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Research And Critique A Qualitative Study 1)Identify the specific qualitative research design used in the qualitative study attached 2)Summarize the main

Research And Critique A Qualitative Study 1)Identify the specific qualitative research design used in the qualitative study attached

2)Summarize the main

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Research And Critique A Qualitative Study 1)Identify the specific qualitative research design used in the qualitative study attached

2)Summarize the main points of the study including information on the research question, sampling strategy, research design, data analysis method(s), findings, and conclusion(s). 

3)Evaluate the published qualitative research study focusing on and identifying the researcher’s paradigm or worldview and any evidence of reflexivity described in the report. 

4)Explain whether or not potential biases were adequately addressed by the researchers. 5)Describe how the researchers applied ethical principles in the research study.

HERE IS THE CITATION FOR THE QUALITATIVE STUDY ATTACHED

References

Harrod, M., Miller, E. M., Henry, J., & Zivin, K. (2017). “I’ve never been able to stay in a job”: A qualitative study of Veterans’ experiences of maintaining employment. Work, 57(2), 259–268. Work 57 (2017) 259–268
DOI:10.3233/WOR-172551
IOS Press

259

“I’ve never been able to stay in a job”:
A qualitative study of Veterans’
experiences of maintaining employment

Molly Harroda,∗, Erin M. Millerb, Jennifer Henrya and Kara Zivina,b,c,d
a VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
bDepartment of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
cDepartment of Health Management and Policy, University of Michigan School of Public Health,
Ann Arbor, MI, USA
dInstitute for Social Research, University of Michigan, Ann Arbor, MI, USA

Received 5 February 2016
Accepted 4 December 2016

Abstract.
BACKGROUND: Ensuring Veteran employment needs are met is a top priority for the Department of Veteran Affairs
and the United States government. However, Veterans, especially those with mental health disorders, continue to encounter
difficulties when employed. While many employment related programs offer numerous services aimed at helping Veterans
gain employment, their ability to maintain long-term employment remains unknown.
OBJECTIVE: The objective of this study was to understand factors that affect the ability of Veterans with mental health
disorders to maintain long-term employment.
METHODS: An exploratory, qualitative study design consisting of semi-structured interviews with 10 Veterans was per-
formed. Inductive thematic analysis was performed to identify salient themes.
RESULTS: We found that participants’ symptoms manifested themselves within the workplace affecting their ability to
maintain employment, participants felt as if they had been demoted from what they did in the military, and they felt unable
to relate to civilian co-workers. Strategies that helped some transition into the civilian workforce were also identified.
CONCLUSIONS: A better understanding of the difficulties some Veterans face when trying to maintain employment is
needed. Our findings suggest that increasing awareness of existing programs and ensuring that services provide resources
and skills that help Veterans maintain long-term employment is critical.

Keywords: Long-term employment, mental health, reintegration

1. Introduction

Within the United States there are approximately
5.5 million Veterans who served during the Gulf War
era (from August 1990 until present) [1]. These Vet-
erans are younger, more likely to be of working age
(18–55), and looking to secure civilian employment.

∗Address for correspondence: Molly Harrod, HSR&D (152)
P.O. Box 130170 Ann Arbor, MI 48113-0170, USA. Tel.: +1 734
845 3600; Fax: +1 734 222 7503; E-mail: Molly.Harrod@va.gov.

Ensuring that Veteran employment needs are met is
a top priority for the Department of Veteran Affairs
(VA) and the United States government. Several poli-
cies and programs have been developed at Federal,
state, and local levels to help Veterans obtain employ-
ment including the American Jobs Act, the Veterans
Opportunity to Work to Hire Heroes Act, and the
Veterans Job Corps, among others [2–4].

