Please provide the following information to nominate a nurse for Nurse of the Year:
Nominated Registered Nurse’s Name (please print): __________________________________________________________________
Institution of Employment (please include unit or floor number if known):
_________________________________________________________________
Address of Nominee: ________________________________________________
Phone number: _____________________Email: ________________________

Information about the person submitting the nomination:
Name: ____________________________________________________________
Address: __________________________________________________________
Phone number: _____________________Email: _________________________

Categories of nominees
1. Staff Nurse   

2. Nurse Educator/Researcher     

3. Nurse Manager       

4. Community Health Nurse (Office, Industrial, School, Public Health)             

5. Nurse Administrator               

6. Home Health Nurse
                    
7. Advanced Practice Nurse


In no more than one page, please provide information with examples of why you are nominating this registered nurse for the Nurse of the Year award.
Sample criteria: Has the nurse: Made a substantive difference in promoting the professional image of nursing? Had an impact on nursing and healthcare? Advocated for accessible,
affordable, safe patient care? Served as a role model and/or mentor to nurses? Does the nurse possess exceptional leadership skills in his or her area of practice?  How did this nurse impact you or your family?  Why are the actions of this nurse above and beyond his or her role as a professional nurse? Please give examples.

The deadline for nominations is Monday, April 12th, 2010
The Showcase will be held Friday, April 30th, 2010 at the Doubletree Hotel, Augusta


Please mail nominations to:              Individual tickets for Showcase may bee
GNA                                              purchased for $35 each, no tickets sold at the door
P.O. Box 1936                                ______ Number of tickets
Evans, GA. 30809                           ______ Total amount enclosed
E-mail: Terri.raines@va.gov                        (make checks payable to CSRA Chapter GNA)