I request to formally recognize Megan Agugliaro, a nurse currently working in the VA Emergency Department, for a DAISY Award. While I generally think this award is most appropriate for nurses who demonstrate consistent and repeated acts “above and beyond” what is expected of them, I find that recent patient-centered care and advocacy demonstrated by Megan meets the threshold for special recognition. As such, I am proud to be submitting my first-ever DAISY Award nomination today despite working at the VAMC for the past ~10 years.

Megan is a great nurse in general (as are so many working in the Emergency Department), and I have enjoyed working with her as a colleague for the past ~2 years since she joined our ED family. However, I became aware of her exceptional focus on patient-centered care last month when I overheard her advocating for a veteran patient. She was inquiring with a patient’s ED treating physician about possible hospitalization instead of discharge (at this point, the physician had already formally discharged the patient home from the ED, and he was essentially waiting on a ride home). This patient (for confidentiality, referred to as “Mr. F”) is a quadriplegic after a devastating cervical spine injury. Megan had apparently cared for this individual previously, but reportedly knew there was more that could be done for him and had several legitimate concerns about his safety at home, his overall wellness, and the challenges facing both the patient and his family. Megan shared medication concerns and mental health concerns and had already done an extensive review of the EMR to try to advocate for this patient as much as possible. She even contacted this patient’s spinal cord injury coordinator to see what, if any, further resources could be allocated toward the care of this veteran.

As the patient’s initial treating physician was leaving his shift, I offered to evaluate the patient, and after a thorough conversation with him/wife as well as review of the EMR, I agreed that this patient was most appropriate for hospitalization and further sub-speciality evaluation/care. Megan was, of course, grateful for this, but did not stop there. She visited the patient numerous times during his hospitalization (every shift Megan worked in the ED and even on a day off) so that Mr. F could enjoy having a visitor/companion nearby and also to ensure that Mr. F was receiving the inpatient attention he needed. Megan would even assist the patient’s inpatient RN with nursing tasks simply to be helpful, given his multiple inpatient physical and emotional needs.

Megan then visited his home and met with his wife, which she has now done several times. Utilizing personal contacts and resources, Megan then arranged to have expensive home modifications completed at no cost to the patient or his family so that a concrete wheelchair ramp into the home could be elongated, which would enable Mr. F. to safely transition in/outside freely and safely. Without this ramp, Mr. F is essentially confined inside his own home and has no means of going outside safely. Megan continues to communicate with Mr. F’s family and has plans to help him out when/where she can. She continues to work with his spinal cord injury coordinator to seek ways of improving his comfort and quality of life.

I have been functioning as an Emergency Medicine physician for the past ~13 years and I don’t think I have ever witnessed such advocacy for a patient, certainly one that needs as much support as Mr. F. Megan’s recent (and expected ongoing) actions are a testament to her amazing committment to patient care, excellence in nursing, and above all, advocacy for her patient(s). For these reasons, I believe Megan has not only adeptly demonstrated VA I-CARE values, but has also improved the physical and emotional well-being of a patient (and his family) in a way that likely nobody else would have. And she did none of this for personal recognition; that, too, is something to be celebrated and recognized.