These programs offer a wide range of services
from providing web portals that connect Veterans

1051-9815/17/$35.00 © 2017 – IOS Press and the authors. All rights reserved

mailto:Molly.Harrod@va.gov

260 M. Harrod et al. / Veterans’ experiences of employment

with employment opportunities in their community to
providing more personalized services such as match-
ing military skills with civilian occupations, career
counseling, resume writing, job retraining and edu-
cation [2]. However, despite robust programming,
several studies have identified difficulties Veterans
may encounter when employed especially those Vet-
erans with mental health disorders. For example,
Sayer et al. [5] surveyed Iraq-Afghanistan combat
Veterans and found that nearly 35% had difficulty
completing tasks, potentially affecting their work
productivity, and nearly 25% experienced job loss.
Additionally, Veterans with post-traumatic stress dis-
order (PTSD) tended to miss more work days, were
unhappy with their employment, and had difficulty
getting along with their co-workers when compared
to non-Veterans [6, 7].

While many employment related programs for Vet-
erans (with and without mental health disorders)
offer numerous services aimed at helping them gain
employment, it remains unclear how many offer ser-
vices related to maintaining employment. In fact, a
study by Burnett-Zeigler et al. [8] found that Veterans
with mental health disorders may have more difficulty
maintaining their employment rather than obtain-
ing employment. Studies have also noted the need
for research and information on reintegration experi-
ences and on-going needs, including those related to
employment of Veterans [4, 9].

Considering that studies [4, 10–13] have found that
unemployment can impede successful reintegration,
it is crucial to not only offer employment support to
Veterans, but to identify gaps in services to main-
tain employment. Therefore, the aim of this study
was to understand factors that may affect the ability
of Veterans with mental health disorders to maintain
long-term employment.

2. Methods

2.1. Study design, sampling and recruitment

We conducted an exploratory qualitative study
to better understand the general employment expe-
riences of Veterans with mental health disorders,
and their ability to maintain long-term employment
specifically. We chose a purposive sampling approach
which enables a “detailed exploration and under-
standing of the central themes” (p. 78) of interest
[14]. Thus, Veterans from one VA primary care clinic
were mailed a survey exploring employment related

issues and mental health status [15]. Inclusion criteria
for the survey consisted of patients who had a recent
primary care visit with planned follow-up and were
between the ages of 18 and 55 (ages most associated
with employment). Based on 287 survey responses,
32 respondents who screened positive for depression
and/or anxiety and indicated that they were experi-
encing unemployment, under-employment (workers
who are overqualified for the job they perform or
workers who are working part-time but prefer to work
full-time), or considered themselves to be insecurely
employed were eligible for the interview portion of
the study. All 32 survey respondents were contacted
by phone by the study’s project manager, explained
the purpose of the study, and offered a phone or
in-person interview. If they agreed to participate,
they were mailed a letter describing the study and
the informed consent form. Informed consent was
obtained prior to the interview. Of the 32 eligible,
10 survey respondents agreed to participate in semi-
structured interviews (October 2014-February 2015).
Each participant received a $25 gift card as a token
of appreciation. The local VA medical center Insti-
tutional Review Board approved all aspects of this
study.

2.2. Data collection and analysis

Semi-structured interviews focused on employ-
ment, mental health, and reintegration (Appendix A).
The questions were developed to be open-ended and
explore if and how Veterans were able to maintain
employment. Each interview lasted, on average, 48
minutes (30–89 minutes), was audio-recorded and
transcribed. Transcripts were analyzed using an iter-
ative [16], inductive thematic analysis approach [17].
Prior to coding, all transcripts were read by the first
author (MH) and principal investigator (KZ) to better
understand the data set as a whole. Then, each tran-
script was re-read resulting in codes being created,
defined, and applied. As coding progressed and addi-
tional codes emerged, previously coded transcripts
were revisited to ensure new codes were applied
to all transcripts. All codes, definitions, and criteria
were documented in a codebook. Once initial cod-
ing was complete, pattern coding, in which codes are
reanalyzed and grouped into categories based on sim-
ilarities and relationships, was performed to develop
themes [18]. NVivo 10® software was used to man-
age the data and check for consistent application of
codes. This process led to the development of themes
discussed below.

