It’s my sincere honor to nominate Raelando “Rae” Miller for a DAISY Award for his work with a very complex patient (who will be referred to as “Patient X”) who stayed with us on the Adult Psychiatric Treatment Unit (APTU), after boarding for many months on the medical floors. Patient X was a transgender female-to-male patient who came to us with a Functional Neurological Symptom Disorder (FND) diagnosis along with many other medical and psychological co-morbidities, including failure-to-thrive, Borderline Personality Disorder (BPD), extensive trach care, and the near-constant threat and possibility of self-harm. Due to FND, the patient was essentially paralyzed most of the time in their lower and partially upper extremities. Due to Rae’s expertise, attention to detail, and care – all led with empathy – this patient was able to safely discharge from our hospital after a relatively short amount of time.

Psychiatric nursing is unique – often nurses have to navigate setting firm boundaries with our patients, which can be perceived as counterintuitive to what the patient in the moment would wish for themselves. In other words, we often must provide not what the patient wants but, rather, what the patient needs. This can often create conflict and escalation with our patient population, yet this is all done in order to help our patients achieve their best possible outcomes. Rae masterfully navigated this careful balance with patient X. After some years away from the bedside, I was re-orienting onto APTU, and Rae was my preceptor during the time we took care of patient X. I saw firsthand how painstakingly Rae approached his care.

Rae created a complex behavioral plan, down to an item-by-item daily inventory of what was allowed in the patient’s room, in order to reduce the chances of the patient self-harming, all while steadily trying to also foster increased independence for patient X. Due to patient X’s BPD, he significantly questioned and rebuffed Rae and the interdisciplinary team nearly every step along the way. This daily, sometimes hourly, situation would have been nearly impossible for even very experienced psychiatric RNs to successfully navigate, but Rae had established a deep rapport with patient X from the beginning and grew that rapport over time. Rae was able to strictly adhere to patient X’s plan all while navigating the patient’s trach care and medical co-morbidities, on top of taking care of his other assigned patients.

Rae’s attention to detail and perseverance significantly contributed to patient X’s safe discharge from APTU and it was reported to APTU after discharging that patient X was walking and fully attending to his own activities of daily living; for anyone that took care of patient X during his time at Baystate Medical Center – this was frankly staggering to hear and a true testament to Rae’s care.

If someone I cared about was having a psychiatric emergency, I would want Rae to be their nurse. He is the epitome of a “nurse’s nurse,” and his extensive medical background and psychiatric skills, combined with his calm demeanor, truly bring so much to the table here on APTU. Our staff always looks forward to working with Rae, knowing that the unit is going to be just a bit safer that day.