Compassion & Choices Illinois Compassion-in-Nursing Award Nomination Form

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Compassion & Choices Illinois Compassion-in-Nursing Award Nomination Form - DUE BY SEPTEMBER 6, 2022

The nomination deadline has been EXTENDED UNTIL SEPTEMBER 6, 2022.

Questions? Please contact Amy Sherman at asherman@compassionandchoices.org

The Compassion & Choices Illinois Compassion-in-Nursing Award is presented to licensed Illinois nurses and certified nursing assistants who excel in patient care and are committed to supporting patients and their loved ones at the end of life.

The Illinois Compassion-in-Nursing Award will recognize up to three Illinois licensed nurses or certified nursing assistants. The winners will receive a $500 honorarium and be recognized in publications and on social media.

Diversity in nominations, including individuals from systematically disadvantaged populations and under-resourced communities, is strongly encouraged.

Please submit this form by September 1st for consideration, answering all questions as thoroughly as possible. If you wish to nominate multiple candidates, please submit separate forms for each of them.

YOUR INFORMATION (NOMINATOR)

Your full name (nominator) *

Your employer (nominator) *

Your department (nominator) *

Your work title (nominator) *

Your email address (nominator) *

Your cell phone number (nominator) *

Your relationship to the nominee *

NOMINEE INFORMATION

Please answer these questions as thoroughly as possible to ensure our committee has the information they need for this process.

Nominee's full name *

Nominee's employer *

Nominee's work title *

Nominee's email address *

NOMINATION

Describe how the nominee demonstrates excellence in delivering palliative and hospice care. Please give specific examples. *

Describe how the nominee demonstrates excellence in showing compassion and support for patients at the end of life. Please give specific examples. *

Describe how the nominee demonstrates excellence in administering patient clinical care and service. Please give specific examples. *

Describe how the nominee demonstrates excellence in promoting a patient-directed care model. Please give specific examples. *

Describe how the nominee demonstrates excellence in recognizing that patient care includes the support of the patient's family and loved ones. Please give specific examples. *

Describe how the nominee demonstrates excellence in exhibiting a commitment to the public through service and to the professional community through education and advocacy. Please give specific examples. *

Please list the nominee's outstanding accomplishments, such as awards, testimonials, etc. *

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