April has been working at our clinic for almost a decade, and about 5 years ago, she took over as our charge nurse. I say this on behalf of all the providers and nurses in the clinic that she is one of the best things that has ever happened to our clinic. April is a very professional, compassionate, dedicated, and hard-working nurse. Thanks to her efforts, we have been able to retain some excellent nurses, exceptional pharmacists, outstanding schedulers, and, unfortunately, some doctors who haven't been a good fit in our department.

She is our go-to person for all of our problems. She does a lot more than what is expected of a nurse. She manages the day-to-day affairs of our clinic, troubleshoots all our system issues, and serves as our de facto social worker and pharmacy benefits manager. I could write a long essay outlining all her contributions to our department and still come up short, so I will just highlight a few of her direct interventions that have led to better outcomes for our patients and us as a department and as an organization. During the COVID-19 pandemic, she kept us going by efficiently triaging patients amid overwhelming demand for monoclonal antibodies. She also provided real-time education on newer oral antiviral drugs that were available but not being used due to a lack of awareness or familiarity among frontline providers.

Our clinic serves many patients with multiple socioeconomic barriers to care. She ensures these barriers are addressed in real time. She works closely with an outside program to ensure their meds are covered. This alone improved the longevity and quality of life of our patients and keeps them out of the emergency room and hospital beds. She also ensures they have transportation arranged for their appointments, and if their health literacy is low, she coordinates medication pickup from the pharmacy and lab work while they are in the clinic, so that all their medical needs can be addressed in a single clinic visit. She has also been instrumental in quickly incorporating the latest, best evidence-based treatments into a busy clinical practice. Thanks to her efforts, we have been able to treat a number of hepatitis C patients with just a single clinic visit. More recently, she has been overseeing our program to treat patients with recurrent C diff with stool enemas and oral microbiota therapy. These treatments have helped resolve recurrent C diff infections and reduced repeated ER visits and hospitalizations. Thanks to these treatments, they have also avoided more invasive procedures like colonoscopies and EGDs. Our department is extremely lucky to have such an awesome charge nurse. As an organization, we could not have asked for a better return on our investment. Her alma mater should be proud of her for advancing the field of nursing and using her knowledge and skills to the best of her ability. She is a role model for all of us!

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In just the last 3 years, our clinic has expanded its specialized care thanks to her efforts. As a nursing leader, she collaborates with providers to make our combined visions into fruition. She has led innovation and improvement initiatives that have increased the specialty-specific services our small clinic provides. She is the lead travel medicine nurse specialist in the Sanford Travel Medicine clinic within the Infectious Diseases department. She is a member of the Association of Travel Health Nurses of America (ATHNA). Since she started, we have doubled our clinic days and been able to accommodate more patients, ensuring they receive the education and preventive care they need for their travels.

During the early days of the COVID-19 pandemic, she took on the painstaking work of scheduling, screening, and following up with our patients. This experience led her to expand ID-specific services at the clinic. April took the initiative to establish the workflow and protocols for medication approval. Recently, she set up the HIV long-acting treatment clinic, where we are able to provide monthly injections of Cabenuva and Apretude to replace the daily pills some of our patients are taking. We were the first clinic in the enterprise to formalize the protocol and offer the services to our HIV patients. As a demonstration, the gross revenue from these injectables exceeded $370,000 in the first six months. Even with so much on her plate, she was still able to open our refractory C. difficile clinic, where we now offer Rebyota, the first and only single-dose FDA-approved fecal microbiome-based treatment for recurrent C. difficile. This procedure is delivered rectally without the need for anesthesia, bowel prep, or colonoscopy. This has been beneficial to our patients because we can administer the treatment in a simpler way. April is one of two nurses who administer this intrarectally to high-risk patients. This service would not be possible without April's dedication to making this happen. She also makes sure patients are eligible and follows up on insurance coverage. As the results show, we generated over $100,000 in revenue from our first six patients. No complications were reported. All patients have improved and have done very well on this treatment, including one with Keytruda-related colitis.

In her leadership, April also strengthened our hepatitis C clinic by increasing treatment adherence through virtual nursing visits. This improved our outcomes in the hepatitis clinic despite the social challenges that we face in this population of patients.

I believe that recognizing April Leiran as a Sanford awardee for new knowledge, innovations, and improvements would not only acknowledge her exceptional contributions to our department but also serve as an inspiration to other staff within Sanford. She quickly learned about the vast array of new therapeutics we can offer and ensured our patients had access to these newer treatments, whether at the peak of the COVID-19 pandemic, in chronic HIV and hepatitis care, or for intrarectal C. difficile treatments. She sought evidence and studies supporting these treatments and ensured our patients understood the benefits and risks. She is truly a gem, and we are lucky and honored to work with her. She truly lives by Sanford's values of Service and Advancement, and to her, we will always be family