M. Harrod et al. / Veterans’ experiences of employment 261

3. Results

In order to contextualize participants’ employment
experiences, they were asked about their military his-
tory including employment experiences while in the
military and since discharge (see Table 1). All of the
participants were Gulf War era Veterans. Although
post-traumatic stress disorder (PTSD) was not a
criterion for participation in an interview nor did
we ask specifically about this diagnosis, 5 out of
the 10 participants stated they had been diagnosed
with PTSD in conjunction with depression and/or
anxiety either while they were still active duty or
post-discharge.

What follows are three salient themes regard-
ing the difficulties participants faced in maintaining
employment. These themes reflect their experiences
of how their mental health symptoms, especially
those resulting from PTSD, manifested within the
work environment, their feelings of demotion from
what they did in the military to their civilian employ-
ment, and their feelings of being unable relate
to civilian co-workers, all of which affected their
abilities to maintain employment. We also include
strategies that have helped some of the participants
make the transition into the civilian workforce (see
Table 2).

Table 1
Veteran demographics

Gender
Male 8
Female 2

Marital status
Single 0
Married 5
Divorced/Separated 4
In a relationship 1

Education
High school or less 3
Some college 2
Bachelor’s or more 5

Military Branch
Army 5
Marines 2
National Guard 2
Navy 1

Years in Military
1–5 years 2
6–10 years 4
11–15 years 2
16+ years 2

Employment status at time of interview
Full-time 2
Part-time 3
In school 2
Unemployed 3

3.1. Symptom manifestation

How PTSD affected some of the participants’ abil-
ity to maintain employment came up organically in
the interviews. They told vivid stories of how their
PTSD symptoms, especially flashbacks which are
common PTSD symptoms [19], manifested while
they were at work. These unexpected events often left
participants struggling with how to react in a civilian
context when reminded of their wartime experience.
For example:

“I took a month off after deployment and then I
went back [to substitute teaching] and I was at
[named] High School and as it turns out, their
bell for passing between hours was a lot like the
incoming fire alarm in Iraq and every time I heard
that I would freeze up and at one point I had to say,
‘You know I can’t do this, can I go home?’ and
they knew that I had just come home and they
were like, ‘Yeah, we’re okay with that,’ . . . and

Table 2
Themes with definitions

Theme/Sub-theme Definition

Symptom manifestation Symptoms of PTSD
PTSD effect in

workplace
Stories about how Veterans’

symptoms of PTSD affected their
ability to function in the
workplace.

Triggers Veterans not knowing what would
cause a flashback.

Effect on social
interactions

Talk of how PTSD and its symptoms
impacted Veterans abilities to
interact with co-workers.

Feelings of demotion Civilian work did not compare to the
level of importance of Veteran
military careers.

Non-utilization of
military skills

Military skills are context dependent
and may be underutilized.

Inability to relate Difficulties relating to civilian
co-workers

Work ethics Sense that work ethic did not match
those of civilians.

Unappreciated Feeling a lack of respect or lack of
appreciation from co-workers for
their military service.

Lack of camaraderie Lacking a connection to co-workers.
Finding their way Coping mechanisms or strategies

Veterans developed themselves to
maintain employment.

Supportive co-workers Support and understanding from
co-workers, especially supervisors.

Independent work Work that allowed the Veteran to
work independently and control
own environment.

Change in career Change in career that is more
conducive to current needs.

262 M. Harrod et al. / Veterans’ experiences of employment

after that, you know, I just avoided that school
for a little while of course as you can imagine.”
(Identification (ID) #200189)

Compounding these feelings was the uncertainty
of what might trigger a flashback. One participant
spoke of not knowing what his triggers were and
therefore, had difficulty controlling how he felt in
certain situations.

“ . . . [the] hardest part is I don’t know my triggers
for my PTSD. I do know when it hits, it hits,
you know, the anxiety goes up and stuff like that
and the anger just comes right to the top.” (ID
#200219)

These types of reactions occasionally affected their
interactions with co-workers. In an attempt to control
a situation, some of the participants stated that they
would often fall back on how they communicated
and interacted with their fellow soldiers, assuming
this was the way to get work done. They described
how the approach to work is significantly different
in the civilian context and they would often be per-
ceived as being “aggressive” or “harassing” towards
co-workers.

