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2024 APNA Award for Excellence in Practice – RN

Captain Thi Lua, BSN, PMHRN-BC

Nominated by Lt. Col. Renel Ramos, DNP, MSN, RN, NPP, PMHNP-BC

Captain Thi Lua’s innovations indicate her ability to see the big-picture impact that’s possible when small details and processes are working efficiently. An early belief in teamwork was instilled through her family roots in the Marine Corps. She explains, “I believe serving in the military is a reward. There’s nothing like taking part in something bigger than yourself. So, I was thrilled when I was accepted to work as a psychiatric-mental health nurse in the Air Force.”

After graduating in 2015 with her Bachelor of Nursing Science degree (BSN), Thi began her career at a skilled nursing facility. But when her husband entered Marine basic training, they moved to Jacksonville, North Carolina, where Thi took on a new role as an inpatient Psychiatric-Mental Health (PMH) nurse working in a large adolescent unit. She shares, “In Jacksonville,

I fell in love with PMH nursing and knew I’d never leave it.”

Thi began her own military career as a commissioned officer in the U.S. Air Force, working as a PMH nurse at Brooke Army Medical Center in Fort Sam Houston, Texas. She encountered very different diagnoses and challenges among a new patient population of trainee airmen. Despite the learning curve, Thi soon saw the impact she could make with the smaller nurse/patient ratio there. “At Fort Sam Houston my patients were predominantly new recruits trying to adjust, often feeling hopeless. I found I could put more time into each patient – keep them safe, help them develop effective coping skills, and achieve their mission.”

Thi’s next set of orders took her to England to serve in a very different role, as a PMH Nurse Case Manager coordinating patient care. Working as the sole Mental Health Case Manager in the second largest mental health clinic in the U.S. Air Force in Europe (USAFE) was a new challenge.

As the first PMH nurse to fill the role of Mental Health Case Manager, she quickly saw opportunities to redefine the position. Thi transformed the role during her first 7 months on the job, establishing clear processes and procedures for the clinic. As a result, the clinic was able to more efficiently coordinate hospitalization for active-duty service members, better communicate between a variety of inpatient facilities, and coordinate patient travel back to the United States.

Thi next created a clinical management tool to enable rapid identification of medication shortages and decreased gaps for refills by 30%. Ensuring safety and continuity of care, Thi streamlined an existing care tracking system to facilitate more consistent follow-up for high-risk patients and proper oversight of a monthly average caseload of 46. Thi’s work has led to expedited care, closer patient monitoring, and ultimately, much more positive patient outcomes across all three Air Force Bases within the United Kingdom (UK).

Thi shares, “As a Mental Health Case Manager, you have to give everything you can the moment you have the opportunity. In the beginning, I would work a 12-hour day because the needs and communication didn’t stop. With new processes in place, we can more easily manage the progression from intake to coordination of care, and admission to a variety of inpatient facilities we partner with in Texas, Florida, and the Netherlands. We’re now better able to prevent suicide and help patients develop the skills needed to manage the life stressors that military life can bring.”

Colleagues agree that Thi is an “amazing nurse who crushes expectations,” and the numbers support their claim. Despite working with a 50% personnel deficit in a resource scarce environment, she was instrumental in the management of 35,000 beneficiaries and 3,000 deployers while completing more than 1,000 initial psychiatric triages and 350 de-escalations during her 3 years on the job. Thi has also led air evacuation of 22 joint service members across two facilities and among 10 providers, while leading the development of quality inspection standards for the medical group and teaching primary care providers about the importance of appropriately identifying and managing at-risk patients.

As mental health stigma remains a challenge in the Armed Forces, Thi consistently works to increase mental health awareness and educate airmen, telling them, “You can’t have health without mental health. Just like you have to work to build muscle, you also have to work to build your brain and strengthen your resilience.”

In service of the Secretary of Defense’s Suicide Awareness Campaign, Thi identified a local practice gap along with the solution, resulting in a new 100% implementation rate. During the pandemic and the two years that followed, she also supported outreach to the local community in England, providing 150 hours of local community support that strengthened ties between the American Joint Forces and the UK. As a result of her incredible work, Thi is a sought-after mental health subject matter expert who regularly provides briefings across the joint services on self-care, mental health, and resiliency, and trains new mental health technicians.

Next year, Thi’s 4-years as a Mental Health Case Manager will come to an end and she will be deployed where she’s needed elsewhere. It’s clear that regardless of her assignment, Thi will continue to positively transform the delivery of high-quality mental health care in the U.S. Armed Forces.