2009 Nursing Excellence Awards Nomination Form
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Name |
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| Your
Email |
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| Your Telephone |
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| Nominee's Category |
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Advancing and Leading the Profession: RNs who have led, advanced,
and/or strengthened nursing, either as a profession or in the delivery of patient
care.
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Clinical Care: RNs who demonstrate excellence in direct-care delivery in any clinical setting.
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Community Service: RNs who have made significant professional or voluntary contributions that have improved patient care. |
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Management: RNs who have demonstrated exceptional
management of nursing or patient care services in any setting. |
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Mentoring: RNs who provide a positive professional influence, guidance and support of other nurses in any setting |
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Teaching: RNs who have made significant contributions in education, professional development, and/or long term learning of nursing professionals. |
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| Nominee's First Name |
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| Nominee's Last Name & Credentials |
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| Nominee's Job Title |
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| Nominee's Home Address |
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| Nominee's Home Phone |
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| Nominee's
Work Phone |
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| Nominee's Fax |
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| Nominee's Email |
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| Nominee's Employer |
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| Employer's Address |
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What is your nominee's professional role? |
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Please do not refer to the nominee or their employer by name in this portion of the nomination.
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How do you know the nominee?
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Please do not refer to the nominee or their employer by name in this portion of the nomination.
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| Why should this nominee be selected as a winner?
What sets this
nominee apart from other nurses?
Specific information and examples must be
included that describe how the nominee demonstrates excellence in the
chosen category. |
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Please do not refer to the nominee or their employer by name in this portion of the nomination.
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How has the nominee contributed to the nursing profession in general?
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Please do not refer to the nominee or their employer by name in this portion of the nomination.
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What else should the judges know about your nominee? |
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Please do not refer to the nominee or their employer by name in this portion of the nomination.
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Please keep a copy of your nomination.
IF YOU DO NOT RECEIVE AN EMAIL CONFIRMATION WITHIN ONE HOUR AFTER SENDING, PLEASE EMAIL ALISON REICHERT AT areichert@gannetthg.com.
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