Senior NurseSelf-Assessment and Peer Assessment Form
Senior Nurse Name / Senior Nurse Role / Senior Nurse APC / Senior Nurse Practice Area/RegionSenior Nurse signature / Self-Assessment Date
Nursing Peer Assessor Name / Nursing Peer Assessor Role / Nursing Peer Assessor APC / Nursing Peer Assessor Signature
Peer Assessment Date
Senior Nurse PORTFOLIO REQUIREMENTS
All evidence must be page numbered, sectioned, and indexed. In the workbook all examples and evidence must show a reference to the page number in the portfolio.
Letter of Support from Line Manager
Signed statement of integrity
Curriculum Vitae (Inclusive of work and education history)
A verified copy of both sides of current Annual Practising Certificate (APC) or a copy of entry on NCNZ online register with any conditions of practice.
A verified record of practice hours (a minimum of 450 hours over the last 3 years). This must be stated in hours (e.g. 940 hours) and not proportion of FTE or number of days worked.
A verified record of professional development (60 hours over the last 3 years) and must include a separate written reflection on three professional development attendances, describing the difference this learning has made to your nursing practice.
The record must include evidence that professional development on the Code of Conduct for Nurses, and Guidelines: Professional Boundaries has been completed before July 2015 as per NCNZ requirements (Nursing Council of New Zealand 2012)
A Performance Agreement completed within the last 12 months.
The PDRP Self-Assessment and Peer Assessment Record which clearly identifies evidence / examples that demonstrate how you meet the competencies for Senior nurse’s in management, education, quality, policy and /or research. Sufficient evidence will include one example within the self-assessment and one example within the Peer Assessment for each competency that demonstrates practice at the senior nurse level. The evidence identified should be from the current area of practice and be within the previous 12 months.
Those Plunket senior nurses practising in direct health consumer care and also in management, education, policy and/or research must meet the competencies for both direct health consumer care and the competencies for their specific role (management, education, policy development, advisory, or research).
Any evidence of Level 8 post graduate education (or currently working towards) relevant to your area of current practice (a verified copy of the certificate or course transcript are required). This can be included in the 60 hours of professional development.
Self-Assessment and Peer Assessment which clearly identifies one piece of evidence / example from current area of practice within the previous 12 months that demonstrates how you meet the competencies for Senior Nurse in direct clinical care, management, education, policy and /or research (as relevant to role).
Evidence demonstrating
- Leadership in education, management, research or policy development, and this evidence reflects the central requirements of your position/role.
- Evidence demonstrating leadership in regards to innovation in practice and the change process in quality improvement activities. This should include evidence of the integration of evidence, best practice and implementation evaluation.
- Reflection on the learning and development of colleagues including and advocating for evidence based practice.
- Active participation and leadership roles in wider service, professional or organisational groups or activities and the implementation of this within the Well Child / Tamariki Ora context. This should highlight leadership and advocacy for nursing/client needs.
- Evidence demonstrating quality monitoring and analysis of professional processes and how this information has been used to affect improvements in healthcare delivery. This evidence should reflect the central requirements of your position/role.
All evidence must demonstrate cultural competence, cultural responsiveness and cultural safety in well child health.
All evidence must demonstrate the ability to apply the principles of the Treaty of Waitangi / Te Tiriti o Waitangi to well child health and practice in a culturally safe / Kawa whakaruruhau manner.
NB. One example may be used as the basis to demonstrate competency across a range of competencies but must be written separately within each.
Domain 1: Professional ResponsibilityTo be completed by all senior nurses (A)
Performance Criteria / Self Assessment
Provide an example from your practice that shows how you demonstrate each competency. / Nursing Peer Assessment
Provide an example of observed practice that shows how the nurse demonstrates each competency.
Indicate where competence is not observed and record recommendations for developing practice.
A1.1 Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the professional, ethical and relevant legislative requirements.
A1.2 Demonstrates the ability to apply the principles of the treaty of Waitangi/Te Tiriti o Waitangi to nursing practice.
A1.3 Demonstrates accountability for directing, monitoring and evaluating nursing care that is provided by enrolled nurses and others.
A1.4 Promotes an environment that enables health consumer* safety, independence, quality of life, and health.
A1.5 Practises nursing in a manner that the health consumer* determines as being culturally safe.
* ‘Health Consumer:’ An individual who receives nursing care or services. This term represents patient, client, resident or disability consumer. This term is used in the Health Practitioners Competence Assurance Act (2003). Competencies for registered nurses, NCNZ, 2007, Reprint May 2012, Amended September 2016
Senior nurses practising in direct health consumer care (DC) must meet both the DC competencies and the competencies relevant to their senior nurse role of either management (M), education (E), research (R) or policy-making (P) and the competencies relevant to all (A) in the last section in this domain.
