NOMINATION FORMJudith Philipson Excellence Award

This will be awarded to a Registered Nurse who is recognised by their peers as a nurse who demonstrates inspired child health nursing care delivery at the bedside.

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.

Value based, compassionate nursing care delivery

Respectful partnerships with families and children

Excellent standards of clinical nursing

Supports their nursing colleagues and has a team approach to care

Upholds professional nursing standards

Any other comments

(Maximum word count: 200 words for each section)