“I get mad at people and talk to them with a really
authoritative voice that was really powerful and
some people didn’t know how to take that. They
thought I was being harassing when I was just
telling them to clean the spider webs off a dis-
play for the third time . . . But that’s just the way
I’m used to communicating in the military, you
know?” (ID #200700)

Whether it was the unexpected events or the
inability to control one’s environment, many of the
participants either quit their jobs or were fired. Their
military experiences, especially for those with PTSD,
seemed to affect how they were able, or not, to adjust
to their work environments.

3.2. Feelings of demotion

While in the military, the participants stated
that they had received copious amounts of training
and education. Some had top level security clear-
ance in highly classified jobs, and others spoke
of being responsible for leading troops in com-
bat missions. However, once they returned to the
civilian workforce, participants stated they felt as
though they had been demoted. They felt their civil-
ian work was demeaning and they were not able

to use the skills they had acquired while in the
military.

“I mean it’s just, it wasn’t fun, it’s pretty demean-
ing and you go from being a platoon sergeant
to . . . filling a [expletive] vending machine and
you’re getting paid, you know, $10 an hour, so
yeah, it was pretty demeaning.” (ID #200848)

While many of the programs offered to Veterans
focus on translating skills acquired in the military
into a civilian context for securing employment we
found that, for some of the participants, it was the
context in which those skills were to be applied that
was the issue. For example, one participant, who had
been a military police officer, knew that because of
his PTSD, he was no longer capable of performing
these functions.

“I don’t have the mentality and I know I don’t.
I get easily aggravated and I’m smart enough to
know to not put myself into a situation where I
have a gun . . . ” (ID #200463)

Feeling demoted and/or that their skills were not
being utilized led some of the participants to seek out
new employment. However, this resulted in many of
them cycling through several jobs in an attempt to
find a work environment they felt utilized their skills
and knowledge. The two participants who returned
to school did so in an attempt to obtain not only bet-
ter employment but positions that were equivalent to
their military experiences. However, both wondered
if they would be able to adjust to the work environ-
ment, especially the social interactions that are often
required, in a way that would be successful.

3.3. Inability to relate

Many of the participants spoke about the difficul-
ties they had relating to civilian co-workers. Reasons
included differing work ethics, feeling a lack of
respect for their military service and skills, and a lack
of camaraderie/loyalty.

“. . . so many times I shake my head in different
places I’ve worked and thought, ‘Man, you can
tell these guys weren’t in the military.’ I guess [the
military] just raised my expectations of . . . work
ethics or respect to other people.” (ID #200016)

Some participants disassociated themselves from
their work and were more comfortable not develop-
ing work relationships. By keeping these two worlds

M. Harrod et al. / Veterans’ experiences of employment 263

separate, some participants felt that they were better
able to control their work environments.

“I try not to let my personal life interfere with my
professional life. I’ve learned over time, when I
go to work, I leave home at home and when I go
home, I leave work at work . . . That’s just the way
I’ve wired myself to deal with [problems].” (ID
#200219)

However, participants recognized that their inabil-
ity to cultivate work relationships put them at a
disadvantage for work-related opportunities and pro-
motions.

“I just sort of stick to myself when it comes to
co-workers . . . I think if I was a little bit more
outspoken, I probably would get a little bit further
but it’s really hard to [do that].” (ID #200848)

Inability to relate to co-workers affected partic-
ipants work relationships, sometimes in significant
ways, and many of them felt that it prevented them
from advancing in their careers.

3.4. Finding their way

One goal of the interviews was to try to discern
what types of employment services participants had
engaged in both during and after discharge. Half of
the participants stated they had attended the Tran-
sition Assistance Program/Transition Goals Plans
Success (TAPS) program during their discharge pro-
cess. TAPS is focused on offering services meant to
ensure that the separating service member is career
ready when they transition out of the military [2].
Although this program became mandatory in 2012,
the participants who had gone through the program
found it to be only moderately helpful. They stated
that it was too much information at once, they were
focused on going home rather than what they were
going to do for employment, and they did not know
how to apply the strategies they were taught once
discharged. For example, one focus of the TAPS
program is help with resume writing, including trans-
lating military skills into a civilian context, but one
participant stated:

“. . . that’s what the class [resume writing] was
and then they say, ‘Oh, just go on the computer
and put your resume on the computer.’ But if I
don’t know how to explain military life to civilian
life, they’re not helping me.” (ID #200145)

When asked if they had used any VA employment
support programs since discharge, 9 out of the 10
participants said they had not. A few had met with
a Veteran representative at the state unemployment
office, but did not find this resource helpful. Most
had heard of Veteran job fairs, but for the two who
had attended these, they found them to be unhelpful
in terms of actually securing a job.