Senior nurses not practicing in direct client care must meet the competencies relevant to their senior nurse role of either management (M), education (E), research (R) or policy-making (P) and the competencies relevant to all (A) in the last section in this domain.
Performance Criteria / Self-Assessment
Provide an example from your practice that shows how you demonstrate each competency. / Nursing Peer Assessment
Provide an example of observed practice that shows how the nurse demonstrates each competency.
Indicate where competence is not observed and record recommendations for developing practice.
To be completed by senior nurses practising in direct health consumer care (DC)
DC 2.1 Provides planned nursing care to achieve identified outcomes.
DC 2.2 Undertakes a comprehensive and accurate nursing assessment of health consumers in a variety of settings.
DC 2.3 Ensures documentation is accurate and maintains confidentiality of information.
DC 2.4 Ensures the health consumer has adequate explanation of the effects, consequences and alternatives of proposed treatment options.
DC 2.5 Acts appropriately to protect oneself and others when faced with unexpected health consumer responses, confrontation, personal threat or other crisis situations.
DC 2.6 Evaluates health consumer’s progress toward expected outcomes in partnership with health consumers.
DC 2.7 Provides health education appropriate to the needs of the health consumer within a nursing framework.
DC 2.8 Reflects upon, and evaluates with peers and experienced nurses, the effectiveness of nursing care.
DC 2.9 Maintains professional development.
To be completed by senior nurses in a management role (M)
M2.1 Promotes an environment that contributes to ongoing demonstration and evaluation of competencies.
M2.2 Promotes a quality practice environment that supports nurses’ abilities to provide safe, effective and ethical practice.
M2.3 Promotes a practice environment that encourages learning and evidence-based practice.
To be completed by senior nurses in an education role (E)
E2.1 Promotes an environment that contributes to ongoing demonstration and evaluation of competencies.
E2.2 Integrates evidence-based theory and best practice into education activities.
To be completed by senior nursesin a research role (R)
R2.1 Promotes a research environment that supports and facilitates research mindedness and research utilisation.
R2.2 Supports and evaluates practice through research activities and application of evidence-based knowledge
To be completed by senior nurses in a policy-making role (P)
P2.1 Utilises research and nursing data to contribute to policy development, implementation and evaluation.
To be completed by all senior nurses (A)
A2.1 Participates in professional activities to keep abreast of current trends and issues in nursing.
Domain 3: Interpersonal Relationships
Senior nurses practising in direct health consumer care (DC) must meet both the DC competencies and the competencies relevant to their senior nurse role of either management (M), education (E), research (R) or policy-making (P) and the competencies relevant to all (A) in the last section in this domain.
Senior nurses not practicing in direct client care must meet the competencies relevant to their senior nurse role of either management (M), education (E), research (R) or policy-making (P) and the competencies relevant to all (A) in the last section in this domain.
Performance Criteria / Self Assessment
Provide an example from your practice that shows how you demonstrate each competency. / Nursing Peer Assessment
Provide an example of observed practice that shows how the nurse demonstrates each competency.
Indicate where competence is not observed and record recommendations for developing practice.
To be completed by senior nurses practising in direct care (DC)
DC 3.1 Establishes, maintains and concludes therapeutic interpersonal relationships with health consumers
DC 3.2 Practises nursing in a negotiated partnership with the health consumer where and when possible.
A3.1 Establishes and maintains effective interpersonal relationships with others, including utilising effective interviewing and counselling skills and establishing rapport and trust.
To be completed by all senior nurses (A)
A3.1 Establishes and maintains effective interpersonal relationships with others, including using effective interviewing and counselling skills and establishing rapport and trust
A3.2 Communicates effectively with members of the health care team, including using a variety of effective communication techniques, employing appropriate language to context and providing adequate time for discussion
Domain 4: Inter professional health care and quality improvement
To be completed by all senior nurses (A)
Performance Criteria / Self Assessment
Provide an example from your practice that shows how you demonstrate each competency. / Nursing Peer Assessment
Provide an example of observed practice that shows how the nurse demonstrates each competency.
Indicate where competence is not observed and record recommendations for developing practice.
A4.1 Collaborates and participates with colleagues and members of the health care team to facilitate and coordinate care
A4.2 Recognises and values the roles and skills of all members of the health care team in the delivery of care
A4.3 Participates in quality improvement activities to monitor and improve standards of nursing
Plunket PDRP: template version date November 20171