NOMINATION FORMRotary Ann Craig Medal Award

Awarded to the Registered Nurse in Child Health whose professionalism promotes and demonstrates the highest standards of the nursing profession.

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.

Provide examples of when they have excelled in communication, teamwork, c, compassion and empathy evident in care delivery.

Provide examples of their Leadership, Teaching or Preceptorship

Provide examples of when they have improved patient safety, include membership of professional group and audits or case review

Provide examples of when they have demonstrated excellence in family-centered care delivery and contributing to best patient outcomes and coordination of care.

Provide an example of recognition by families and peers of their professional commitment

(Maximum word count: 200 words for each section)