NOMINATION FORMCancer and Blood Award

This is awarded Registered or Enrolled Nurse who is recognised by their peers for their values-based 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 and raises the profile of nursing

Demonstrates a high standard of patient and family-centred care

Has undertaken or takes the lead in patient care improvement initiatives

Supports their nursing colleagues and has a team based approach to nursing

Goes the extra mile for patients

Any other comments

(Maximum word count 200 per section)