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Excellence in
✚
NURSING
A W A
R
D
Presented by
S
General Instructions
All winners will be selected by an expert panel of nurse leaders from outside Rhode Island. Please be sure to
include enough information in the application.
The nominator should submit four copies of the following material by the deadline:
1. Nomination cover sheet. Please list only one nominee per cover sheet. Should you wish to make multiple nominations, please include a separate copy of the cover sheet for each nominee.
2. Application information. Typewritten responses addressing application information for each nominee in each
category (use as many sheets as necessary to address each point completely).
Nominees must meet the following general criteria to be considered:
1. The nominee holds a license to practice nursing in the state of Rhode Island.
2. The nominee has served/practiced in the area/position for which he/she is nominated in the last 365 days.
Nominations must be received either electronically or via mail by May 22, 2015.
Email completed packets to [email protected], or mail hard copies to:
Rhode Island Monthly
Excellence in Nursing Awards
717 Allen’s Ave., Ste. 105
Providence, RI 02905
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Excellence in
✚NURSING
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Presented by
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Nomination Cover Sheet
Award Categories:
Clinical Nurse Educator of the Year
Nurse of the Year in Academic Setting
● Clinical Practice Nurse of the Year
● Nurse Practitioner of the Year
● Certified Registered Nurse Anesthetist of the Year
● Clinical Nurse Specialist of the Year
● Nurse of the Year in Non-Traditional Setting
● Nursing Leader of the Year
●
●
I wish to nominate _______________________________________________________________________________________________________________________________________
(Full name of nominee with credentials)
for the following award category: _____________________________________________________________________________________________________________________.
Nominee Contact Information
Name:
Address:
Home Phone:
Work Phone:
E-mail:
Place of Employment:
Contact Name (for employer, hospital or organization):
Nominator Contact Information
Name:
Address:
Home Phone:
Work Phone:
E-mail:
Nominator Signature:
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Excellence in
✚NURSING
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Clinical Nurse Educator of the Year
This award honors the registered nurse educator in any health care setting who is involved in ongoing
continuing education programs for nursing staff.
In order to ensure you have submitted a complete application, please check to see that you have included/
addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Nominee’s impact on nursing staff in the pursuit of continuing education.
5. Nominee’s demonstration of teaching skills and goal setting.
6. Nominee’s interpersonal communication skills.
7. Nominee’s creativity in the educational process.
8. Comments from nominee’s staff/students.
9. Nominee’s participation in professional organizations.
10. No more than three letters of support from colleagues and/or employer (attach).
11. Any additional relevant information.
12. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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Excellence in
✚NURSING
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Presented by
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Nurse of the Year in Academic Setting
This award is given to an outstanding nurse educator involved in a formal entry-level or graduate-level nursing
education program. This award may also recognize a registered nurse who has led significant formal or informal
nursing research which has impacted health care or the community.
In order to ensure you have submitted a complete application, please check to see that you have included/
addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Nominee’s impact on students in the profession (nurse educator) or description of nominee’s demonstrated research
capabilities (nurse researcher).
5. Nominee’s impact on students pursuing continuing education (nurse educator) or impact of nominee’s research on
profession or community (nurse researcher).
6. Nominee’s excellence in classroom presentation (nurse educator) or nominee’s ability to procure funding (nurse researcher).
7. Nominee’s excellence in clinical expertise (nurse educator) or description of nominee’s completed or ongoing research,
within the last two years (nurse researcher).
8. Comments from nominee’s students.
9. Nominee’s participation in professional organizations.
10. No more than three letters of support from colleagues and/or employer (attach).
11. Any additional relevant information.
12. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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Excellence in
✚NURSING
A W A
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Presented by
S
Clinical Practice Nurse of the Year
This award recognizes a registered nurse delivering exemplary patient care in the clinic, hospital or office setting.
In order to ensure you have submitted a complete application, please check to see that you have included/
addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Nominee’s impact on patient outcomes through application of nursing knowledge.
