STAR Awards 2021

Date of Nomination

Name of nurse being nominated for STAR Award

First Last

Nominee's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nominee's Phone

Nominee's Email

Name of Nominator

First Last

Nominator's Phone

Nominator's Email

How many years has the nominee been practicing as a nurse?*

1-9 years
10 or more years

Does the nominee possess an unemcumbered Colorado Nurse's License?*

Yes
No

The nominee must work in the SW Colorado AHEC region. In which county does the nominee work?*

Please answer the following 5 questions that demonstrate how the nominee meets the stated Competencies. Give 2-3 SPECIFIC EXAMPLES for each question.

1. How does the nominee demonstrate caring and critical thinking skills to assist the patient/family/group to identify and meet basic health needs?

1.1 How does the nurse coordinate cost-effective quality care using a culturally competent, collaborative and interdisciplinary approach?

2. How does the nominee provide individual/family/group or population-based education to promote, maintain, and restore health from birth through death?

2.1 Does the nurse promote a caring environment, provide culturally appropriate learning activities, and effectively utilize resources and current technology?

3. Does the nominee demonstrate leadership qualities by working well with others to promote: quality of patient care; awareness of costs of care; patient satisfaction?

3.1 How does the nominee demonstrate the ability to coordinate care for individuals or groups by effectively using technology, resources, information, and other systems?

4. Is the nominee accountable for the ethical, legal, and professional responsibilities related to nursing practice?

5. Does the nominee promote a climate in which patients/families/groups may act in their own interest, including accessing available resources, and intervene when they are unable to act in their own interest?

*An additional 1-2 points will be given if the nurse's practice demonstrates the ability to overcome barriers associated with medically underserved and/or rural/frontier populations. Please give very specific examples:

701 Camino Del Rio, Suite 320, Durango CO 81301. Call 970-426-4284.
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Southwest Colorado AHEC STAR Awards 2021