Background:  Mr. C is a very difficult to treat Paranoid Schizophrenia who’s psychosis is sub-optimally controlled due to antipsychotic side effects.  In his psychotic episodes, he has destroyed the infrastructure of the unit, requiring considerable financial resources to repair and replace.  Due to the nature of his psychotic aggression and prolonged stay on the unit (“going a little stir crazy”), there is tendency to over-medicate because it is hard to differentiate how much of what we are seeing is psychotic vs a normal reaction to feeling trapped.  The former requires medication, the other requires primary nursing.  Mr. C also has atrial fibrillation, and due to the QTc prolonging nature of antipsychotics, there is a real danger of Ventricular Fibrillation as Mr. C gets noncompliant with his cardiac medications too and is frequently in tachycardia.  I’ve had several incidents where I was able to successfully de-escalate Mr. C when ETOs and Seclusion/Restraints were requested.  I find the frequency of these incidents are lessened when Frank is the safety companion for Mr. C.

Integrity: Frank is often seen with Mr. C playing chess, listening to music, and caring for him in such a way that it exemplifies the best of primary nursing.  He is able to de-escalate him without putting him at added risk of sudden death or damage to the unit.  While this puts him in close proximity to a psychotic/violent patient, it also makes sure he is able to get Mr. C the best care while simultaneously providing the best odds of aggression-free behavior that would harm the staff around him.

Commitment: Franks's ownership of his responsibilities to a psychotically tormented individual is some of the best mental health primary nursing I’ve seen in a long time.  It can not be underscored enough, given the circumstances, Frank’s service to his patient and to the staff around him.  I’ve always known him to be a reliable and excellent nurse, in this scenario, Frank sets himself apart from his peers.

Advocacy:  Frank continues to find nonharmful ways to de-escalate Mr. C.  This protects Mr. C from sudden death.  The lack of collateral damage keeps our units open for other veterans to seek mental health help.  And when Frank requests medications, I’m confident that all other methods have been tried; Frank is consistently a reliable nurse with reliable assessments.

Respect:  Frank cares enough about Mr. C to engage with him.  Most safety companions sit on the side. Frank engages.  While we can all make more money, what we can’t do is make more time, we all have an expiration date that we are speeding towards with each tick of the clock.  The fact that Frank cares enough to spend his time engaging is, in my mind, one of the highest compliments of respect one individual can give to another individual; especially a psychotic individual most people avoid.

Excellence:  If Frank’s Excellence in nursing is not apparent by now, I’m not sure what else I can say!!

Please consider Nurse Valentine-Vega for a DAISY Award; his contributions have kept Mr. C out of danger and saved the VA considerable financial resources.