Nightingale Award Nomination Form 2012

NOVA Foundation 2012 Nightingale Award

Nomination Form

DEADLINE: May 1, 2012

Given in recognition of:

"an outstanding nurse who has made significant contributions and achievements in advancing nursing education within the Department of Veterans Affairs."

Restrictions:

Must be willing to be present to receive the award at the NOVA Foundation Awards Luncheon on June 8, 2012 at the Gaylord Texan Resort, Grapevine, Texas.

Nightingale Award Description & Instructions
(click here)

NOMINATION

I - Nominee Information -- Note: Address, email, and phone number should be the preferred ones for contacting the nominee.

Filter Type:

Email:

First Name:

Middle Initial:

Last Name:

Credentials (i.e. RN, MSN, NEA-BC):

Title:

Address:

City:

State:

Zip:

Phone Number:

Current employer:

II - Criteria -- Describe the nominee's accomplishments in each of the following evaluation factors. The total submission for all factors cannot exceed 2,000 words (excluding the attachment required for Criteria #1). For each factor the point weight is noted.

1. Advancement of Nursing Field (20 Points)

(Describe specific examples of nominee's work related to the advancement of nursing. Provide one example of the nominee's work, attach below. Type of examples may include but are not limited to academic program descriptions, grant applications, student/employee academic support programs, curriculum development work.)

Attach Example of nominee's work (PDF or Word Doc)

2. Advancement of Veterans Care (15 Points)

(Describe how the nominee's work enhanced existing or promoted development of new health care programs for Veterans.)

3. Innovation in Nursing Education (10 Points)

(Describe nominee's development and implementation of new approaches in nursing education.)

4. Project Accomplishments (10 Points)

(Provide specific outcomes related to nursing education and Veterans health care which were a result of the nominee's work.)

5. National Impact of Work (10 Points)

(Describe the level of impact of the nominee's work. Is the impact local affecting primarily one VA Medical Center, regional (such as a VISN program), or national with impact across the VA health care system?)

6. Leadership (5 Points)

(Describe the leadership positions the nominee has held. Include job titles with brief description as well as task force, committee or other work in which the nominee had a leadership role.)

7. Mentorship/Career Influence (5 Points)

(Describe nominee's activities and outcomes related to mentoring or influencing the career of VA nurses.)

8. Publication(s) (5 Points)

(Provide a list in APA format of nominee's publications. If the list is extensive, provide those from the last 5 years with an explanatory note reflecting the total number of publications and timeframe.)

9. Continuing Education/academic education (5 Points)

(Provide a summary of the nominee's academic education and continuing education participation. The purpose is to reflect how the nominee has acquired and maintained expertise in nursing. Do not provide a listing of education events attended.)

10. Sustained Commitment to nursing education (5 Points)

(Provide the number of years the nominee has been in roles related to nursing education. Describe awards or other recognition nominee has received as a result of her or his work.)

III - Citation -- For use in the formal award presentation, succinctly (in 50 words or less) describe the highlights of the accomplishments with emphasis on impact for nursing and Veterans health care.

IV - Nominator Information -- Note: Address, email, and phone number should be the preferred ones for contacting the nominator.