I have had the pleasure of working with Andrea Bolts for over three years. During that time, I have known her to be one of the most determined, focused, creative, and driven nurses I have ever met. Andrea strives to improve outcomes for veterans through education and evidence-based practice. Therefore, with great pleasure, I nominate Andrea for the DAISY Award.

Andrea is well-known in our unit for her clinical knowledge, easy-to-approach nature, and willingness to help. She has been my mentor, as well as the mentor to other newer nurses in the unit. Andrea is constantly sharing her knowledge with all of us. Once, I had a veteran with a complicated wound requiring wound vac application. Andrea came to the bedside with me, and she invited another nurse who was available. She gave us a master class about wound vac dressing that has substantially improved my practice. Being a WCC and floor nurse, Andrea constantly wears several hats in our unit. While being the charge nurse, during plastics or skin rounds, Andrea is always available to measure wounds in a new admission or assess a change of condition.

After the wound practitioner resigned on short notice, Andrea assumed the lead of the wound team. She worked extra hours to help with logistics, answered phone calls on her days off, and in the middle of the night to answer questions about dressings and ordering supplies. Andrea was invited to be the team leader of RNTTP (RN transition to practice) next cohort, and she also volunteers her time to serve on the NPSB Nursing Professional Standards Boards.

Andrea facilitated wound education at the SCI boot camp with kindness and made all attendees feel comfortable to ask questions and participate in the training. Andrea attends conferences and brings new ideas and knowledge to the SCI practice. She participated in the Wild on Wounds Conference and suggested the A&D ointment for our veterans' dry skin. Our physicians adopted the ointment, and its benefits are well evidenced by before and after pictures done during skin rounds.

During wound rounds, Andrea noticed a veteran hemorrhaging. He had resumed anticoagulation therapy days after OR wound debridement, and the wound was actively bleeding. After successfully managing the emergency, Andrea collaborated with the nurse educator to develop an SCI hemorrhage protocol and wrote a Standard Operating Procedure. Andrea reached out to Logistics and made it possible for our unit to carry emergency hemorrhaging supplies and labeled them in a way to be easily found during a code.

Andrea often becomes the voice for change and improvement not only to our veterans but to staff as well. During plastic rounds, she suggests appropriate changes in wound management and makes sure all patients that need consults are seen by the providers. Andrea recently noticed that an Envella mattress was still being used by a veteran with a completely healed flap incision. The rented mattress makes turning and repositioning very challenging for the staff. Andrea requested the providers to discharge the mattress, ensuring staff safety and stewardship.

Andrea was the chairperson for our UBC for three years. During her tour participating in the Shared Governance, Andrea’s accomplishments reflected her focus on improving outcomes for our veterans and colleagues. Under Andrea's initiative, the UBC led and supported the SCI month. The unit wore themed t-shirts, and SCI was showcased in the Tri-council meeting. It brought awareness to the specific care SCI veterans need. This information is necessary for other units when SCI veterans are transferred to acute care in the main building.

Andrea wrote an ARF for standard and reference for Acute Rehab veterans, and it was followed through by team members who wrote a reference binder. Andrea wrote a standard operating procedure for renting specialty mattresses that handles the dynamics of admissions and transfers while being cost-effective. Also, she prepared an SOP in collaboration with a former wound teammate on how to discharge specialty mattresses. Andrea discouraged and made the staff aware of the unsafe use of verbal orders in non-emergent situations, drastically decreasing this practice by our physicians. She wrote an ARF for providers to keep their orders current and up-to-date to ensure all veterans receive appropriate care. Andrea has an initiative nature and awareness of safety. She made it possible to remove wound treatment carts from hallways, decreasing supplies waste and infection control issues.

When advocating for better staff working conditions, Andrea brought new whiteboards to the veterans’ rooms and created a communication sheet to organize the many appointments our veterans attend, which improved staff time management. She requested and received an ergonomically safe refrigerator and freezer and step stools with long handles for staff to reach items in the Omnicell. Andrea collaborated and wrote for a Wellness Grant that granted wellness equipment and a break room redesign for our unit.

Andrea worked to change our hallway artwork to reflect the nature of the population we serve. She proposed to showcase SCI athletes in actions such as sports and recreation, demonstrating how they can live up to their full potential. Andrea understands the care process of the SCI veteran. She is aware of potential issues and has the creativity and initiative to make changes. These changes have created new protocols, and improved health outcomes and safety for our veterans and the staff.

Andrea utilized her background in business to create logistics, manage inventory, and make ordering supplies efficient. She created a system with dated wound vac kits containing all necessary supplies for each veteran in the unit. The staff verbalized their appreciation since it improved organization and time management. Andrea contributed to the skills development of the whole unit. She collaborates at the monthly SCI education meetings, and she set up an in-service with the KCI representative for a wound vac application refresher class when our unit had over ten veterans using wound vacs.

Andrea noticed that veterans receiving enteral nutrition were having many feeding interruptions due to bowel care, RT treatments, transfers, and other procedures. It would decrease the total feeding volume for the veteran, jeopardizing wound healing and participation in acute rehab. Andrea requested the providers to change feeding orders from rate to volume, providing the veterans with adequate nutrition. Andrea collected data from our weekly plastic team rounds, and it was used for the PVA onsite visit to demonstrate how we manage patients from plastic surgical level and trends. This data was also used for CARF, so we could validate the need for plastic surgeon support at SCI centers.

In 2020, Andrea identified the need to ensure hydration for veterans receiving enteral nutrition. She researched the literature about the kangaroo feed and flush and wrote an Action Request Form (ARF) to the Unit-Based Council. The matter went to the clinical practice committee, and leadership approved the kangaroo trial in the main hospital. Because of Andrea’s initiative, this year, the kangaroo feed and flush became part of the hospital supply chain.

Andrea has been invited to attend the ARN 2023 Rehabilitation Nursing Conference, where she presented her poster, “Managing Postoperative Bleed in Anticoagulated SCI Patients.” It demonstrates Andrea’s commitment to keeping our veterans safe while having the highest quality of care. Our Evidence-based coordinator has formed a team to turn Andrea’s abstract into policy and the ARN is interested in turning the abstract into a paper and publish it.

Andrea calls staff at the bedside to sing happy birthday to veterans. Family members remember her by her name and happily greet her in the hallways. Never have I seen Andrea too tired or unavailable to help. Her energy and knowledge have no bounds. Unquestionably, Andrea Bolts deserves the DAISY Award.