How do you measure the achievement of a nurse? Is it by the job title, the amount of education, or credentials? Or could the greatest achievement of a nurse be the legacy that serves as inspiration and the beacon that paves the way for the next generation of nurses to model after? Education and career advancements are undoubtedly paramount, but I would argue that the latter is equally imperative to the nursing profession. Therefore, it is my privilege to nominate Sandra Young, RN, PMH-BC, "Sandy," for the DAISY Award to recognize Sandy's contribution as a remarkable role model. With over 25 years of experience as an RN, she is an exceptional mentor, team player, and patient advocate who embodies the spirit of nursing excellence. 

Sandy may not be aware of this, but I have considered her my mentor since joining the Utilization Management (UM) department years ago. She is warm, kind, inviting, patient, and not afraid to be frank at the same time. Sandy makes it easy to approach and talk to her. She makes you feel like you can ask her questions without fear of judgment. Sandy will also give you her honest feedback. Sometimes, they are brutal, but somehow, she makes it easy to digest and accept it as constructive criticism. She makes it easy to laugh aloud, acknowledge the mistake, and move on without hard feelings.

Sandy has taught and guided me with so many things that it is hard to pick just one example, from conducting the clinical review with the payors to handling setbacks, such as insurance denial, and navigating and avoiding pitfalls with different teams. It all started with work, but eventually, over the years, she would also guide me in my personal life and family, right down to when I experienced the loss of my beloved dog, Blinky. Today, Sandy is still my go-to when I need guidance for just about anything. She is an exceptional mentor because you can trust that she has your best interest and only wants you to succeed.

Sandy is a remarkable team player who goes above and beyond her assigned duties and embodies the spirit of collaborator and supportive co-worker. She is our team's pillar with her expertise, positive attitude, and uncompromising dedication. Her commitment to the team is unparalleled; she often would check in with us while on vacation, confirming everything was taken care of and we didn't need anything from her. Even with her hands filled, Sandy is always willing to help, take on extra work, and support everyone who needs it. She takes on additional duties for the team. There are so many things that Sandy has been doing in the background, and we barely notice them. One of the things she is still doing is auditing our work queue. The work queue lists our deficiencies and mistakes that must be corrected. Sandy takes it upon herself to go through them, let us know our mistakes, and support us with how to fix them. I am convinced that once Sandy is no longer with us at work, we will have many things that need to be done that Sandy was doing without realizing it. With no hesitation, Sandy is one of the first to jump in and collaborate on any new issue or initiative of the department. Her enthusiasm would make you believe she is just starting her career. In reality, she is looking to retire in less than a year. 

Although largely invisible to most people, a UM nurse plays a vital role in healthcare. One of the UM nurse's duties is advocating for optimal patient treatment by securing adequate payment from the insurance. Healthcare is not free. Proper funding is needed for the patients to have the best possible outcome. For most patients, it means utilizing their health insurance. If healthcare is a car with the healthcare provider as a driver and the patient as a passenger, our role as UM nurses is to ensure sufficient funds for the gasoline to power the engine so the patient can reach their final destination and treatment goal.

Sandy is a fierce patient advocate. From admission to discharge, she works tirelessly to obtain authorization through the utilization review process, critical thinking, collaboration with interdisciplinary teams, the insurance company, the patient/their family, the medical necessity criteria, and the applicable evidence-based guidelines. In one instance, after being on a long hold with the insurance, Sandy did not let the insurance reviewer get off the phone without the authorization of her patient. After she did her initial review by answering the reviewer's questions, knowing that appropriate questions were not asked and approval for the treatment would not be granted. Sandy swiftly switched gears and, with laser precision, started striking the reviewer with additional crucial clinical facts, implications, and rationales that the reviewer failed to consider. After a few minutes of these, she ended up with the authorization for her patient. Sandy calmly hung up, entered her auth, and moved on. That particular phone call took a little over two hours. Eight hours is our work day.

Sandy takes great pride in her work. She often tells us a story of one of the patients in the KidConnect PHP, formally known as Early Childhood PHP. The patient suffered from severe maladaptive behaviors due to autism. He wrote a thank you letter to the program after successfully completing the treatment, which enabled him to function and graduate from college. As she tells the story, the happiness in her eyes is profound, but the patient probably doesn't even know Sandy's existence and how she has helped him. 

Sandra Young, RN, PMH-BC, is the epitome of all the unsung heroes in healthcare. A DAISY that is out of sight, out of mind, hidden behind thick grass. It is time to shine the light on this DAISY for all to see. Let us recognize and celebrate her contribution to nursing as an outstanding mentor, team player, and patient advocate. All of which I plan to emulate and play it forward. 

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For the better part of the last decade, I have dedicated my life to the area of psychiatric nursing. Within this time, I have had the opportunity to be a part of many institutions throughout the country. Being new to the UCLA family, I am humbled by the amazing things that are occurring here. One of the biggest impacts on my onboarding journey has been witnessing strong nursing leadership at the forefront.  Specifically, I would like to highlight Nurse Sandra Young RN of the UM department at Resnick Neuropsychiatric Hospital at UCLA, or “Sandy” as she likes to be called.

In nursing, we joke and say that senior nurses will “eat their young.” This nursing stereotype could not be further from the truth in the case of Nurse Sandy. As a new nurse in this department, she has shown outstanding leadership and compassion. She serves in her position by way of example and of love. Her devotion to nursing and the desire to teach others are qualities in her that I have not witnessed to this degree in all my years as a nurse. To see her in action, channeling love and service though her profession of nursing is a force for good that is not often seen. Her selflessness is boundless. To put it frankly, when I come into the hospital and realize that Nurse Sandy is working with us that day, I know we are going to have a good shift. She is a burst of light tour team. Her positive energy changes the day, however challenging it may be, to a great one.

