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NOMINATION FORMRotary Alistair McFarlane Memorial Award

The Midwife and or Nurse who best typifies the spirit of professional practice within Women's Health

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 or midwife, please include something in each of the appropriate sections.

Provide examples of when they have excelled in communication, teamwork and caring

Provide examples of their teaching/Preceptorship, mentoring students and Leadership

Provide examples of Quality Initiatives, Patient Reviews, Policy, Audit – case review and Membership of Professional Group

How have they Contributed to Improvement and Leadership Skill Development.

Provide examples of peer Feedback, Patient Feedback and MDT Aspect.

Tell us about research, teaching and policy development they have been involved in.

How have they involved whānau in provision of nursing care and Integrate Treaty of Waitangi principles.

(Maximum word count: 200 words for each section)