Women’s History Month: As Army Surgeon General, Horoho Pioneers Leadership for Nurses, Women

Issue Date: 
March 19, 2012

This article is reprinted with permission from Pitt Nurse, which published it in its Spring 2012 issue.

Patricia D. HorohoPatricia D. Horoho

Patricia D. Horoho, lieutenant general (three stars), in the U.S. Army, has enjoyed a career marked by significant firsts: She was the first woman and the first nurse to command the Walter Reed Health Care System, and she mounted the first medical response to the attacked side of the Pentagon when it was struck by terrorists on Sept. 11, 2001.

Ten years after that fateful morning in the Pentagon, Horoho (NURS ’92G) was again honored as a pioneer, becoming the first nurse and first woman in the 236-year history of Army Medicine and of the U.S. Department of Defense to serve as a surgeon general.

“I would submit that I am just the next person who is passing through the crack that has been opened by pioneers and leaders who came before me, regardless of gender, culture, race, or creed,” she says. “And I will take that role (Army Surgeon General) seriously. It’s a tremendous honor to be able to serve in that position.”

On Horoho’s most recent deployment to Afghanistan, officers and enlisted men and women approached her to say that her nomination to the surgeon general’s post inspired them and gave them hope that their daughters could one day serve in such a role.

Considering that nurses could not command when Horoho first joined the service in 1983, her rise to the highest rank in the medical corps becomes virtually meteoric.

Horoho credits, among her many mentors, her grandfather, an Italian immigrant named Eddie Tarone, with instilling the values that she considers the bedrock of what it means to be an American: faith, family, honesty, and being a team player. A coal miner with a sixth-grade education, Tarone never bought anything on credit. He later opened a small bar and owned apartments, making his way in his new homeland and teaching his descendants the value of a kind word.

“I never heard my mom or him say a bad word about anybody,” recalls Horoho, whose mother, Jo Dallas, has been one of her most ardent supporters.

Today, her parents live with Horoho, her husband, Ray, and their three children. She credits their support for allowing her to spend 28 years on active duty while serving as a mother, wife, daughter, officer, warrior, and nurse.

As the senior officer of the U.S. Army Medical Department, the surgeon general provides advice and assistance to the secretary of the Army and chief of staff of the Army on health care matters. In her new role, Horoho serves as medical commander for an organization that provides health care to 3.9 million beneficiaries—including both active and retired personnel and their dependents—and oversees 616 fixed medical facilities as well as 345 field units. The budget alone, which she also manages, is $13 billion.

“It’s a very comprehensive system,” says Horoho, who served as deputy surgeon general prior to her 2011 confirmation.

Hands-on Leadership

Although she has three offices in the United States—in the Pentagon; elsewhere in the Washington, D.C., area; and at the medical command in San Antonio, Texas—Horoho also intends to travel to parts of the world where Army Medical Department members are assigned. “I want to be able to hear and see how the provision of care is implemented in all environments where care is rendered,” she says.

That desire to see firsthand what is happening on the ground has followed Horoho throughout her military career. Though she initially joined with the intention of staying three years and “seeing the world,” as she puts it, she quickly learned that the Army offered a breadth of experiences and opportunities that could not be duplicated in civilian life.

She has traveled to Haiti, Egypt, Kuwait, Iraq, Afghanistan, Australia, Switzerland, and virtually all of Europe. Everywhere she goes, she helps to ensure that the best possible care is available for American service members. Moreover, she has served in a diplomatic role by helping to partner with other countries to improve care.

“Army service allows you to meet international health care leaders and be able to look at where there’s a global issue that might spark collaboration,” she says.

As a nurse leader, Horoho often speaks about her “C4SG” philosophy: Connection, Character, Competency, and Conviction, along with Serving and the Gifts offered by the profession. “The reason those words are so powerful is because we have strategic implications at the point of health care delivery,” she says. “We not only impact the health of that patient and his or her family members, we also have the ability to impact the strategic aspect of health care.”

Working in a dynamic environment means nurses must have the courage to change. “If you don’t change, you become irrelevant,” she says. “And for nurses, I think it takes a tremendous amount of courage to connect emotionally and spiritually with patients.”

Looking Ahead

During the next four years of her tenure as Army Surgeon General, Horoho plans to focus on collaborative partnerships and the collective health of military service members, their families, and all those entrusted to their care. She believes that the Army Medical Department can work not only with colleagues within the Department of Defense, but also with civilian counterparts in an effort to improve American service members’ health and well-being and partner to improve the health of the nation.

Horoho also urges young nurses to develop a strong clinical background that will better inform them as they eventually move on to leadership roles: By learning how to balance direct patient care with administrative experience, they will have added insights about the impact policies have on care.

“You need to be able to be open to new experiences and make sure that life is a continual lifelong learning process,” she says.

And while Horoho cites many role models—as varied as President Ronald Reagan; Anna Mae Hays, the first woman to earn the rank of brigadier general; and Elizabeth L. (Noroian) Graham (NURS ’68, ’70G, EDUC ’80G), her trauma instructor at the University of Pittsburgh School of Nursing—she says none is as influential as her mother and grandfather.

“None of this would have been possible if the two of them had not been instrumental in guiding me to pursue a profession in nursing,” she says.