ADN RN Diploma RN BSN RN. MSN RN. PhD RN. Educational Institution(s) for Nursing Degree(s):. Nominator's Information. Pr
2018 NIGHTINGALE AWARD FOR EXCELLENCE IN NURSING PRACTICE NOMINATION Nominee’s Information: Nominee's Name (Please print)
Number of years in nursing:
Nominee’s Address
City
State____ Zip
Nominee’s Email Address________________________________________ Nominee’s Phone (___)__________________ Nominee’s Present Position: at (institution or agency) Nursing Education:
LPN
ADN RN
Diploma RN
BSN RN
MSN RN
PhD RN
Educational Institution(s) for Nursing Degree(s):
Nominator’s Information Primary Nominator's Name Nominator’s Address
Nominator’s Phone ( City
) State____ Zip
Nominator’s Email Address Association with nominee (e.g., supervisor, patient, peer)
Awards are given to staff-level nurses in direct care who demonstrate excellence in clinical nursing practice. Nominator: Please complete steps A, B, and C below. A. Attach typed letter stating how you think your nominee demonstrates excellence in nursing practice and deserves a Nightingale Award. Include specific examples to demonstrate how he or she has made a difference. Limit nomination letter to 1,000 words, double-spaced, submitted in 12 point font. B. Secure three additional letters of support for your nominee. It is helpful to have a supporting letter from a patient or patient’s family; however this is optional (patient/family letters may be handwritten.) Other support letters should be typed and limited to 2 pages or less. Please include email addresses for all letters support. Letters of nomination and support criteria: 1. Letters should be as specific as possible and provide examples of how the nominee makes a difference in peoples’ lives. 2. Describe the nurse’s area(s) of practice, and reflect how the nurse demonstrates exceptional care, evidencebased practice, and exceeds expectations. 3. Include examples of additional areas of service, community and nursing involvement, e.g. professionallyrelated volunteer work, leading support groups, leadership on committees (especially those resulting in positive change), educational offerings to the public (e.g., talks at schools, churches, etc.) and other initiatives in nursing that have led to improved care/outcomes for patients, families, community and public.
C. Secure a minimum of three (five preferred) digital colored pictures of the nominee that include: 1. Two close-up photos of nominee. 2. Large group photos should be avoided, as should photos with patients. 3. Action photos such as nominee interacting with others; following agency guidelines, (providing nominee is apparent), involved in nursing activities with at least one work related photo. 4. High resolution cell phone or camera photos are acceptable. 5. E-mail photos to
[email protected]. If you must send via CD, please view the CD on another person’s computer to ensure that the photos can be viewed.
Nightingale Award Criteria •
Resident of the State of Wisconsin and currently employed in Wisconsin.
•
Currently licensed as a registered nurse or licensed practical nurse in Wisconsin.
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Submit completed nomination form with attachments.
Directions and Deadline Nominations must be received by the College of Nursing no later than January 19, 2018, for consideration. The Nightingale Award nomination form for the Nightingale Award can be downloaded on the UW Oshkosh College of Nursing website at con.uwosh.edu/alumni-and-community/nightingale-awards/. The nominator’s letter with three letters of support should be attached to the completed nomination form. A minimum of three color digital photos of the nominee (five photos preferred) with at least one work-related photo must be sent by email to
[email protected] or sent with nomination by CD.
Send completed nomination form, letters of support and required photos by the deadline of January 19, 2018, to: For emailed nominations: 2018 Nightingale Awards,
[email protected] For U.S. Mail: University of Wisconsin Oshkosh College of Nursing – 2017 Nightingale Awards 800 Algoma Boulevard Oshkosh, WI 54901
Questions may be directed to: Nightingale Award Program at
[email protected] or 920-424-3114. The final selection of award recipients is made by the College of Nursing Board of Visitors and will be announced at the Nightingale Award Dinner on Thursday, April 12, 2018.
