As I thought about nominating Stacy Fritts for this award, I wanted to understand what the DAISY criteria were asking for or what the nurse leader should exemplify. I committed to a bit of research before writing. I wanted to know what it meant to be extraordinary. In summary, two articles summed it up for me. An article in American Nurse titled: Beyond Thank You: The Powerful Reach of meaningful recognition states extraordinary nursing is defined by the nurse’s ability to identify needs and meet those needs in a manner that is meaningful to the patient, family member, or colleague (American Nurse: The Official Journal of the American Nurses Association (ANA), n.d.) and an article titled Top qualities of an exceptional nurse writes, The best nurses are considered exceptional because they have a thirst for knowledge, continual skill development, and lots of experience. What makes a good nurse is more than practical knowledge - their personality traits are every bit as important (Ihde, 2017). Stacy Fritts meets the definition of an extraordinary nurse, role modeling extraordinary behavior as depicted in these articles.

Ms. Fritts, in her role as Primary Care Manager, creates an environment where attributes of trust, compassion, mutual respect, continued professional development, and ethical behavior are modeled and supported. It has been four years (June 2020) since transitioning to Primary Care (PC) under the leadership of Ms. Fritts. I frequently thank God for the opportunity to work in partnership with Ms. Fritts, the person. From my first day in PC as a Registered Nurse (RN) Care Manager, she has been more than accommodating and gracious towards me and the entire staff. She is a wealth of PC knowledge and doesn’t waver in sharing that knowledge and experiences. For me, she has made PC a sanctuary, allowing me to be all of me at work; she accepts me for who I am and doesn't want me to be a carbon copy of her. My favorite Stacy attribute is that she doesn't get stuck on her position or perspective. She listens and considers others’ perspectives, respectfully disagreeing or, most often, being open to change. I am blessed to have had the opportunity to work and grow under her leadership. Ms. Fritts has treated me not as a subordinate but equally as a colleague and friend. It is because of her kindness that I have been able to heal and feel psychologically safe again. Ms. Fritts, while not perfect, not only shines as a leader but also makes others shine, for iron sharpens iron. Because of her leadership, our team has achieved significant milestones and grown in ways we never thought possible.

I have seen Ms. Fritts' yearly planning recognition luncheons for nurses, physicians, administrative staff, etc. There are no dollars for these luncheons, but they are coordinated efforts led by Ms. Fritts and PC leadership in an earnest attempt to recognize and promote satisfaction with employees. Ms. Fritts spends hours at home hand-making beautiful nurses' week celebration banners, thank you notes, and other thoughtful "things to remember" trinkets for each employee, often individualized to that person. Every year, Ms. Fritts also hand-makes personalized Christmas ornaments for staff, including a small, sweet treat with this gift. She is the kindest, most thoughtful, and generous person I know. With her compassion and moral clarity, she works to create an environment of teamwork and civility.

Ms. Fritts not only adheres to the principles of a just culture but also embraces it, consistently providing the benefit of the doubt approach and advocating for individual self-awareness and improvement among staff. Her leadership style, which is based on trust, empowerment, and collaboration, has significantly contributed to the success of the Primary Care unit. She understands the big picture and can get employees to buy into the larger vision. Most managers have subordinates and create circles of power, whereas a leader has followers and builds influence. However, Ms. Fritts is extraordinary in her ability to influence, motivate, and enable PC staff to contribute toward organizational success. While I can’t speak for any PC employees, as a leader, I certainly would follow her anywhere. Her PC accomplishments imply that PC employees would, too!

