In veteran healthcare, the most important work doesn’t always happen in the operating room. It unfolds in the ongoing conversations, follow-up calls, and steady relationship building that keep patients connected to care long after an appointment ends.
Inside the VA system, nurses are far more than support staff. They serve as the connective force within the care team, translating medical plans into practical next steps, identifying early warning signs, and helping prevent serious complications like amputation before they escalate into emergencies.
In our most recent episode of Smart Steps, our Medical Director, Gary Rothenberg, DPM, CDCES, CWS, interviewed Helen Kennedy, LPN, a PAVE nurse at the Ernest Childers Outpatient Clinic in Tulsa, Oklahoma. Her story is a powerful reminder that behind every successful limb preservation program is a nurse holding it together.
A Veteran Caring for Veterans
With nearly twenty years of nursing behind her and her own experience as a veteran, Helen approaches care with a perspective that resonates deeply with the patients she serves.
Many veterans carry the long-term consequences of military service, including exposure to chemicals such as Agent Orange and compound injuries that may not appear until years later. As a result, conditions like diabetes, peripheral vascular disease, and neuropathy are common within this population, often compounding one another and increasing the risk of serious foot complications, like diabetic foot ulcers (DFUs).
For many veterans, foot complications develop quietly, progressing without pain as an early warning sign, so that what begins as a small callus can gradually become a wound or ulcer before anyone realizes the severity. In those moments, when the difference between early intervention and serious escalation can be measured in days, the role of the nurse becomes essential.
The Heart of the PAVE Program
Helen serves as a PAVE nurse, part of the VA’s Prevention of Amputation for Veterans Everywhere initiative. She sees high-risk patients, including those with prior amputations, Charcot deformity, severe neuropathy, peripheral vascular disease, or non-healing wounds.
Each week, Helen manages a full clinic of high-risk veterans, often seeing up to 11 patients a day while balancing direct foot care with the coordination their complex conditions demand. In addition to nail and callus care, she ensures proper footwear is ordered, compression is addressed, and follow-up is scheduled. On top of that, she fields phone calls, answers medication questions, and relays urgent concerns to podiatry.
When asked how she views her role within the care team, Helen described it as both primary and supportive. On days when podiatrists are not on site, she is the consistent point of contact. Patients call her directly, and primary care forwards questions to her. She triages concerns, determines urgency, and ensures veterans do not fall through the cracks.
That steady involvement is not separate from treatment, but an essential part of how prevention actually takes place.
Prevention Is Built on Education
At the core of Helen’s approach is consistent, practical education reinforced at every visit. Her team uses a simple acronym, WIN, which stands for washing your feet every day, inspecting them daily, and never going barefoot.
She tells patients plainly that socks are not shoes, and even if they do not shower every day, they still need to examine their feet carefully. The goal is not to overwhelm them with instructions, but to equip them with habits that feel manageable and sustainable.
As Helen explained, “If it’s too complicated, they’re not going to do it. And if it feels like we’re ignoring them, they’re not going to feel validated.”
That philosophy reflects a deep understanding of behavior change. If care feels unrealistic or dismissive, patients disengage. If it feels manageable and validating, they participate.
Reinforcing Access Through Technology
To make prevention more practical for veterans, Tulsa’s VA clinic integrates the Podimetrics Program, which combines at-home monitoring and nurse-led clinical outreach to enable earlier intervention for high-risk individuals. For veterans who cannot feel their feet or cannot easily inspect them, daily temperature monitoring becomes an added layer of protection.
When an alert is triggered, Helen relies on a structured assessment process to determine severity, recognizing that some concerns can safely wait for a scheduled visit while others require immediate evaluation in urgent care. What stands out most to her is not just the data, but the way the program strengthens communication. As she explained, “They’re not only telling the veteran, ‘Hey, you need to get in,’ they’re also telling us so we can contact them, get them seen sooner, and get them the care they need.”
That shared awareness between patient and clinic ensures that potential problems are addressed early rather than ignored. In a high-risk population, not every wound can be prevented, but problems identified at the first sign of change are far less dangerous than infections discovered weeks later. In many cases, the difference comes down to whether someone responded at the first sign of change.
Ongoing Challenges in Care
Even in a well-coordinated system, challenges remain. Staffing shortages, provider schedules, and communication breakdowns between specialties can create delays. Some veterans, especially those from earlier eras, still carry a belief that their concerns are not worth attention, so they wait, they minimize, and they push through. Helen understands that mindset and works intentionally to counter it, knowing that validation and listening carefully can be just as important as any clinical tool in preserving a limb.
Beyond those personal and relational barriers, there are structural ones as well. While the VA model in Tulsa benefits from strong social work support, transportation assistance, and housing coordination, those resources only make a difference when someone ensures veterans are connected to them, and more often than not, that responsibility falls to the nurse.
The Unsung Hero of Veteran Care
Limb preservation is rarely defined by a single moment, but instead unfolds through dozens of small interventions, timely referrals, and repeated education that reinforce prevention over time. It is found in the nurse who returns a phone call on a busy day, who ensures shoes are ordered without delay, and who recognizes that what a patient dismisses as “no big deal” may, in fact, require urgent attention.
Within the VA system, nurses are often the steady force bridging gaps, reinforcing trust, and ensuring that prevention does not depend on chance. They may not always stand in the spotlight, but it is their daily persistence that quietly protects mobility, independence, and quality of life.
