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Nursing Awards
Trevor Clendenin
2025-06-10T07:47:40-04:00
Hastings Center Cunniff-Dixon Nursing Awards
Nursing Nomination Form
Step
1
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9
- Nominator Information
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1/9 Nominator's Information
Please fill out this form as the nominator suggesting a nominee for the Nursing Awards.
Name
*
First
Last
Title
Organization
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
*
Email Address
*
2/9 Nominee's Information
Please fill out this form with your nominee's contact information.
Award Category
Inpatient and/or Outpatient Nurse
Hospice and/or Home Care Nurse
Name
*
First
Last
Title
*
Organization
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
*
Email Address
*
3/9 Nominee's CV
Please provide a current CV for the nominee at the PDF, JPG, DOC or TXT format
Drop files here or
Select files
Accepted file types: pdf, jpg, doc, txt, Max. file size: 300 MB.
4/9 EVIDENCE BASED PRACTICE
Please provide a description of the nominee's excellence in evidence based practice of palliative nursing care
*
The nurse integrates evidence of best practices in palliative care to insure the highest quality of care for patients and families. The nominee applies evidence based practice through their own care and also leads efforts within their organization or community to insure the highest quality of care. Evidence based practice includes all domains of palliative care as established by the NCP Clinical Practice Guidelines for Quality Palliative Care..
(500 words or less)
5/9 PERSONAL INTEGRITY
Please provide a description of the nominee's excellence in personal ethics and integrity
*
The nominee exemplifies a model of clinical practice based on the nursing professional code of ethics and acts with integrity. The nurse provides leadership in the many ethical challenges in palliative nursing care including supporting patients and families in health care decisions, honoring values, and respecting diversity.
(500 words or less)
6/9 FAMILY AND FRIENDS
Please provide a description of the nominee's excellence in compassionate relationships with the family
*
Recognizing that family, as defined by the patient, is central in the support of seriously ill patients and those facing the end of life, the nominee provides competent and compassionate support of the family. (500 words or less)
7/9 COMMUNICATION
Please provide a description of the nominee's excellence in Empathic, human centered communication
*
The nurse recognizes that communication is the foundation of nursing practice and relationships with patients, families and colleagues. The nominee exhibits communication that supports patients and families and communication with colleagues to foster cohesive, patient centered care.
(500 words or less)
8/9 TEAM WORK & LEADERSHIP
Please provide a description of the nominee's excellence in Interprofessional team collaboration and leadership
*
The nominee demonstrates excellence in interprofessional care and provides leadership to insure that care is coordinated and brings the strengths of all disciplines to support patient and family care. These efforts strengthen quality physical, psychosocial and spiritual care. The nominee also promotes self care for the team .
(500 words or less)
9/9 COMMUNITY SERVED
Please provide a description of the nominee's excellence in the application of diversity, equity and inclusion
*
The nurse demonstrates commitment to diversity, equity and inclusion. Examples may include the nurse’s own practice as well as efforts to insure that these critical elements are integrated in the organization and that care is responsive to the most vulnerable populations.
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