5. Comments from nominee’s patients. (optional)
6. Nominee’s interpersonal communication skills.
7. Nominee’s technical expertise.
8. Nominee’s demonstration of pursuance of continuing education.
9. Nominee’s clinical expertise.
10. Nominee’s participation in professional organizations.
11. No more than three letters of support from colleagues and/or employer (attach).
12. Any additional relevant information.
13. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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Excellence in
✚NURSING
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Presented by
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Nurse Practitioner of the Year
This award honors an advanced practice registered nurse (NP) for outstanding direct patient care.
In order to ensure you have submitted a complete application, please check to see that you have included/
addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Nominee’s impact on patient outcomes.
5. Comments from nominee’s patients. (optional)
6. Nominee’s interpersonal communication skills.
7. Nominee’s technical expertise.
8. Nominee’s demonstration of pursuance of continuing education.
9.. Nominee’s furtherance of the role of advanced practice nursing in the community.
10. Nominee’s participation in professional organizations.
11. No more than three letters of support from colleagues and/or employer (attach).
12. Any additional relevant information.
13. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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Excellence in
✚NURSING
A W A
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Presented by
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Certified Registered Nurse Anesthetist of the Year
This award honors an advanced practice registered nurse (CRNA) for outstanding direct patient care.
In order to ensure you have submitted a complete application, please check to see that you have included/
addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Nominee’s impact on patient outcomes.
5. Comments from nominee’s patients. (optional)
6. Nominee’s interpersonal communication skills.
7. Nominee’s technical expertise.
8. Nominee’s demonstration of pursuance of continuing education.
9. Nominee’s furtherance of the role of advanced practice nursing in the community.
10. Nominee’s participation in professional organizations.
11. No more than three letters of support from colleagues and/or employer (attach).
12. Any additional relevant information.
13. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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Excellence in
✚NURSING
A W A
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Presented by
S
Clinical Nurse Specialist of the Year
This award honors an advanced practice registered nurse (CNS) for outstanding direct patient care.
In order to ensure you have submitted a complete application, please check to see that you have included/
addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Nominee’s impact on patient outcomes.
5. Comments from nominee’s patients. (optional)
6. Nominee’s interpersonal communication skills.
7. Nominee’s technical expertise.
8. Nominee’s demonstration of pursuance of continuing education.
9. Nominee’s furtherance of the role of advanced practice nursing in the community.
10. Nominee’s participation in professional organizations.
11. No more than three letters of support from colleagues and/or employer (attach).
12. Any additional relevant information.
13. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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Excellence in
✚NURSING
A W A
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Presented by
S
Nurse of the Year in Non-Traditional Setting
This award honors a nurse best exemplifying the art and science of nursing in a non-traditional employment
setting (law firm, public policy, health care management, quality assurance, military, etc.).
In order to ensure you have submitted a complete application, please check to see that you have included/
addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Participation in organization/employer affairs.
5. Demonstration of art and science of nursing in the professional setting.
6. Demonstration of pursuance of continuing education.
7. Evidence of mentoring.
8. Demonstration of ambassadorship for the field of nursing in the non-clinical workplace.
9. Participation in professional organizations.
10. No more than three letters of support from colleagues and/or employer (attach).
11. Any additional relevant information.
12. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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Excellence in
✚NURSING
A W A
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Presented by
S
Nursing Leader of the Year
This award recognizes a registered nurse who administers the business/patient care activities of a health organization and/or who manages other personnel.
In order to ensure you have submitted a complete application, please check to see that you have included/addressed each of the following (attach as many sheets as necessary to address each criterion completely):
1. Nominee name.
2. Years licensed as a registered nurse.
3. Years in current position.
4. Comments from facility registered nurses about nominee.
5. Nominee’s communication skills.
6. Nominee’s participation in professional organizations.
7. Nominee’s evidence of mentoring.
8. Nominee’s reactivity in leading/administering nursing care delivery.
9. Nominee’s demonstration of pursuance of continuing education.
10. No more than three letters of support from colleagues and/or employer (attach).
11. Any additional relevant information.
12. Nomination cover sheet.
Failure to include any of the requested information may result in the submission not being
considered for nomination.
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