Blue Jay Consulting/Emergency Medicine Foundation Award

Official 2012 Awards Nomination Form 

This form must be completed entirely. Do not indicate “see C.V.”
*Entries are to be limited to 7 pages plus an abbreviated C.V.  

Nominator Information

 

The nomination form, nominee’s curriculum vitae, a letter explaining why the nominee merits the award and how specifically their background relates to the award criteria, and letters of support must be submitted to the EMF website in .pdf format, no later than Friday, February 17, 2012 (COB) to be considered by the Awards Committee.  

Nominated By:    
Date Submitted:       
Address:      
City, State, ZIP:     
E-mail:       
Telephone:      

Nominee

Name of Nominee:    
Address:       
City, State, ZIP:      
E-mail:    
Telephone:     

Communications Department (If selected for the award): 

Name of Contact:      
Telephone:     
Institution Name:      
E-mail:       
 
Successful emergency departments have the strongest collegial relationships between medicine and nursing.  It is through this collaboration that lasting improvements are made in quality care and patient satisfaction. Please state why this person should be honored with this award, with specific attention to the following criteria. The nominee must demonstrate collaborative relationships with nursing to implement and improve operational and clinical standards in the following areas: Quality Patient Care, Operational Effectiveness, Education, Community Service, and a synergistic approach to leadership within the hospital or hospital system.  The nominee will create and sustain a high degree of patient satisfaction with emergency care delivery and will implement creative and innovative strategies to address ED throughout.
 
   
 
 ACEP Offices Held (National and Chapter):  
   
 Committees (National, Local/Name of Committee, and Length of Service):   
   
 Other Emergency Medicine-Related Services (Title and Length of Service):  
   
 Other Activities of Special Merit (Civic, Institution, etc.):