Guidelines
Friends of Borgess Nursing
Awards, Scholarships and Grants
Non-monetary category awards:
1. Rising Star Award
2. Nursing Leadership Award
3. Sisters of St. Joseph Legacy Award
4. Excellence in Clinical Practice Award I (one at each of the following entities: BMC, Borgess
Ambulatory clinics/departments, Borgess Gardens, Pipp, Lee Memorial, VNA/Hospice)
5. Excellence in Clinical Practice Award II
6. Lamplighter Award
Monetary category awards:
1. Scholarly Project Grant (up to $500) (1 award)
2. Certification (up to $500) (8 awards)
3. Certification Renewal (up to $250) (2 awards)
Tips for Writing a Successful Nomination
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Ensure candidate meets inclusion criteria
Type a double-spaced nomination
Use headers or criteria numbers within nomination
Provide a concrete example for each criterion
Responding “see above” or skipping a criterion will result in a score of zero for that item
If criteria is two-part provide examples for both parts (ie “demonstrates leadership inside
AND outside the organization”)
7. If multiple criteria are connected by “and/or” the nominator can choose to provide examples
for one or more (“contributions to the enhancement of nursing practice, education AND/OR
research”).
8. Use the check boxes to ensure you have addressed each criterion.
9. References in addition to those required in the criteria will not be considered. Instead,
incorporate written or verbal quotes of others within the nomination as evidence for specific
criterion.
10. Adhere to the strict deadline
Completed documents, including Demographic Form, are due to Pam McKenzie via
email or mail by 4:30 pm, February 28, 2010
Pamela McKenzie
Borgess Foundation
1535 Gull Road
Medical Specialties Building, Suite 300
Kalamazoo, MI 49048
269-226-8100
pammckenzie@borgess.com
Please note: Borgess Health includes Borgess Health and Fitness Center, Borgess Lee Memorial Hospital and Medical Group, Borgess Medical Center, Borgess Nursing Home,
Borgess Pipp Hospital, Borgess Visiting Nurse & Hospice, Borgess VNA Home
Care/Borgess Staffing Solutions, Borgess at Woodbridge Hills and Borgess Ambulatory
Care, Borgess-owned practices.
2011 FOBN Nursing Leadership Award
Purpose:
Eligibility:
Friends of Borgess Nursing Annual Awards 2011
Nursing Leadership Award
A visionary award that recognizes a nurse leader who possesses extraordinary
passion, creativity, and dedication to the profession. The recipient’s leadership and
work showcases the Borgess nursing vision, imagination and originality. This
charismatic nurse leader captures the essence of the Borgess nursing spirit.
This award is open to Borgess Health registered nurses employed in management
positions with at least 36 months continuous Borgess employment. In the 12 months
prior to submission candidates must be free of corrective action (excludes counseling/
coaching), have met competency requirements and completed mandatory education.
Criteria:
 1. Recognized as a nursing leader in education, practice, shared governance, administration,
and/or research (4 points)
 2. Performs a leadership role in patient care management which contributes to patient
satisfaction, employee engagement and fiscal responsibility (4 points)
 3. Is a change catalyst and creates an environment that embraces change and facilitates the
achievement of Borgess Health organizational goals (4 points)
 4. Impacts Borgess nursing through innovative and visionary approaches to patient care and
nursing leadership (4 points)
 5. Participates in the development and encouragement of other nursing leaders (4 points)
 6. Seeks feedback from others, is open to alternative opinions (4 points)
 7. Communicates with competence in difficult situations and conflict (4 points)
Nomination: To nominate a nurse for this category, please describe how the nurse meets each criterion listed
above. Site specific examples of how each point has been met. Keep in mind that the more
comprehensive the nomination, the more weight will be given to the application. The Awards
Committee will numerically score each criterion of the application to determine the recipient(s).
The maximum available points are indicated. Letters of support or documentation in addition to
those required by the nomination will not be considered. The successful nomination must:
 1. Include completed demographic form (2 points)
 2. Include a supervisor reference form in sealed envelope (4 points)
 3. Include a double-spaced, typed paper describing how each criterion is
met. (28 points as above)
 4. Meet deadline (2 points)
Submit to Pam McKenzie via email or mail by 4:30 p.m. Feb. 28. 2011.
Borgess Foundation
1535 Gull Road
Medical Specialties Building, Suite 300
Kalamazoo, MI 49048
269-226-8100
pammckenzie@borgess.com
In the 3rd week of March nominators will be notified by email of application outcome
Please note: Borgess Health includes Borgess Health and Fitness Center, Borgess-Lee Memorial Hospital and
Medical Group, Borgess Medical Center, Borgess Nursing Home, Borgess Pipp Hospital, Borgess Visiting
Nurse & Hospice, Borgess VNA Home Care/Borgess Staffing Solutions, Borgess at Woodbridge Hills and
Borgess Ambulatory clinics/departments, Borgess-owned practices.
2011 FOBN Nursing Leadership Award
Nursing Leadership Award
Supervisor Reference
Candidate:
_____________________________________
In the 12 months prior to this date the candidate:
This RN is in a management position, has at least 36 months of continuous Borgess Health employment
and demonstrates:
Signature of supervisor: _____________________________________________ Date_______________
Provide an example that supports this assessment. If the supervisor is the primary author of the nomination, the
exemplar below must be written by another supervisor, manager, director, administrative director, executive
director, or individual holding a comparable position.
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Signature of supervisor completing exemplar___________________________ Date_______________
SUBMIT IN A SEALED ENVELOPE
2011 FOBN Nursing Leadership Award
Friends of Borgess Nursing Award
Demographic Form
Candidate Information
Name/Credentials_______________________________________________
Home phone________________
Work phone_________________
Email ____________________________________________________
Home Address_ ___________________________________
_____________________________________
_____________________________________
Award Category___________________________________
Brief History of Borgess Health Employment
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Is candidate aware of the nomination?____________________
Nominator(s) Information
Primary Nominator/Contact___________________________________________
Home phone____________________
Work phone___________________
Email____________________________________________________________
Others who participated in the Nomination
_________________________________________________________________
_________________________________________________________________
2011 FOBN Nursing Leadership Award
2011 FOBN Nursing Leadership Award