PSRC Lifetime Achievement Award Nomination Form

PSRC Department of the Year - Nomination Form
The PSRC is seeking nominations for the 2023 Department of the Year award.

The PSRC Department of the Year Award recognizes outstanding departments managed and staffed primarily by Respiratory Care Practitioners,. The PSRC may honor DOY to all outstanding departments meeting criteria. Criteria increase each stage to progressively prepare departments for AARC APEX criteria, with the highest level of PSRC award being higher standards than the APEX award.

Examples of award criteria include but are not limited to:
- Percentage of RRT Credential.
- Percentage of AARC membership amongst staff.
- Percentage of advanced degrees amongst staff (BS, MS, etc.)
- Annual competency testing.
- Clinical ladder availability.
- Participation on interdisciplinary committees.
- Availability of High School student job shadowing.
- Availability of evidence-based policies/protocols.
Nominations should include a statement outlining the department’s accomplishments and activities. Example categories and criteria include, but are not limited to, those outlined on the nomination form.

To view the full criteria used to determine this award, click here.
Nominator:

Person submitting the nomination
Full Name*

First NameLast Name
Company*
Position*
E-mail*
example@example.com
Phone Number*
Nominee Information

Please indicate details about your nomination
Name of Organization / Company*
Name of Department Within Organization*
Name of Department Manager / Director*
Manager / Director E-mail Address*
example@example.com
Phone Number (if known)
Manager / Director's Highest level of education
Manager / Director's credentials
Manager / Director is an AARC member. (Y/N)
Percentage (%) of staff with RRT credential
All respiratory therapists (full-time, part-time, PRN, and contract employees) must undergo annual competency testing on low volume, problem-prone, and/or high-risk procedures on a regular basis:

YesNo
The department offers educational events to staff and provides continuing education credit - please provide details below:
The department has a mechanism by which qualifying employees are eligible for professional advancement (in job title or in salary) through the use of a clinical ladder(or similar program) - please provide details below:
The department has a shared governance structure and/or staff participation on interdisciplinary committees or teams - please provide details below:
The department is actively involved in promoting public awareness of respiratory care through health fairs, community outreach events, speaking engagements, etc. - please provide details below:
The department allows for job shadowing for those interested in the respiratory care profession and/or presents to middle or high school students - please provide details below:
The department is an active participating clinical site for a respiratory care program and allows students hands-on learning - please provide details below:
Respiratory therapists are available 24 hours within the facility. (Y/N)
Respiratory therapists are available 24 hours within the facility.

YesNo
The department has a defined staffing plan that is used to project anticipated staffing and is used consistently for scheduling and flexing of the staff - please provide details below:
Department policy prohibits the routine delivery of care to multiple patients simultaneously. (Y/N)
What percentage of time are evidence-based protocols established, approved by the medical director and utilized?
A department policy and procedure manual is available to staff and is driven by evidence based practice (including references) - please provide details below:
There must be a tool used to measure and track quality, patient satisfaction, safety, staff satisfaction and/or operational performance - please provide details below:
A doctor of medicine or osteopathy is designated as Medical Director of Respiratory Care Services. (Y/N)
Percentage (%) of staff with active AARC/PSRC membership
Percentage (%) of staff with (or pursuing) a Bachelor's Degree
Enter any additional comments you would like considered for this award.
Please feel free to attach any supporting documentation you feel is necessary.

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PSRC Department of the Year - Nomination Form

Nominator:

Nominee Information