RN Nomination for Excellence in Practice Award 2011
Rockland County Nurse Recognition Day
May 5, 2011
Name of Nominee:______Phone: ______
Home Address:______
Affiliating Agency:______
Job Title:______
Please circle one: STAFF ADMINISTRATOR (ID# ______Awards Committee to complete)
Nomination Submitted By: ______Work Phone:______
Nominees must be Registered Professional Nurses working in health care, e.g., hospitals, nursing homes, school nursing, community health, home care, nursing education, medical offices or nurse entrepreneurs. Please, no group nominations – INDIVIDUAL NOMINATIONS ONLY. Please note: Nurse Recognition Day Nomination Committee Members are not eligible. Recipients of the Excellence in Practice Award;
May 2000 to May 2010 will be recognized, but are not eligible to win if nominated a second time in 10 years.
The nominee’s name must appear on this FACE SHEET ONLY. In order to ensure objectivity on the part of the judges do not use the nominee’s name or work location anywhere else in the application. All nominations must be typed. Hand written entries will not be accepted.
The judges will rate the nominee on the attached criteria. When responding to each criteria, please number them accordingly. Tell how the nominee is excellent in each area. SPECIFIC EXAMPLES are very important in how the judges rate each criterion. Citing additional examples improves the nominee’s score.
Nominations must be completed and either postmarked, hand delivered or faxed no later than
5:00 PM, Thursday, March 17, 2011 to:
Kerry Sokolohorsky, Chairperson
Helen Hayes Hospital
Nursing Office
Route 9W
West Haverstraw, New York 10993
E-mail:
Phone - 845-786-4283
Fax – 845-786-4953
*Note: Please try to limit faxing nomination as a last resort and keep fax confirmation for your records. For clarification or additional information, you can contact a member of the Nurse Recognition Day Nomination Committee:
Name / Facility / Phone #Anne Fella / Summit Park Hospital / 845-364-2735
JoAnn Robinson / Good Samaritan Hospital / 845-764-1536
Belle Villafuerte / Rockland Children’s Hospital / 845-499-1929
Dawn Sugrue / Nyack Hospital / 845-348-2345
NO LATE ENTRIES WILL BE ACCEPTED
NOMINATION FOR EXCELLENCE IN PRACTICE AWARD
Rockland County Nurse Recognition Day
Please answer the following questions, USING SPECIFIC EXAMPLES, to demonstrate why this nominee is deserving of this award.
Each question is worth a maximum of 4 points.
- How does this individual remain current in nursing knowledge?
- How does this individual demonstrate expertise in the practice of nursing?
- How does this individual develop a creative approach to nursing practice that contributes to quality client/patient/resident care?
- How is this individual an advocate for the profession of Nursing? Describe how she/he conveys this image to staff, clients and the community.
- How does this individual collaborate effectively with other members of the health care team?
- How does this individual demonstrate leadership skills within nursing?
- How does this individual investigate, recommend or participate in studies to improve nursing.
- Please make additional comments as to why the nominee is deserving of this award. (Comments should not repeat information already stated in questions 1-7).