NOMINATION FORMChild Health Directorate Starship Foundation Excellence in Clinical Practice Award

This will be awarded to a Registered Nurse who is recognised by their peers as a nurse who demonstrates leadership in the development of excellence in child and family nursing practice.

Please complete ALL sections of the nomination form.

Nomination forms must be submitted on or before Thursday 24 March 2016

Completed nominations should be emailed to NurseMidwifeAwards@adhb.govt.nz

NOMINEE DETAILS (Their details)

Full name:

Current role:

Service area:

Email address:

NOMINATOR DETAILS (Your details)

Full name:

Service area:

Contact phone number:

Tell us why you are nominating the nurse, please include something in each of the appropriate sections.

Is professional, proud to be a nurse in our Directorate and raises the profile of nursing through their actions and leadership

Exemplary child health nursing clinical knowledge that others aspire to attain

Commendable interpersonal skills and works respectfully with teams

All nursing actions are compassionate and focus on infants, children, young people and their family/whānau care needs

Any other comments

(Maximum word count: 200 words for each section.)