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Nominations

Please Note: Nominations are now closed

2013 Nursing Excellence Awards Nomination Form
Attention: 2013 Nominations are now closed for all regions.
Nominator Information
Your First Name*
Your Last Name*
Your Nursing Credentials*
Your Employer
Your Job Title
Your Email*
Your Telephone
The nominator must be an RN who shares a professional relationship with the nominee and who is not a member of the nominee's family.


Nomination Categories
			Advancing and Leading the Profession: An RN who is well-known and respected as a visionary, innovative leader and change agent, who moves the profession forward through work in patient care administration, education or research, or strengthens it through other professional activities, endeavors or contributions.
			Clinical Nursing, Inpatient: An RN who demonstrates superior clinical nursing knowledge and expert skills, and applies both in ways that measurably impact the quality of care and improve patient care outcomes in any inpatient clinical setting or nursing specialty.
			Education and Mentorship: An RN who contributes to nursing's body of knowledge through formal nursing education, skills training or continuing education, or who guides, supports or influences nurses' career development in meaningful, measurable ways through the art of professional nursing.
			Home, Community and Ambulatory Care: An RN who exemplifies outstanding clinical knowledge and nursing expertise in caring for patients in settings outside the hospital in professional home care nursing, home hospice, sub-acute and intermediate, or in other ambulatory community, industrial, or school nurse roles.
			Patient and Staff Management: An RN who makes significant contributions to the management, supervision or direction of the environment of care and the performance of staff, demonstrating an ability to lead, influence and improve outcomes of care in any inpatient or outpatient setting.
			Volunteerism and Service: An RN who gives of self in outstanding humanitarian and/or heroic ways by providing nursing care, skills and expertise in outreach to the community, either at home or abroad, to improve the lives, well-being, and healthcare of others.

Nominee's First Name*
Nominee's Last Name*		, Credentials*
Nominee's Job Title*
Nominee's Home Address*
		,
Nominee's Home Phone*
Nominee's Home Fax
Nominee's Email*
Nominee's Work Phone*
Nominee's Work Fax
Nominee's Work Email*

Nominee's Employer*
Employer's Address*
		,
Employer's Phone*


Nomination Questions
*Please Keep Total Responses to Under 1,500 words
Question #1 (200-300 words) What is your nominee’s role at work; what are the nominee’s responsibilities and accountabilities; and for whom or how many is the nominee responsible; what is your work relationship with this nominee; how long have you been colleagues? Directions: Along with describing the nominee’s role and responsibilities, include the size and type of the unit/department/service/program, and the team/staff/group or patient/student/client population the nominee works with or is responsible for. Discuss the way(s) in which you interface with the nominee in your role over the time you have worked together.

Question #2 (400-500 words) What measurable differences to patients, staff, coworkers or to the profession does your nominee make; how do these differences set this nominee apart; and what are some specific accomplishments that make this nominee excellent and worthy of recognition? Directions: Discuss qualities that make your nominee superior, providing illustrations of knowledge, skill set, or value added to those served, the organization or the profession. Specify what makes the nominee stand out and how that brings recognition to the workplace. Include why the nominee is respected by colleagues, using specific examples.

Question #3 (400-500 words) What are some contributions of this nominee that make measurable differences on the unit or in the department or organization, or to patients, staff or students; how do these differences impact outcomes, quality or reputation of the organization? Directions: Describe how your nominee goes "above and beyond” ordinary role expectations. You may include any special initiatives, programs, committees, publications, speaking engagements, professional organization work, offices held, military history, travel on behalf of the profession or awards. Give examples that set your nominee apart, including quotes or endorsements from colleagues.

Question #4 (100-200 words) What additional information not included in your previous responses would you like our judges to know about your nominee; what final thoughts on your nominee do you wish to share with our judges as they make their decisions? Directions: Add here noteworthy contributions the nominee may be making outside of the workplace, including projects related to professional or charitable organization memberships. Discuss any interesting accomplishments or special awards the nominee may have received. Give examples of any human interest aspects of the nominee’s life that are different or unique.
Note: Please keep a copy of your nomination for your records. You will receive a confirmation number after pressing the submit button below. This confirmation number ensures that we've received your nomination and no further action will be necessary on your part.