A new job can be a challenge. New systems to learn and navigate. I could not have asked for a better teacher. On more than one occasion, while fumbling through a task and full of anxiety, I had the good fortune to have Nurse Sandy at my side and guiding me through. Her gentle guidance and positive energy are like a bacon, steering me to shore.

I am blessed to be on this nursing journey with Sandra Young RN. Her love and service will have a lasting impact on our department and my nursing career for years to come.

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I transitioned to a new area of nursing, almost 5 years ago, called Utilization Management (UM). It was a career opportunity that we do not learn about in nursing school, nor had I heard of it during my early career on the floor, however, I often wondered how some patients could stay in the hospital so long in terms of cost, insurance coverage, and how that was all determined. Often times UM Nurses are not as visible on the floor as Clinical Nurses are providing direct patient care, however, what I've learned is that there is a whole other team of unseen nurses/heroes working just as hard behind the scenes. They work relentlessly advocating for patients and have difficult conversations with insurance companies regarding patient conditions, treatment plans, medications, and why continued hospitalization is needed. UM Nurses have to work diligently to ease the stress and burden of pending insurance coverage or authorizations for our providers, families, and patients, which is a behind-the-scenes and often thankless job.

It was during this transition that I was introduced to one of the friendliest, caring, compassionate, hardworking, and knowledgeable nurses in UM. This nurse made me feel so welcome and made it enjoyable to learn this new skillset that is not taught or learned anywhere else in the health system or nursing school. Their approach to teaching was so fun, laidback, and gentle, and they always jokingly reminded me, when I made a mistake or received a denial from insurance, that we didn't have sentinel events in UM. They emphasized that we just try our best to advocate for patients' and families' healthcare treatment needs.
 
With a nursing career spanning well over 25 years in various roles as a Clinical Nurse on the floor to their current role in administration as a UM Nurse, I without a doubt nominate my colleague for the DAISY Award. To share my heartfelt experience, here are just a few outstanding examples from my nearly 5 years working alongside this amazing and inspiring Registered Nurse, board certified in Psychiatric-Mental Health Nursing. They most certainly have a distinguished career as a nurse in clinical practice, administration, and education, which promote a positive image of professional nursing.

No other UM nurse serves well as an exemplar for improvement of patient care and enhancing the patient experience with insurance companies for our partial hospitalization patients ages 2-6 with autism. Their voice always came out strong during discussions of patient care and treatment planning with our Doctors, Social Workers, while emphasizing the importance and medical necessity of patient care. Despite their high caseload, and longest lengths of stay, they’d be seen always on the phone, emailing and faxing various providers and working relentlessly with success to overturn denials, alongside frustrated family and team members. Even though this nurse never met a patient or family, their compassion and care for them was evident in their emotion, conviction and determination to get these kids' care covered. As a result, enhancing the patient experience with improved mental health, functioning, and overall outcomes. I recall a patient/family letter shared with our team regarding one of these young patients who completed the program and had become a success going on to college and leading a healthy, productive life. It is through the relentless efforts like my colleague that keep these kids' treatments moving forward and contribute to the improvement and enhancement of patient care and experiences.  

I have always looked up to my colleague as the unofficial charge nurse and leader on our team, as they always looked at assignments, admissions, and went through the work queue to see what hadn't been done or needed follow-up. I would say this nurse has the most knowledge regarding behavioral health insurance policies, throughout the health system, and has worked relentlessly to ensure that this knowledge has been transferred to all members of our team. Moreover, like a true transformational leader, they showed us how to work hard during the short staffing we all experienced during the pandemic and would always offer to help us with our caseloads and tend to the daunting administrative tasks that we often didn't have time for. My colleague never hesitated in stepping up to this leadership role on our team, and we all have the utmost respect, appreciation, and admiration of them always picking up the slack and leadership reigns for our team.

As a board certified Psychiatric-Mental Health nurse with over 25 years of service in both clinical and administration roles, they have also contributed to the education of new nurses on floor as a preceptor and more recently in UM. Their clinical knowledge shines through during lengthy discussions of complex clinical cases of our geriatric inpatient cases and those age 5 and under with very long treatment stays at partial hospitalization programs. I was often inspired at their compassion and advocacy for patients and families where they would become so visibly upset any time denials were issued, and would go the extra mile many times, sometimes talking to parents and families on the phone to guide them through stressful appeals with insurance at the state level. It is not under our regular set of duties to speak directly with patients and families, but I've seen how much this nurse cares and they always go above and beyond the call of duty. 

In terms of education, they have always actively engaged in orienting and teaching new UM nurses, including myself, about the world of UM, insurance and hospital administration. They have a wealth of knowledge and have greatly contributed to the health system’s current UM educational resources for behavioral health, which is so highly specialized and detailed. I have watched this professional nurse deliver UM education and orientations to our residents, social workers, nursing staff on the floor, year after year. Education that includes documentation requirements by insurance, defining insurance medical necessity criteria for treatment, aftercare planning, and contributing to countless power point presentations, manuals, and resources that have contributed to the educational and professional development of all UCLA staff and students. Moreover, they are always eager to contribute in other ways such as attending nursing seminars, conferences such as APNA and Magnet, engagement of solution-oriented staff meetings, and providing a voice for UM throughout the health system and nursing profession.

I hope that I have been able to provide the selection committee just a brief snippet into my nursing colleagues 25+ year career in the profession that demonstrates their devotion to the compassionate care of others, including staff, families and our patients. As such, without hesitation, I highly recommend my colleague to be this year’s recipient of the DAISY Award.