Lewis County Nurse of Distinction Nomination

I, _______________________________________, nominate__________________________________
Name of Person Nominating

Candidate for Award

for consideration of the Lewis County Nurse of Distinction Award in the following category
(please check one):
RN
Advance Practice Nursing (Nurse Practitioner, CRNA, other_________________________)
Hospital / Acute Care
Long Term / Home Health (including Hospice)
Community / Other (school, outpatient, other ________________________)
LPN
Hospital / Acute Care / Long Term Health Care
Community / Other (school, outpatient, other ________________________)
Nominators Contact Information:
Phone and/or Email
________________________________________________________________
Address: _________________________________________________________________________

Candidates Practice Setting: (Candidate must practice in Lewis County):

_____________________________________________________________________________________

Candidates Contact Information:

Phone and/or Email __________________________________________________________________
Address: ___________________________________________________________________________
Please complete the following questions on a separate piece of paper.
1. Excellence: How does candidate consistently display dedication to nursing excellence through
expertise and commitment to the profession? In addition, provide at least one example of how candidate
encourages team contributes to the cohesiveness and function of the healthcare team.

2. Innovation: How does candidate work to creatively improve the quality of healthcare? Please include
examples of how these improvements have been integrated into practice, and resulted in greater
efficiencies, effectiveness, and/or quality of care.

3. Compassion: How has candidate consistently demonstrated high levels of compassion while
delivering nursing care and/or assisting those in need?

4. Inspiration: How has candidate inspired others to pursue a career in nursing? Motivated other
nursing colleagues to seek/sustain an evidence-based practice?

5. Impact: How has candidate made distinctive contributions to the health and well-being of the residents
of Lewis County? Enhanced community relations through education and service?

Please submit this completed nomination to:

Jennifer S. Shaver, MSN, RN
Director of Nursing
Lewis County General Hospital
7785 North State Street
Lowville, New York 13367