Individual Perioperative Nurse - Outstanding Achievement award

Criteria and Nomination

The Individual Perioperative Nurse: Outstanding Achievement award will be presented to four (4) perioperative nurses who have made a significant contribution to any of the following aspects of perioperative nursing:

  • Clinical Practice
  • Patient Education
  • Nursing Management
  • Nursing Education
  • Nursing Research

The award is given to one nurse at each level from the below groups:

GROUP ONE / GROUP TWO / GROUP THREE / GROUP FOUR
Senior Nurse Manager
Nurse Manager
Nurse Unit Manager / Clinical Nurse Consultant
Nurse Educator
Clinical Nurse Specialist
Clinical Nurse Educator / Registered Nurse / Enrolled Nurse

You may nominate any number of nurses, but you must address the criteria for each nurse separately.

Documented evidence (max. 500 words total) for the following criteria may include, but not be restricted to:

COMPULSORY CRITERIA:
Customer Focus / Describe how the nominee has ensured they are responsive to the needs of your customers. Describe who the nominee has identified as your customers.
Continuous Improvement / Describe how the nominee has incorporated continuous improvement into their daily work practices.
Outcomes / Describe the significant outcomes the nominee has achieved for nursing/healthcare.
Striving for Best Practice / Describe the steps the nominee has taken towards achieving best practice.
Leadership / Describe how the nominee has implemented or supported excellent leadership initiatives within your workforce.
OPTIONAL CRITERIA
Innovation / Describe how the nominee has demonstrated an innovative approach to achieving appropriate outcomes.
Application to other settings / Describe the ways in which the nominee’s outcomes are transferable to other nursing/healthcare settings.

The application must be completed below and provided as per OTA Perioperative Awards Policy

Checklist – Member nominating please complete white areas
  • Name and zone of the full financial member of the Association who is proposing the nomination

Print name………………………………………………………. Zone: ………….…
Signed……………………………………………………….... Date…………….…
NSW OTA Honorary Secretary complete:
Received on: ……………….. Correct NSW OTA nomination form Yes

Comprehensive curriculum vitae is attached Yes Proceed to panel assessment Yes No
Comments:…………………………………………………………………………………………………………………..……..
Print name…………………………………………………….Signed……………………………………….. Date…………
NSW OTA Assessment panel complete Received on: …………………
Nominee fulfils all the criteria in the application form Yes Endorsed /Not Endorsed
Print name…………………………………………………….Signed……………………………………….. Date…………

The following criteria must be addressed in the body of the submission to assist the selection committee in assessing the candidate’s eligibility for the above award: Documented evidence (max. 500 words total) may include, but not be restricted to:

Individual Perioperative Nurse- Outstanding Achievement Award -Nomination Details
  • Surname
/
  • Other names

  • Postal address and postcode

  • Phone numbers
/ Home: Mobile:
  • Email address
/
  • Member of zone

Please provide evidence (in ALL of the COMPULSORY shaded sections below) outlining the accomplishments of the person you are nominating which demonstrate they fulfil the criteria.

(attach additional page/s or expand boxes below if more space is required).

  • PROVIDE COMPULSORYCustomer Focusevidence:
  • Describe how the nominee has ensured they are responsive to the needs of your customers. Describe who the nominee has identified as your customers.

  • ………………………………………………………………………………………………………………………………..…….
  • …………………………………………………………………………………………………………………….…………….….
  • …………………………………………………………………………………………………………………….………………
  • …………………………………………………………………………………………………………………….……..…….….

PROVIDE COMPULSORY Continuous Improvement evidence
Describe how the nominee has incorporated continuous improvement into their daily work practices.
  • ……………………………………………………………………………………………………………………………….…….
  • ……………………………………………………………………………………………………………………………….…….
  • …………………………………………………………………………………………………………………….……………….
  • …………………………………………………………………………………………………………………….…………….….
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PROVIDE COMPULSORY Outcomes evidence
  • Describe the significant outcomes the nominee has achieved for nursing/healthcare.

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PROVIDE COMPULSORY Striving for Best Practice evidence
Describe the steps the nominee has taken towards achieving best practice.
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PROVIDE COMPULSORYLeadership evidence
Describe how the nominee has implemented or supported excellent leadership initiatives within your workforce.
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PROVIDE Innovation evidence (optional)
Describe how the nominee has demonstrated an innovative approach to achieving approach to achieving appropriate outcomes.
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PROVIDE Application to other settings evidence (optional)
Describe the ways in which the nominee’s outcomes are transferable to other nursing/healthcare settings.
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Mail this form to the: NSW OTA Secretariat, PO Box 212, Croydon NSW 2132

OR fax to: (02) 97991867 OR email to:

NSW OTA Inc Individual Perioperative Nurse: Outstanding Achievements award– Criteria and Nomination Page 1 of 4

Updated and approved by NSW OTA Executive Committee Oct 2016