I am pleased to nominate our coworker for the DAISY Nurse Leader award based on her outstanding efforts to create a healthy and ethical practice environment in the Burn Center through positive interactions, compassionate action, and leadership.

Our institution's Burn Center is both a rewarding and challenging work environment. The patients we care for have frequently experienced repetitive pre-morbid psychological and physical trauma that make providing holistic and patient-centered care even more important. Recently, we cared for a young patient with significant physical injuries and a complicated psychiatric history. Over the course of his 14-month admission, the interdisciplinary care team included Burn Intensive Care Unit and Acute Care Unit nursing staff and leaders, Burn physicians and Advanced Practice Providers (APPs), psychologists, psychiatrists, the Palliative Care team, and the Ethics team.

Throughout the course of this patient’s admission our nominee embodied strong leadership and ethical decision making. She consistently focused on prioritizing the patient’s dignity and autonomy while fostering a collaborative environment for staff to engage with the interdisciplinary team. She provided a safe space for the nursing team to raise concerns and ask questions, particularly when staff were unsure how to ethically proceed in providing care that supported patient autonomy in the context of fluctuating medical decision-making capacity. This was especially evident when providers were optimizing pain management and sedation with increasing narcotic and anxiolytic medications that are not often utilized on an acute care service. Our nominee coordinated multiple meetings between providers and nursing staff to promote transparency and create a flexible and responsive care plan. She thoughtfully guided the re-evaluation of the plan of care to meet the patient’s changing needs, goals, and direction of care, and ultimately supported the team to provide the environment for a dignified death.

Our nominee personally modeled engagement and professionalism by actively participating in direct care for the patient during the most difficult moments and sharing her own vulnerability with staff when she felt conflicted. Her communication with the entire interdisciplinary team was timely and transparent. 

In this particular case, the patient requested to stay in the acute care unit and redirect care to comfort measures only. This was a testament to how hard our nominee and her staff worked to ensure they had built a strong trusting relationship with the patient over the course of his admission. After caring for him for over a year this was difficult emotionally for the staff to change the goals of care, however our nominee provided ongoing support to staff throughout his last weeks of life. Through her ongoing dialogue and education with staff everyone agreed that upholding his autonomous decision was of utmost importance. She ensured that any ethical dilemmas were thoroughly discussed and the concerns of the staff were heard. When the patient decided to redirect care, he consistently voiced his trust in the nursing staff and did not want to be anywhere else. This patient’s family lived several hours away; however, he was clear that he wanted the team on the acute care unit to care for him during his last weeks. 

When his death was imminent our nominee ensured that staff were surrounded by support from multiple disciplines including chaplains and employee peer support. Our nominee arranged an opportunity for the team to mourn together after the patient’s death. As a strong leader she recognized that this was important for the wellbeing of all team members involved in his care. The experience of caring for this patient highlighted our nominee’s commitment to creating a healthy, collaborative, respectful, and ethical environment in the Burn Center.