2018 UH SMC Nursing Excellence Nomination

Please take a few minutes to fill out this nomination form. Deadline for submission is April 22, 2018. Nominations will be reviewed by the Celebrate Nursing Excellence committee and 5 winners chosen. Selection will be based on criteria listed below.

• Individual must be employed by UH Samaritan Medical Center
• Committed to excellent nursing practice
• Exemplify the nursing profession

Name of Nurse being nominated:*
Unit/Department of Nurse*
Your Name (optional)
I am *

Your Unit
Your Email Address
Your Phone Number
Qualities the nominee should exemplify: (Please choose one or as many as apply)

Please describe how this nurse exempifies the nursing profession through qualities of mission, vision, values, integrity, and service excellence. Please note: be as descriptive as possible about the person you nominate. Be sure to write more than just one or two sentences since that will not provide us with enough info.*
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