2012 Nursing Excellence Awards Nomination Form

What is your nominee’s professional nursing work role; what are the responsibilities and accountabilities he or she has, and for whom; what is the type of work relationship you have had with this nominee, and the length of time you have known and worked with him or her?

Directions: Describe the nominee’s role and his or her 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 way(s) in which you interface with the nominee, as manager, co-worker, mentor, staff, teacher, etc., and include how long you have worked with him or her.

What has the nominee done in his or her role that has made a measurable difference to patients, staff, or the profession; how has the nominee set him or herself apart in the workplace; and what are the specific accomplishments that make him or her worthy of recognition?

Directions: Cite examples of excellence related to the nominee’s professional endeavors that have made him or her stand out in the profession or that have brought recognition to the workplace. Discuss qualities that distinguish the nominee as superior, providing illustrations of professionalism, nursing knowledge /skill set, and value he or she adds to staff, patient care, the facility or the profession. Include why he or she is respected or admired/valued by colleagues, using specific examples or situations to illustrate.

What are some important contributions the nominee has made in his or her professional role that have positively impacted outcomes, quality, or reputation of the facility in the community, or made measurable differences on the unit or in the department/organization, or to the nominee’s patients, staff, or students?

Directions: Describe ways in which the nominee has gone "above and beyond” the expectations of the job description. What has been accomplished that is out of the ordinary? Include any special initiatives and projects, committee work, publications, programs, or speaking engagements, professional organization work or affiliations, offices held, military history, work or travel on behalf of the profession, and/or past recognitions as a nursing professional. Give examples that set your nominee apart, including quotes or endorsements from other colleagues.

What other additional and/or worthwhile information would you like the judges to have as they make their decision regarding your nominee? What would you want the judges to know that has not been included in the previous responses? What are some final reasons they should select this nominee?

Directions: Add noteworthy contributions made outside of work, projects nominee is involved in, or professional and charitable organizations he or she may be part of. List interesting accomplishments or special awards received. Discuss special projects or areas of interest, and any human interest aspects of the nominee’s life that are different or unique.