From Caregiver to Combat Multiplier

Army Nursing in Large-Scale Combat Operations

By MAJ Teresa Rios-Rodriguez

Article published on: May 1, 2026 in the 2026 E-Edition of Pulse of Army Medicine

Read Time: < 4 mins

While the nature of war endures, it is more apparent than ever that its character is rapidly evolving and transforming. After two decades of counterinsurgency operations in support of the Global War on Terrorism, the U.S. military has shifted its focus toward Large Scale Combat Operations and tactics that can be used against near-peer adversaries. This shift has significant implications for Army Medicine and, specifically, for the role of Army Nurses. The operational conditions of Iraq and Afghanistan that enabled rapid aeromedical evacuation and relatively secure treatment facilities are less likely to exist in future conflicts.

The Operational Environment in LSCO

Future battlefields will consist of contested domains, denied evacuation corridors, and deliberate threats to once protected medical assets. Adversaries possess the capability to target medical infrastructure and evacuation platforms with long-range fires, disrupt communications through cyber and electronic warfare, and challenge freedom of maneuver across all domains.

Under these conditions, medical units will have to operate in dispersed formations, often without reliable evacuation or resupply. The assumption of having a medical system where time to definitive care is short, resources are abundant, and evacuation is dependable, which have been defining features of recent conflicts, will no longer be valid. As a result, Army Nurses will be required to provide extended care in austere environments with limited resources while under constant threat.

Army Nurses as Combat Multipliers

In LSCO, Army Nurses are as vital to combat power as any warfighting systems and must be viewed as combat multipliers rather than solely as caregivers. Their ability to rapidly triage, stabilize, and return Soldiers to the fight has a direct impact on mission success. When evacuation is delayed or unavailable, clinical decisions made by far forward medical assets, or at point of injury, become operationally decisive. This expanded role transcends traditional clinical care requiring a higher-level of proficiency. Army Nurses must be capable of independent decision-making, strategic resource prioritization, and risk assessment in environments characterized by uncertainty and limited support. Their capabilities directly impact unit readiness, tempo, and survivability.

Prolonged Field Care and Clinical Adaptability

Prolonged Field Care (PFC) presents one of the greatest challenges in LSCO. When evacuation timelines extend from hours to days, Army Nurses become central to sustained casualty management. This includes managing complex injuries, preventing deterioration, and maintaining patient stability over extended periods.

Success in PFC requires advanced clinical competence, adaptability, and an understanding of operational priorities. Nurses must balance the needs of individual patients with the demands of the mission, often making difficult and ethically complex decisions regarding the use of limited resources and prioritization of care.

Leadership in Contested Environments

Leadership in the Nurse Corps has never been confined to the bedside; it sits at the intersection of clinical expertise, operational execution and mission command. This role becomes more critical in LSCO. Leaders must train for degraded conditions, enforce standards under stress, and integrate medical planning into broader operational frameworks.

Effective leadership in LSCO requires comfort with ambiguity, the ability to operate within mission command, and the confidence to advise commanders on medical risk. Army Nurses must bridge the gap between clinical expertise and operational decision-making, ensuring medical support is synchronized with the unit's mission so that care on the ground can keep pace with the fight.

Moral and Psychological Resilience

In past conflicts, nurses faced trauma, but LSCO adds layers that intensify the burden, increasing the importance and need for moral and psychological resilience. High casualty environments, limited resources, and difficult triage decisions create emotional challenges. Army Nurses may face situations in which not all casualties can be saved, and prioritization decisions carry lasting emotional consequences.

Preparing for these realities requires more than clinical training, it requires an understanding that resilience is not simply the ability to endure, it is the capacity to make difficult decisions, sustain others, and continue to lead all while absorbing repeated trauma and loss.

Recommendations for Improving Army Nurse Training for LSCO

Necessary preparation includes three main recommendations for training improvement. First, training must become more operationally realistic, matching the battlefield. Army Nurses should be fully integrated into collective training events and Combat Training Center rotations where they can rehearse casualty care in environments characterized by limited communications, delayed evacuations, and constant threat. This exposure builds on the ability to provide care while mobile, dispersed, and under pressure, all of which defines maneuver warfare.

Second, prolonged field care competencies should be expanded and standardized across the force. Future conflicts will require Army Nurses to manage critically injured patients for extended periods in austere environments. Training should move beyond rapid stabilization and focus on sustaining care through realistic scenario-based repetitions. This includes extended patient hold exercises with delayed evacuation, forcing nurses to manage airways, ventilation, resuscitations and pain control over hours, and potentially days, rather than minutes. Training should also include degraded communications that require independent decision-making and resource-constrained scenarios that force prioritization of limited supplies as well as the presence of unmanned aerial systems, requiring care to be delivered under aerial surveillance and intermittent threat, reinforcing concealment, dispersion and rapid displacement. Nurses must also be prepared to make decisions regarding "return-to-duty" that directly preserve the fighting force. Additional stressors, such as sleep deprivation, mobile operations and persistent threat should be deliberately integrated to reflect LSCO conditions.

Finally, resilience and ethical readiness must be addressed as core warfighting requirements rather than ancillary support functions. Scenario-based discussion, leader-led reflection, and realistic ethical problem sets should be embedded into the training pipeline, as well as including behavioral health tools such as EYE-PRO, which is a framework to help leaders and teams recognize stress, regulate reactions, and maintain performance under pressure. Resilience and ethical readiness can build the clinical depth and psychological endurance required for future conflict.

Nurses as Combat Multipliers

As the Army shifts toward LSCO, the Army nurse must evolve with it. Medical units can no longer be viewed as sanctuaries; care will often be delivered under threat, while mobile, and with limited support. In this environment, Army Nurses must fully embrace their role as combat multipliers, integrating clinical expertise with operational awareness and leadership. In future conflicts, survivability will not begin at the hospital; it will begin with disciplined, adaptable, and operationally minded nurses. Preparing the Army Nurse Corps for this reality is not optional, it is essential to preserving combat power and ensuring the force can fight and win in contested environments.

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