“. . . it was a lot of people just handing out busi-
ness cards . . . There really wasn’t much to it, like
a lot of it was just information I could’ve already
received online.” (ID #200189)

Although use of employment services was almost
non-existent among participants, some of them were
able to manage their work environments in a way that
supported their transition back into the work force.
They spoke of having employers that understood their
circumstances and offered support and a willingness
to work with them in times of distress. This often
required the participant talking with their employer
about what they were going through and the difficul-
ties they were having reintegrating back into the work
environment.

“I talked to my boss . . . I said, ‘I won’t be able
to take it, I’ll explode and I’ll get up and walk
out’ . . . and we kind of [talked our] way through
it and he got me to smile . . . he’s a good guy like
that.” (ID #200016)

Not all participants were comfortable speaking to
their employers about their struggles. Instead, they
found jobs in areas that allowed them to work on their
own. For example, one participant found that working
in a job that offered him more independence and less
day-to-day direct contact with co-workers provided
him the time and space he needed to respond to stress
in a more measured and controlled way.

“I think what has helped me is my independence
from somebody being constantly on me . . . [it’s]
given me more reason to stand back and it’s that
time and space that allowed me to react within
reason and not immediately, you know, force back
when something upsets me.” (ID #200848)

Another participant stated that he found a change
in career was needed. He found solace in a factory
job that provided an environment that was stable and
predictable.

“Like people are puzzled like, ‘Why did you
leave the professional world for that? You went

264 M. Harrod et al. / Veterans’ experiences of employment

to school for how many years and now you’re just
a factory worker?’ But I’m like you know what?
I’ve never been happier with the job. I mean its
menial labor, but it pays well, I get along with
everybody, there’s no stress so and I’m actually up
for promotion, and I’ve only been there a month,
so it works.” (ID #200189)

Even though these participants found ways of rein-
tegrating back into the civilian workforce, almost all
had done so without help from a Veteran employ-
ment program. Although they had been able to obtain
employment, they were not able to maintain their
employment, changing jobs frequently or leaving
the job market altogether. When asked what they
thought would be most helpful in terms of employ-
ment services, participants stated knowing what was
available, what they were eligible for, and where
they could find information would be most useful.
Some also stated that support for changing careers
was needed given that many had changed jobs and
others were still trying to figure out where they fit in
the employment sector.

4. Discussion

Although understanding the difficulties Veterans
face when trying to obtain employment is impor-
tant, we found that understanding their struggles
with maintaining employment is crucial. Many of the
existing programs were developed with the idea that
Veterans reenter and remain in the workforce. How-
ever, all of our participants were no longer employed
in the job they had immediately following discharge.
Several of them had cycled through multiple jobs and
3 remained unemployed.

Resnick and Rosenheck [20] note that because
symptoms of PTSD are difficult to control, those with
PTSD may withdraw to environments that are known
and predictable. Participants in our study described
how PTSD symptoms or triggers manifested them-
selves within the workplace and ultimately impacted
their ability to perform at their jobs. As a result, some
remained unemployed while others chose to return to
school or change careers. We also found that some of
the participants felt they had been demoted from the
jobs they performed in the military to what they were
doing in civilian employment. Feelings of demotion
came from not applying the skills they had obtained
while in the military and how they felt they were
treated within the workplace, especially during their
interactions with co-workers.

