Joan Lesmond Award Nomination Form Rating Scale

Categories are based on College of Nurses of Ontario Professional Standards (to be completed by the Nominee, Nominator or Endorser)

Please rate criteria on a scale from 0 to 5 and provide comments.

0-absent, 1-fair, 2-good, 3-very good, 4-excellent, 5-exceptional

CATEGORY ONE: Respect, Teamwork

Maintains and continually improves her/his competence by participating in the College of Nurses of Ontario’s Quality Assurance (QA) Program.
Understands, upholds and promotes the values and beliefs described in CNO’s Ethics practice standard.

CATEGORY TWO: Accountability, Professionalism

Continually improves the application of professional knowledge.
Demonstrates her/his leadership by providing, facilitating and promoting the best possible care/service to the public.

CATEGORY THREE: Compassion, Diversity

Professional relationships Establishes and maintains respectful, collaborative, therapeutic and professional relationships.
Professional relationships Establishes and maintains respectful, collaborative, therapeutic and professional relationships.
Please provide comments (or attach a letter of reference) containing examples of how the IEN being nominated demonstrates the above criteria. Including supporting information or feedback from Peers, Patients/Clients or Families would be helpful.

ENDORSER:1

ENDORSER:2

Endorsement(s) from: (name, role, organization) By putting your name to this document you are acknowledging that you have read the examples (1-7) above and agree the nominee has demonstrated each in an exemplary manner.
Please include a personal essay about your experiences. This essay should demonstrate your personal commitment to nursing. Your own “story” will also be assessed as part of this nomination. The reviewers will be looking at your story for indicators of courage, resilience, passion. The essay should be copied into the page(s) below. Essays over 500 words will not be read. THE ESSAY MUST BE INCLUDED WITH THE FORM FOR A COMPLETE SUBMISSION. Please feel free to discuss with your CARE Centre Case Manager for assistance or ask your colleagues/manager/supervisor to assist you with this process.