As Manager, Stacy Fritts is excellent in executing the PC and organizational vision systematically and directing employees on "how to." She is not afraid to model the work that needs to be done. As for her accomplishments, Ms. Fritts creates an environment where trust, compassion, mutual respect, continued professional development, and ethical behavior are modeled and supported. She collaborates with and on multidisciplinary teams and departments to meet PC and overall organizational goals. As the Erie PC Manager, she doesn't hesitate to go the extra mile to ensure that the Community Based Outpatient Clinics (CBOC) (5) are included in all roads to success as she fully understands the struggles of these sister facilities, having been a manager at the Ashtabula CBOC in the past responsible for providing guidance and coverage for each on several occasions. As an example of her inclusive leadership, she initiated and currently leads the bi-weekly PC managers' meeting to discuss gap provider utilization and ensure coverage for all PC facilities. Coverage is reviewed with each CBOC manager to anticipate planned and unplanned coverage for providers and provide improved veteran access. Ms. Fritts coordinated with VISN leads to host PACT University education for all staff, including CBOC staff. She recognized the impact that staff turnover, together with an increase in staff new to the organization, was having on the quality of care and saw it as an opportunity to re-educate and professionally develop the entire team regarding the Foundations of the Patient Aligned Care Teams (PACT), and the PACT model as it relates to the Veterans' Affairs (VA's) Transformational initiatives. This action led her to move staff away from the weeds of "alerts" to focus on PC metrics and organizational goals. Ms. Fritts then collaborated with the Quality Clinical Reviewer to coordinate hands-on education and training of PC Healthcare Effectiveness Data and Information Set (HEDIS) metrics and Strategic Analytics for Improvement and Learning (SAIL) database, including how to find data, review, and monitor their team's data, metrics, and goals. To date, 7 of 12 teams have been through this training. All teams will have completed the training by January 10, 2025. In addition to monthly staff meetings, Ms. Fritts hosts a weekly staff huddle to address staff questions, staffing challenges/changes and updates, supply issues, and unit concerns. Also, she disseminates updated PC information, problem-solving progress, and information from executive leadership to the team. This open communication allows staff to voice their concerns with nursing leadership and address rumors and potential barriers to providing excellent patient care. She led her team in the Pathway to Excellence Shared Governance (SG) engagement that began in the PC fiscal year (FY) 2022 with the LPN staff only. In FY23, Ms. Fritts collaborated with the PC team to identify an opportunity to improve staff relationships and team cohesiveness by combining RN and LPN Shared Governance (SG) committees. The registered nurses (RN) and LPNs agreed to begin conducting a collaborative SG group, which also expanded to the Community Based Outpatient Clinic (CBOC) staff (2), who are now attending the SG meetings, resulting in improved team cohesiveness and improved staff and interdepartmental relationships. Because she has the trust and confidence of the staff, she is often invited to the SG meetings to provide feedback and insight to assist staff with problem-solving.

Ms. Fritts works to ensure not just the delivery of quality care and staff development but also to create an environment of compassion and mutual respect through maintaining adequate work-life balance for staff as much as possible, to do so without compromising quality and access. The staff has not consistently reported positive satisfaction with PC in the past. As part of the All-Employee Survey (AES) action plan for FY24, Ms. Fritts collaborated with the PC Assistant Nurse Manager to address FY23 negative satisfaction survey results. She led departmental changes to enhance supervisor relationships, including improved work-life balance for staff, which involved collaborating with staff to strengthen leave flexibilities through improved collaborative communication and negotiation. Registered Nurse Care Managers (RNCM) and provider staff were offered telework options when possible; surrogacy for planned and unplanned absences was initially assigned daily; Ms. Fritts worked collaboratively with the SG committee, implementing their suggestion to assign surrogacy coverage every week to alleviate workload burden and burnout related to staffing gaps. As a result of her efforts, the RNCMs were afforded extended breaks between surrogacy assignments, improving overall satisfaction. Also, supervisor relationships were a top three issue that fell off this year's All Employee Survey (AES) results. 90% of staff Stay Interviews conducted, including Licensed Practical Nurses (LPNs), report satisfaction with work-life balance and improved overall satisfaction within PC during this past fiscal year. Ms. Fritts continues to be fair and consistent in considering planned and unplanned leave and acts with grace and compassion regarding unforeseen employee-related family issues. She considers each case and works with the individual involved to reach mutual and beneficial solutions for both the individual and the organization without compromising quality care or access to care. Ms. Fritts motivates staff with a shared vision and enthusiasm to achieve better outcomes for Veterans and their families.

