nursing care – as long as what you’re doing is executed to the best of your ability with scientific rationale and passion – you can do a lot of good and make a difference.

• Talk about your work with service members suffering from PTSD.

I was in the Navy before PTSD emerged as a diagnosis in 1980 … but it was hardly a new phenomenon. I’d known plenty of WWI, WWII, Korea, and Vietnam vets who had it – it was called Vietnam Syndrome back then, as well as shell shock, after the first and second World Wars.

There were medications that could ease symptoms of PTSD, but ultimately, I came to realize that therapy and healing was really about human connection. It is very powerful to work with young women and men, most of whom didn’t have a mental disorder, who had lost their sense of self in trauma; one of the major tasks of recovering from trauma is to ask, “who am I now that I have had these experiences?” – nursing knowledge and skills are critically important in supporting post-trauma recovery.

By `89, I was a certified psychiatric-mental health nurse working in Okinawa, Japan. I was feeling the limitations of my knowledge and knew it was time to change roles. So in 1990, I attended UCSF for a master’s in mental health nursing and became a clinical nurse specialist. I graduated in 1992 and was transferred to Portsmouth, Va. to one of the largest medical centers for the US Navy where my clients included professional caregivers. I took care of the nurses, doctors, chaplains and others who cared for others. The Gulf War provided a prelude to the stress and health demands associated with even a short and intense combat exposure.

Military nursing research was gaining momentum during the ‘90’s, and by 2000 I was selected to complete my Ph.D. at UVa, a program from which I graduated in 2004.  I returned to the Naval Medical Center, Portsmouth, VA where I was the head of nursing research. By 2006, we were seeing many more service members with PTSD and traumatic brain injury, and I also continued my work as the caregivers’ caregiver, as somebody with the skillset to understand the psycho-social issues of trauma – I was really busy.

But another change was coming. I was at a conference with Admiral Bruzek-Kohler, and we were talking about stress and stigma and the psychological impact of war on caregivers and service members – and on the back of a napkin I sketched out a colored-coded metric about stress-related injuries.  One of the main points was that we were seeing people with stress injuries who were not ‘disordered’ per say but were being stigmatized and marginalized because of symptoms.

Two months later, I got a phone call: “Richard, we have a job for you in Washington, D.C.” That was move number 26. By January, 2007, I was brought in to design an intervention for caregivers, a stress control program. And the timing was right for such things. The national outcry about care at Walter Reed meant that $900 million was funneled into the military for mental health and brain injury programs. So my job became managing the execution of a $117 million a year program for psychological health and Traumatic Brain Injury in the Department of Navy; that’s all Marines and sailors.

My doctoral preparation at UVa had prepared me for this task – leading teams to focus on the best science, valuing mixed methods research, grant management, health promotion and health policy, all the while maintaining a focus on the person we are trying to help. One of the critical funding requirements I developed for our team was to fund only initiatives that had a direct quality of life impact for a Marine, sailor or their family.  This was an investment strategy for culture change. We were investing in the power of sailors and Marines to care for each other while improving access and care quality.

• How has it been transitioning to academia from military life?

I retired from the Navy in 2010, but have continued my work in stress injury and military culture through contracts with the Navy, Marine Corps, Army and with law enforcement agencies – so the transition is still taking place. I knew as a doctoral student here that I really liked the milieu, the culture, at UVA. And coming here was always on my dream-list – to come here as a faculty member, to give back and help prepare the next generation of nurses.

• What’s UVA been like so far?

The vision and academic culture of UVA – I believe in it. And there is real beauty in my role: I get to be both a mentor and a learner.  So far, there’s been lots of exciting dialogue: I like that about the School of Nursing. “Let’s talk it through, let’s think about it” is the refrain here. There is willingness here to explore ways to improve and to create a best fit between academic goals, student needs, and the faculty/staff team.
I have always embraced change and ambiguity. There is a quote that I often apply to myself: “If I’m not at home, accepting what I cannot change. I am probably out, changing what I cannot accept.”

That’s the motto of a change agent – and that’s the main thing I’ve been in this life – not change for the sake of change, but when you align yourself with good and passionate people, you can really be a part of something marvelous.
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