Director of Nursing
Name of Nominee -
Name of Administrator -
Facility Address -
City - State KY Zip -
Contact Person Submitting Nomination -
Phone - Fax - E-mail -
KAHCF District: (please check appropriate district)
Eastern N. Bluegrass Central Midwestern Western
Administrator's signature acknowledging having seen this completed nomination form
Administrator’s signature Date
Director of Nursing
1. How long has the DON worked in the long term care profession? (Please limit answer to number of years) 19 years
2. How long has the DON worked at this facility? (Please limit answer to number of years) 12 years
3. Patient Care and Administration: (Limit answer to 900 words)
a. Give specific examples of programs your DON has implemented to enhance patient care and administration at your facility or at a previous facility as the DON.
Implemented care plans for fall and incident reporting and immediate wound documentation. devised consistent assignment program for licenced nursing staff. Trained staff related to MDS 3.0 and QIS. Acquired INR machine and new lift to facilitate resident care. Arranged to have a local dentist available to address resident dental issues in-house.
b. From a supervisory standpoint, give specific examples of how your DON interacts with staff.
She is the facility CPR instructor, conducts staff in-service programs, walking rounds, 1-on-1 training. Instituted individual reward and incentive programs for employees. Actively participates in employee rewards banquet, volunteer banquet, and staff Christmas party. Conducts CNA and Nurses' Appreciation Week activities and dinners, as well as holiday dinners for nursing staff. Participates in "Big Heart Fund' for staff/community members in need of financial assistance. Encourages staff to openly communicate issues of concern. Strongly encourages continuing education. Leads through example.
c. Give specific examples of how your DON interacts with patients and their families.
She is an excellent resident advocate. She attends resident council meetings and quarterly Family Night events. Participates in Nursing Home Week activities and encourages residents and other staff members to do so. Visits with residents through the day to ensure quality of care issues are being addressed. Periodically assists with service resident meals. Always willing to talk with residents and family members.
4. Community Involvement: (Limit answer to 500 words)
a.List up to 3 specific examples of community activities your DON has participated in, and how these activities have improved your facility and its relationship with the community.
Partifipates in Bowl for Kids' Sake
Chairman, our city's BPW Relay for Life Team
Designated as facility disaster preparedness team medical specialist
By participating in these and other activities, our DON has encouraged other staff members to assume a more active role in the community. This has enhanced the facility reputation in the community, resulting in an increase in number of local residents seeking placement here.
b.List the organizations (local, state and national) in which your DON is involved.
American Nurses' Association
Kentucky Nurses' Association
Business & Professional Women
a. Give specific examples of the continuing education and /or professional development programs attended by your DON in the past year.
BSN, Chamberlain College of Nursing, February 2011
Began Chamberlain College of Nursing MSN (educator track) program, February 2011
CEU program through KAHCF
b. Give specific examples of the contribution your DON has made through in-service training and/or as a lecturer, or in another similar role at your facility or in your community.
Through in-service training, our DON has encouraged staff members to be more award of the importance of providing excellent care, has taught CPR to staff members, and has addressed and encouraged the importance of continuing education through in-services by example.
ENTRIES MUST BE POSTMARKED BY MONDAY, JUNE 25, 2012