Texas Emergency Nursing Awards Nomination Form

DEADLINE JUNE 15, 2017

RETURN NOMINATIONS TO:

I am nominating the following Individual for the (CHECK ONE) Award:

Behind the Scenes

Requirements

v  Individual has donated hours of time without expectation of compensation or reward

v  Individual does not need to be an ENA member

v  Individual does not need to be a nurse

v  Two narratives from two individuals describing how this individual’s behavior in support of ENA has gone above and beyond – must include specific examples

Rising Star

Requirements

v  Nominee must be a new ENA member of less than five years from the date of nomination

v  A curriculum vitae of the individual’s professional experience

v  A narrative from the State or Chapter President describing the active role that the nominee has demonstrated at the state, local or national level

Nursing Practice & Professionalism

Requirements

v  Individual must be an ENA member

v  A curriculum vitae of the individual’s professional experience

v  Two narratives from two individuals describing this individual’s contribution to the profession of nursing and the practice of emergency nursing care

Nursing Education

Requirements

v  Individual must be an ENA member

v  A curriculum vitae of the individual’s professional experience

v  Two narratives from two individuals describing this individual’s contributions to the knowledge base of colleagues or patients/families through classes, programs, school, educational events or professional publications

Nurse Manager

Requirements

v  Individual must be an ENA member

v  A curriculum vitae of the individual’s professional experience

v  Two narratives from two individuals supervised by this nominee describing how this individual’s leadership style reflects participative management and a positive communication style

Nursing Competency in Aging

Requirements

v  Individual must be an ENA member

v  A curriculum vitae of the individual’s professional experience

v  Two narrative statements from two individuals describing how the nominee has demonstrated a commitment to the care of older adults and the geriatric community. At least one narrative must be written by ENA member.

Team Award

Requirements

v  Individual must be an ENA member

v  A curriculum vitae of the individual’s professional experience

v  Two narrative statements from two different individuals addressing the three separate criteria listed below. At least one narrative must be written by an ENA member.

1.  A description of the team’s project or program that has made a positive impact on the profession of emergency nursing or patients.

2.  A description of how the Team’s project or program will be sustained and will affect a community, regional or national initiative.

3.  A description of how the Team’s project or program has made a significant contribution toward achieving ENA’s mission of advocating for patient safety and excellence in emergency nursing practice

(Narrative statements should address each criterion listed and should NOT include the name of the TEAM)

Mary LeBlond Advocacy Award

Requirements

·  Nominee must be an ENA member

·  Two narrative statements from two different individuals addressing the three separate criteria listed below. At least one narrative must be written by an ENA member.

·  Curriculum vitae/resume summary of the nominee- include education most recent three degrees); employment (most recent two positions); licensure (include type and years valid); certification (type and years valid); fellowship (type and year inducted); ENA membership participation (current and previous); publications; professional presentation.

TxENA CHAPTER Nominating for Award / Name:
Chapter #
President:
Name of Nominee:
First/ Last
ENA#: / First:
Last:
Credentials
Address of Nominee
Street/City/Zip / Street:
City:
Zip:
ENA Member Yes No N/A / Member for Less Than 5 Years Yes No
Contact Information of Nominee
Home/Cell Numbers / Home:
Cell:
Email:
First Nominator Name
Chapter/State President Yes No / First:
Last:
Credentials
Nominator Address / Street:
City:
Zip:
Nominator Contact Information
Nominator ENA #: / Home:
Cell:
Email:
Second Nominator Contact Information
Second Nominator ENA #: / Home:
Cell:
Email: