Nursing Patient Care Award nomination form
This award recognises an individual who can demonstrate excellence in the areas of patient experience and/or patient care. This person provides excellent advice or care and exhibits the ability to respond to individual patient needs; often going above and beyond to achieve a quality standard for patients.

1. Nominee's name (the one you are putting forward for the award, include all names if nominating more than one person): *


2. Job title(s) and base location(s) of the nominee(s): *


3. Contact phone number(s) of the nominee(s) (mobile preferred otherwise, landline): *


4. Email address(es) of the nominee(s): *


5. Your name: *


6. Your contact number (mobile preferred, otherwise, landline): *


7. Your email address: *


8. In more detail, describe why this team or individual should win the Nursing Patient Care Award (400 words max):

1. Provide specific examples of how this person or team goes above and beyond the daily tasks required for their role.
2. Who do they impact? Does their behaviour have a positive influence on the team and/or the wider organisation?
3. Why is this person or team deserving of this award? *

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