NOMINATION FORMPrimary Healthcare Nursing Award

This will be awarded to a Registered or Enrolled Nurse who is recognised by their patients, peers and primary care team as an exemplary nurse that goes above and beyond every day. The nurse demonstrates leadership, innovation and whole of system integration by working in partnership with patients, their families and the interdisciplinary care team, enabling self-management and improved health outcomes.

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:

Organisation/Service/Practice:

Email address:

NOMINATOR DETAILS (Your details)

Full name:

Organisation/Service/Practice:

Contact phone number:

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

Provide an example of what makes this person an excellent Nurse

Takes the lead in new initiatives and quality improvement activities to achieve equitable outcomes and best practice.

Works in partnership with the patient and their family

Forms working relationships with all disciplines to get the support they need to improve patient health and independence and improving integration across the whole patient journey

How do they raise the profile and voice of primary health care nursing

(Maximum word count: 200 words for each section)