APNA AWARD FOR EXCELLENCE IN PRACTICE – APRN-PMH
NOMINATION FORM
Description
Recognizes an APNA APRN-PMH[1] member who has made significant contributions to psychiatric-mental health nursing practice. The APNA member must be in good standing and shall have been a member for two (2) years or more.
Guidelines
1. Demonstrates excellence in psychiatric-mental health nursing. This individual serves as a clinical role model for other nurses by making tangible contributions to the enhancement of nursing practice and client outcomes.
2. Shows evidence of making significant enhancements, refinements or unique contributions to the delivery of psychiatric-mental health nursing care.
3. Demonstrates excellence in working with individuals/families/communities.
4. Shows evidence of being an influential role model to other psychiatric-mental health nurses in the delivery of quality nursing care.
5. Shows evidence of having disseminated innovative clinical knowledge to families, communities, organizations and professional colleagues.
NOMINATION PROCEDURES
Each Nominee must have: 1 Nominator and 1 Reference letter
The Nominator must submit:
♦ Five (5) copies of this completed Nomination Form, attaching the Nominee’s Resume/Curriculum Vitae, and a published paper or an oral presentation written or presented by the Nominee.
The Reference must submit:
♦ This Nomination Form (first page only), attaching a Reference Letter for the Nominee which addresses the 5 criteria listed
above.
Send to: Chair, APNA Awards and Recognition Committee 2008
APNA, 1555 Wilson Blvd, Suite 530, Arlington, VA 22209,
Deadline for Submission: Close of business on June 30, 2008.
PLEASE PRINT OR TYPE:
Nominee’s Name: ______E-mail: ______
Nominee’s Title: ______
Business Address: ______Business Phone: ______
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Home Address: ______Home Phone: ______
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This Form Submitted by: ______My E-Mail: ______
Name
(check one)
I am the: Nominator ٱ
Reference Business Phone: ______
Home Phone: ______
My Title: ______
My Business Address: ______Business Phone: ______
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My Address: ______Home Phone: ______
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If you are the Nominator:
In the space provided on the following pages, please provide information about the Nominee related to the specific award criteria. Be specific and give examples. This form must be signed. Do not exceed this 3-page form.
If you are the Reference:
Write a reference letter about the Nominee. Be specific and give examples which address the 5 criteria listed and return it with page 1 of this form. The reference letter must be signed.
1. Demonstrates excellence in psychiatric-mental health nursing. This individual serves as a clinical role model for other nurses by making tangible contributions to the enhancement of nursing practice and client outcomes.
2. Shows evidence of making significant enhancements, refinements or unique contributions to the delivery of psychiatric-mental health nursing care.
3. Demonstrates excellence in working with individuals/families/communities.
4. Shows evidence of being an influential role model to other psychiatric-mental health nurses in the delivery of quality nursing care.
5. Shows evidence of having disseminated innovative clinical knowledge to families, communities and organizations.
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Signature Date
1
Nomination Form – APNA Award for Excellence in Practice- APRN-PMH
APNA Awards and Recognition Committee 2008
[1] The advanced practice registered nurse in psychiatric-mental health nursing (APRN-PMH) is a licensed registered nurse who is educationally prepared either as a clinical nurse specialist or a nurse practitioner at least at the master's degree level in the specialty of psychiatric-mental health nursing (American Nurses Association/American Psychiatric Nurses Association/International Society of Psychiatric-Mental Health Nurses. [2000]. Scope and standards of psychiatric-mental health nursing practice. Washington, D.C.: American Nurses Publishing, p. 17).