Graber, now associate dean of academic affairs and practice initiatives for SON, put a bug in Ivory’s ear about entering the field of psychiatric nursing.

“I really hadn’t thought about a career in psychiatric nursing, and that conversation and the years that followed helped shape my career path,” Ivory said. “When I returned to UD for my DNP, there was no one else I wanted to work with.” 

Typically, DNP students don’t do research studies, but Ivory was determined. 

“Many nursing programs weren’t receptive to the idea, but UD was ready to accommodate,” Ivory said. “Dr. Graber educated me through a process that would’ve been nearly impossible anywhere else. She’s the best faculty member and mentor in academia I’ve ever had.”

Now, Ivory, an expert in Operator Syndrome, presents at conferences alongside her mentor.

“It’s really amazing to see this come full circle with Dr. Graber having guided me as a student nurse to the psychiatric nursing professional I am today,” Ivory said. “It’s really a testament to how things are done at the University of Delaware in the School of Nursing.” 

Graber was Ivory’s advisor in her accelerated nursing and DNP programs and has watched her grow. 

“Rebecca is doing such specialized work with such a vulnerable population, and I am so proud to see her dream come to fruition,” Graber said. “Through her work with Special Operation Forces, Rebecca is bringing information to the nursing community, which may have never heard of Operator Syndrome before. This education piece is crucial because nurses care for people from all walks of life, and without asking the right questions, care can be hindered. This is what makes Dr. Ivory a nurse leader in veterans’ mental health.” 

Ivory’s DNP research centered on chronic pain and trauma among Naval Special Warfare veterans and psychoeducation. She noticed several themes in conducting more than 100 background interviews with Navy SEALs for her dissertation. 

“Chronic pain, trauma, anger, anxiety, rumination, weight gain, inability to recover after routine exercise, insomnia — it was an unusual jumble of conditions,” she recalled. 

But her nurse’s intuition told her they were intertwined. Ivory connected with Chris Frueh, a clinical psychologist and chairman of the SFF Board of Health, who first published the unique constellation of medical and behavioral healthcare needs among special forces known as Operator Syndrome, symptoms of which often develop between five and 10 years of active-duty special operations work. 

John read that paper in 2021 and said, “I thought it was written about me.” 

That led him to connect with Ivory through her private practice, Tactical Psychiatry, PLLC. 

"I didn't think I needed therapy,” John said. “I never considered it.”

Ivory remembers when John first came to her. 

“Most SEALs feel pretty desperate by the time they get to me,” Ivory said. “Many Special Operators have had unsuccessful treatment elsewhere, and no one can figure out why they can’t sleep, why they’re exhausted all the time, or why they have chronic pain when imaging shows no signs of it.

“SEALs experience unique physiologic and psychological consequences of their service, and traditionally trained healthcare providers don’t receive any specialty training to provide culturally appropriate care, which involves understanding Operator Syndrome.”

Special Operators often feel like they’re on an island, struggling in silence. Ivory helps SEALs like John realize they’re not alone. 

“I instill hope within them and let them know — we can get our arms around this,” she said. “Most people say they feel better after we talk because it gives them a sense of hope.”

Getting off that island was half the battle for John. 

“I feel like I have a plan now, and I’m making a point to educate my friends on Operator Syndrome so they know they’re not alone,” he said. 

Rather than provide traditional therapy, Ivory’s work with Operators focuses on problem-solving, education and connections to community and resources. 

Ivory has also brought SEALs into her research and learned that helping them tell their story is another form of therapy. She recently co-authored an article in the Delaware Nurses Association Reporter with a former SEAL sniper, nicknamed “Hoagie,” who’s working to get his master’s in social work. 

“I am very intentionally working with current and former Special Operators to bring them into research science and mentor them to go into health sciences,” Ivory said. “Many veterans, including Special Forces, appreciate and value helping their community as they exit the military. They have a real sense of altruism and want to give back and improve life for those coming after them.” 

Ivory’s goal is for SEALs to achieve wellness — whatever that looks like for them — through medical assistance, healing, research and scholarship, or storytelling. 

“I want them to feel well and be well,” Ivory said. “But I’m also a big believer in graduating patients. I want them to be able to achieve their goals on their own.”

She’s also on a mission to recruit and mentor more people like her. 

“There could be 10 of me, and we would still feel overwhelmed,” Ivory said. “We need more people doing this important work.” 

You’ll hear her repeating sage advice from her mentor, Graber. 

“You would be good at this,” she’s quick to tell talented psychiatric nurses, who she believes have a skillset uniquely suited for this work.

“You need cultural competence, and you need to take the time to understand the community to do this work,” Ivory said. “Special Operators are very open to talking to nurses, and I think nurses have the bedside manner and patient collaboration expertise to make an impact.”

Aside from the world needing more people like Ivory, she wouldn’t change a thing about her path.

“I really love working with this community; the things that they have experienced, the hardships they’ve endured — it is an honor that they trust me to help them,” she said. “I do not take this work lightly. Psychiatric nursing is a calling, and working with this community is a calling. I feel very lucky to do this work, especially with the SEAL community, which is very closed off; they do not allow strangers in. Building relationships and being allowed into this community took time, and now I’m a trusted guest. It’s an honor.” 

*Editor’s note: A name was changed to protect the identity of a Navy SEAL.