Ms. Fritts has worked in various roles at the Erie VA Medical Center for the past eighteen years. She is passionate about improving Veteran outcomes and employee satisfaction. Ms. Fritts is attentive to Veteran and employee concerns, delegating coverage and providing solutions within the clinic as needed to resolve and maintain access. During budget and staffing constraints, Ms. Fritts’ team had to absorb the Vaccine Coordinator position. As a result, Ms. Fritts led her squad in coordinating this year’s Flu vaccination and Flu drive-thru efforts to offer flu vaccinations to Veterans. As a result, 100% real-time documentation of flu vaccines administered during the flu drive-thru clinic, a first in the history of EVAMC flu drive-through offerings, 100% elimination of safety errors related to delayed documentation, and 0% paid overtime for time spent to document vaccine administration post flu drive-thru contributing to considerable savings for the organization during a time of budget constraints. Most recently, Ms. Fritts has worked with the Women's Clinic Program Coordinator to expand services to women Veterans within the CBOC catchment areas. Together with the Women's Clinic Program Coordinator, she helped to advocate for new Colposcopy in PC Erie and CBOC sites. She coordinated with CBOC managers regarding the establishment of CBOC gynecological clinic days. She met regularly with the Gynecological Nurse Practitioner (NP) to establish processes to prepare for and ensure a smooth implementation of the new processes. Ms. Fritts also met periodically with logistics, working with the gynecological NP to search for and find adequate disposable equipment. Because of these efforts, her leadership and guidance, the current Women's clinic process will be streamlined and improved through the elimination of reusable equipment, saving staff time related to PC pre-cleaning and treatment processes, and sterile processing staff (SPS) delivery and pick-up and cleaning and sterilization processes.

Ms. Fritts is focused on delivering quality care and promoting the organization's vision to be a highly reliable organization. As a member of the Strategic Analytics for Improvement and Learning (SAIL) Committee, she uses her influence and experience to improve the outcomes for Veterans. She is a SAIL subcommittee member addressing ambulatory care sensitive conditions (ACSC), explicitly targeting the 2-day and 7-day post-hospitalization call efforts and the CVRM90 metric, a composite of cardiovascular disease (CVD). Again, as part of her previous vision and goal, Ms. Fritts collaborated with the Quality Clinical Reviewer to coordinate hands-on education and staff training on PC Healthcare Effectiveness Data and Information Set (HEDIS) metrics and Strategic Analytics for Improvement and Learning (SAIL) database. To date, 7 of 12 teams have been through this training. All teams will have completed the training by January 10, 2025. This information has been shared with the committee chair, who has expressed excitement about conducting the training with staff as it lends to the committee's and the overall organizational goals of high reliability. Her efforts this past fiscal year have resulted in the following: FY 23 2-day post-discharge rates were 47.06%; FY 24 was 78.95% (67.76% increase), exceeding the goal of 75% or better. The FY23 7-day rate was 58.82%; FY24 was 88% (49.60% increase). Considering her current strategies and leadership, PC is expected to surpass these results in this new fiscal year.

Ms. Fritts promotes and enhances the image of nursing within PC and the organization, Community, and the profession, including engagement, recognition, and retention. She attends new Veteran orientation meetings, providing a detailed overview of PC services and how to access care. As a service-level patient advocate (SLPA), she advocates for veterans to listen to their issues and initiate actions to provide adequate resolution and satisfaction. Ms. Fritts often nominates staff for recognition, submitting nominations for DAISY, Nursing Excellence, and Standing Ovation awards. She communicates awards and recognizes staff through regular staff meetings and huddles. Ms. Fritts supported the organization's outreach efforts by encouraging staff to participate in volunteer events to reach Veterans. With her support, staff member (2) has consistently volunteered for outreach events, including the Summer Veteran Fest at the Erie City Zoo on August 23, 2024.

In conclusion, personality traits, such as knowledge, skills, and experience, are crucial for a leader. Stacy Fritts meets the definition of an extraordinary nurse, role modeling extraordinary behavior. As a Primary Care Manager, she creates an environment where attributes of trust, compassion, mutual respect, and continued professional development are modeled and supported. As a leader, Ms. Fritts understands the big picture and has successfully gotten her employees to buy into the larger vision, as demonstrated in her continued successes. She works to ensure the delivery of quality care and staff development, and creates an environment of compassion and mutual respect through adequate work-life balance flexibilities geared toward the organization, veterans, and staff needs. Ms. Fritts promotes and enhances the image of nursing as a leader, manager, and friend; this is why she is a true DAISY Nurse Leader.