Richard RayRichard Ray, MS, RN, PMH-BC
2017 Award for Innovation – Individual

For Richard Ray, psychiatric-mental health nursing is all about hope. “I started my career thirty years ago on an older psychiatric adult unit often working with patients who were depressed and deconditioned. They often viewed their life as over, alone with no hope, wishing to die,” he says. “As nurses we not only reconditioned their physical health but offered breaths of life into their broken spirit… Discharging these patients in improved physical and mental condition with restored hope for their future provided me with inspiration that I chose the right profession of being a psychiatric nurse.” His compassionate perspective helped him pioneer a protocol to reduce continuous special observation, and it is for this protocol that Richard Ray is the recipient of the APNA Award for Innovation – Individual.

At a Glance
Psychiatric-Mental Health Nursing Passion:
Engagement to Improve Patient Outcomes; Safe environments

Words of Wisdom to Future Nurses:
“Nursing care needs to have its foundations built on engagement and trauma informed care. Caring interventions derived from a relationship that is based on respect and acceptance can lead to safer environments.”

Psych Nursing Light Bulb Moment:
“Watching patients to prevent untoward events only contains the behavior. Being with the patient in the milieu and demonstrating care can treat the patient.”

Richard prioritizes engagement with those to whom he provides care in his role as Primary Nurse Coordinator at Northwestern Memorial Hospital. “I believe that spending time with the patients is the cornerstone of engagement and the relationship which is established can inspire hope and lead to recovery,” he says. Through these connections, Richard began to refine the role of the psychiatric-mental health nurse within his organization. “In 2001 Richard brought his clinical concerns to me about physician-ordered constant special observations, or CSO, which required nurses to be ‘watchers’ of patients at all times…Too frequently when the patients arrived on the unit, the constant ‘watching’ increased the patient’s rage towards nursing,” says Evelyn Perkins, one of Richard’s references. “Richard’s first protocol, Psychiatric Nursing Availability (PNA), was based on the concept that the nurse can partner with the patient in a relationship based on engagement.”

Richard created the PNA protocol with an eye to maximizing the therapeutic alliance for the benefit of patients. “CSO is based on control and often implemented to reduce the risk of untoward events…I noticed that physicians would often place their patients with suicidal or self-injurious thoughts on CSO because they determined their patient required more intense supervision,” says Richard. “These patients didn’t need to be watched at all times, they needed a relationship with a nurse based on engagement and having staff nearby available for the patient to discuss distressing thoughts or impulses. The nurse establishes a relationship based on trust in which the patient can develop alternative coping skills.”

Richard received a grant to identify alternative interventions for patients whose actions were violent, threatening, impulsive and whose behavior impacted the safety of other patients on the unit. He developed a nursing protocol called Psychiatric Monitoring and Intervention (PMI). This protocol is centered on patient engagement as a means to reduce CSO. In this protocol, staff allows the patient to remain in the room with the door closed to decrease stimuli and increase a sense of privacy. When outside the room, staff work with the patient to assist in impulse control and interventions are individualized to meet each patient’s needs. “Richard's passion for patient and staff safety makes him stand out in his profession,” says Diane Allen, who nominated Richard for this award. “These protocols encourage autonomous decision making by nurses and there is evidence that they have helped to reduce the use of continuous special observations on an inpatient unit.” Patricia Roberts elaborates in her recommendation: “His focus on engagement versus control is at the center of his protocols, while still maintaining the safety of the patient and milieu.”

Richard’s dedication to patient and staff safety is reflected in his advice to future nurses. “Nursing care needs to have its foundations built on engagement and trauma informed care. Caring interventions derived from a relationship that is based on respect and acceptance can lead to safer environments.” His work to build safe environments will be honored at the APNA 31st Annual Conference in Phoenix, Arizona.

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