Supported by Nursing Roles/Relationship-Based Care Council of Nursing Congress

NOMINATION FORM

I would like to nominate from the unit/department as a deserving recipient of the Compassionate Care Partner Award. This award is for a Care Partner Team member (Respiratory Care/Radiology/Lab…)who goes above and beyond the call of duty and is the kind of person that our patients, their families, and our staff recognize as an outstanding role model.
She/he consistently meets all of the following criteria:
Goes above and beyond Inspires others Excellent team player Shows compassion
Takes care of the entire patient Illustrates our core values (Reverence, Integrity, Compassion, Excellence)
Please describe a situation involving the Care Partner Team member you are nominating that clearly demonstrates how this individual met the criteria for the Compassionate Care Partner Award. (use the back if needed)
Thank you for taking the time to nominate this extraordinary Care Partner Team member. We would like to include you in the celebration of this award should your nomination be chosen.
Your Name: Date: Phone:
Email: Unit:
I am (please select one) Staff Patient Family/Visitor MD Staff Volunteer
Please submit this completed nomination form to the Nurse Manager. All nominations will be reviewed by the Nursing Roles/Relationship-Based Care Council of Nursing Congress. It will be issued to one recipient per quarter. If you have any questions, please contact Human Resources Training Coordinator at 552-3672.

Guidelines

Supported by Nursing Roles/Relationship-Based Care Council of Nursing Congress,

St. Vincent Health System

Purpose: The Compassionate Care Partner Award is a quarterly award created to recognize an outstanding Care Partner (Respiratory Care/Radiology/Lab…) who demonstrates the following criteria:

·  Goes above and beyond their normal duties

·  Inspires others in a positive manner

·  Excellent team player

·  Takes care of the entire patient with excellence

·  Shows compassion to patients, families, and colleagues

·  Consistently demonstrates our Core Values: Reverence, Integrity, Compassion and Excellence

Nominations will be offered by patients, families, visitors, physicians, staff, etc... The Nursing Roles/Relationship-Based Care Council will review all nominations and select a recipient on a quarterly basis. Nomination forms can be found on the CHI St. Vincent Insider. Completed nomination forms may be turned into the Department Manager who will send them to the HR Training Coordinator.

The HR Training Coordinator will be responsible for verifying and screening each nomination. A log record will be kept of all nominees, including the name, date received, and source of the nominator. All appropriate candidates will then be given to the Sponsor.

The Sponsor will receive all verified nominations and will black out identifiable information of the nominee without altering the substance of the nomination. A list of nominees will be reviewed quarterly during the Nursing Roles/Relationship-Based Care Council Meeting during Nursing Congress. A recipient will be selected and awarded four times a year. Voting will be an agenda item during the months of December, March, June, and September.

The Nursing Roles/Relationship-Based Care Chair or Co-Chair will coordinate the presentation of the Compassionate Care Partner Award to the recipient.