Joshua Ritz, RN, has had a long, productive career at McLean, so it’s fitting he would be the first person to attain the Professional Nursing Advancement Program’s (PNAP) highest designation—tier four.
PNAP is a professional development program that rewards nurses for education and certification, clinical skills, research, and leadership—among other accomplishments. Ritz, a 17-year veteran of McLean, was recognized at the 2022 Nursing Day Conference on May 6, along with:
- Cheryl Cosgrove Quercio, BSN, RN, Clinical Evaluation Center (Tier 3)
- Genevieve Dougherty, BSN, Short Term Unit (Tier 1)
- Keara Sullivan, RN, Electroconvulsive Therapy Service (Tier 1)
Ritz’s primary role at the hospital has been as a member of the resource team and he also teaches cardiopulmonary resuscitation (CPR) and modified advanced life support (MALS). He is earning his psychiatric mental health nurse practitioner degree from Regis College, with clinical placements in McLean’s Clinical Evaluation Center and the Psychiatric Neurotherapeutics Program.
Ritz said one of his proudest accomplishments was being part of a successful effort to expand the scope of practice of McLean nurses to allow them to place IVs in patients undergoing electroconvulsive therapy (ECT). Previously, only anesthesiologists or nurse anesthetists were allowed to carry out this part of the pre-treatment process, which would sometimes slow down the entire unit’s workflow, he said.
Eventually, Ritz began to train nursing staff in IV insertion and described the first time he had a trainee practice on him.
“I walked out that day a little bruised, but with the knowledge that I had made a difference that would improve patient care and streamline the entire ECT process, all while increasing the competency and capability of McLean’s nurses,” he said.
How did Ritz feel about reaching PNAP’s highest rung? “I was really happy that I got it,” he said. “The requirements are rigorous, but because of my varied and prolific career at the hospital, I could draw on all my experiences to create a successful application.”
Below are highlights of Ritz’s portfolio as well as the other three honorees.
One of Ritz’s three exemplars told the story of a patient he had seen in several care settings over the years. When the patient would stop taking his medications, he would be hospitalized at McLean. Ritz urged him to buy a pill organizer, which he did, but he continued to miss doses.
Ritz encountered him one last time at a residential program near campus where the patient was staying. He was heartened to learn that he was now employed at a local pharmacy. But one day he didn’t return by curfew and Ritz later learned that he had taken his life.
Ritz wrote about the hard lesson he learned from the tragedy.
“We may try as hard as we can, and feel a strong positive connection with our patients that may even be reciprocated, but that still may not be enough to sustain them. While this may discourage some people, it only serves to motivate me further. I am certain that the lessons I learned from him will forever help define my nursing practice.”
As he has advanced in his career, Ritz noted a significant shift in his professional priorities. “I now prioritize imparting knowledge onto others, uplifting my coworkers through education, enabling them to improve their own practice, and work towards the betterment of all the patients we treat,” he wrote.
In addition to teaching CPR and MALS, he has also trained new staff on all 11 of McLean’s inpatient programs, in the ECT and Transcranial Magnetic Stimulation Services, and in two residential programs.
“I try to leave each staff member having learned something new, whether it is how to quickly remove an IV, how to ask a patient about safety when they are reluctant to provide information, or how to file an incident report.”
Cheryl Cosgrove Quercio
One of Quercio’s two clinical exemplars told the story of the disruption that the pandemic caused “Bob,” an older patient.
Bob had been transferred from another hospital that had closed its geriatric unit in order to open a general psychiatric unit for COVID-positive patients. But the unit he was supposed to be transferred to at McLean had two new cases of COVID-19, so Bob had to remain at the Clinical Evaluation Center, where Quercio is a nurse.
Quercio quelled Bob’s anxiety by keeping him apprised of what was going on and did everything she could to make him comfortable.
“I took the time to make sure all of his needs were met, including assisting him with walking and using the bathroom, checking his blood sugar, getting him food and refreshments, and making sure he got all of his scheduled medications crushed in applesauce.”
She also set him up on a recliner so he could take his customary afternoon nap. Quercio kept him safe and secure and a couple of shifts later, he was transferred.
Providing safe, patient-centered, evidence-based, quality, holistic care is central to Quercio’s nursing philosophy.
“One of my first priorities as a psychiatric nurse is to hear from the patient about their main concerns so that I can address their needs and educate them on different options so they can be autonomous and make an informed decision.”
Her overall goal working with patients at the Clinical Evaluation Center is to instill hope that they are on the road to recovery.
Dougherty wrote about a patient who had a profound impact on her during her first year at McLean—a 22-year-old woman with major depressive disorder, generalized anxiety disorder, and borderline personality disorder.
She continuously self-harmed, made multiple suicide attempts, and developed conversion disorder—episodes when she was unable to move, control her bladder, or communicate.
During these periods, she would require support with all of her activities of daily living. A behavior plan was created and she began engaging with others on the unit and attending skills groups. Dialectical behavior therapy also proved very helpful and she was eventually able to transition to outpatient treatment.
Holistic care is at the core of Dougherty’s nursing philosophy.
“I look at each patient as an individual and not just a diagnosis,” she wrote. “Many patients are struggling with physical, social, and spiritual difficulties on top of their mental health issues and all of these factors are essential to address and treat.”
“B” was a new patient at the ECT Service and Sullivan was assigned to educate him and his mother about the treatment process. He was in his mid-40s and had been diagnosed with frontal lobe deterioration with possible early onset dementia.
At the orientation, B was anxious and restless, standing up several times to read signs around the office. When Sullivan asked him if he liked to read, he was unable to answer, but his mother responded that he read his Bible every night. Sullivan gave him an ECT educational booklet to read and he seemed more at ease.
When he came in for his first treatment, it became clear it would not be possible to use the customary screening test measuring memory impairment.
So, Sullivan came up with an alternative. “I’m going to ask you if you remember my birthday, January 20,” she told him. He looked into her eyes and repeated, “January 20.”
During subsequent treatments, he almost always remembered her birthday. “While this assessment doesn’t measure all aspects of B’s memory, it helps in recognizing a possible change to his baseline,” she wrote.
B’s case taught Sullivan the importance of tailoring treatment to the individual, which she did by recognizing that he responded well to reading and by creating a simple way to gauge his memory.
“As nurses, it is our duty to recognize and implement certain interventions in order to improve patient outcomes,” she concluded.
Sullivan recognizes that stigma remains a huge problem in mental health and psychiatric nurses care for patients in some of their most vulnerable moments.
“Patients who live with depression may have poor hygiene,’ she wrote. “Patients who live with bipolar disorder may not remember that they believed they were president during a manic episode.”
Because of the shame that can accompany mental illness, Sullivan always strives to impart a sense of dignity to her patients, approaching each one without judgment.
“In order for a patient to begin healing, they need to feel supported and safe in their environment.”
Journalist or member of the media? We are available 24/7 for media requests.