Difficulty relating to co-workers was a common
theme among the participants. Inability to relate often
prevented many of the participants from developing
work relationships, sometimes resulting in negative
consequences such as placing them at a disadvan-
tage for work-related opportunities and promotions.
While a few of the Veterans we spoke with were able
to find employment within predictable environments
or adapt their work environments to make work more
manageable, they had cycled through several jobs
before reaching stable employment. They were not
aware of any programs that could have helped them
through this process.

4.1. Implications for practice

Our findings support prior research that concluded
that employment services need to address obtain-
ing employment and effective functioning within the
work environment, especially when mental health
symptoms are present [21]. Programs that currently
do not include counseling on how to identify PTSD
triggers and coping strategies to mitigate symptoms
should consider adding these to their programs. In
addition, employer education should include infor-
mation on Veteran mental health disorders including
depression, anxiety, and PTSD and how the work
environment could be optimized to lessen the burden
of these illnesses.

A great deal of attention has been paid to the need
for skill matching between military experience and
civilian job requirements. As noted above, one of the
main goals of the TAPS program [2] is to translate
military skills prior to discharge so that Veterans are
prepared to enter the civilian workforce. However,
we found that it may also be necessary to consider
the contexts in which they are applying those skills.
Assessment of Veteran job skills, or the tasks they
can perform, may be insufficient to determine their
ability to adjust to a different context. Determining
the type of environment a Veteran is comfortable
in may help identify jobs that are a better match,
potentially making long-term employment more
feasible.

Similar to other recommendations, employment
service programs should include counseling on how
to build and maintain relationships within the work-
place for both Veterans and their civilian co-workers.
In addition, developing a network of Veterans who
have been successful in these pursuits could pro-
vide support for newly employed Veterans looking
for guidance and mentorship [22].

M. Harrod et al. / Veterans’ experiences of employment 265

And finally, because most of the Veterans we
spoke with were not aware of any employment pro-
grams that could help them maintain employment,
employment services should be structured as on-
going support programs that are designed not only
to help Veterans find initial employment, but also to
help them adapt to their workplace and, if unsuccess-
ful, provide additional support so that a change in
career is possible.

4.2. Limitations

A limitation of this study was the low number of
Veterans who participated. Therefore, it is difficult to
discern how applicable our findings are to the Veteran
population as a whole and may, in fact be limited to
the Veteran participants in this study. However, we
feel that the use of an exploratory design, purposive
sampling strategy, and thematic analysis approach
mitigates this limitation in that it presents a richer
understanding of the difficulties some Veterans
face while trying to maintain employment. Another
limitation was that very few of the participants
had used a Veteran-related employment service
program since discharge. Therefore, it is necessary
to talk with Veterans who have participated in
employment-related programs in order to determine
how these programs currently provide resources
directed at maintaining employment and understand
their experiences. And finally, we did not include
interviews with staff who administer employment
programs, including career counseling. Understand-
ing their experiences working with Veterans and the
resources required to provide on-going support for
maintaining employment is critical.

5. Conclusion

Our study provides insight into how some Veterans
have experienced employment however, additional
research is needed on those who have been able
to maintain their employment and the skills they
employ to do so. Although there has been a tendency
to focus on Veteran unemployment rates, a better
understanding of the difficulties some Veterans face
when trying to maintain employment is also needed.
Current employment programs tend to prioritize job
obtainment. Our findings suggest that increasing the
awareness of existing programs and ensuring that
these services provide resources and skills that help
Veterans maintain long-term employment is critical.

Acknowledgments

The authors wish to extend a heartfelt thanks
to the participants in this study for sharing their
time, thoughts, and experiences. The authors alone
are responsible for the writing, content and views
expressed in this paper and do not necessarily repre-
sent the views of the Department of Veterans Affairs.

Conflict of interest

The authors report no conflicts of interest.

References

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[2] Collins B, Dilger RJ, Dortch C, Kapp L, Lowry S, Perl L.
Employment for Veterans: Trends and programs. Congres-
sional Research Service, Washington DC; 2014.

[3] West M, Kregel J. Employment services and supports
available to veterans with disabilities through the U.S.
Department of Veterans Affairs and other Federal agencies
(No. 8092). Mathematica Policy Research; 2014.

[4] Yosick T, Bates M, Moore M, Crowe C, …

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