Joan Lesmond Award Nomination Form Rating Scale

Categories are based on CARE values- Respectful, Collaborative, Compassionate, Accountable, Professional, Inclusive. To be completed by the Nominee, Nominator or Endorser.

A) 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 (30 points)

CATEGORY ONE: Respect, Collaborative

CATEGORY TWO: Compassionate, Accountability

CATEGORY THREE: Professional, Inclusive

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. (40 points)
Click or drag files to this area to upload. You can upload up to 4 files.

If self-nominating, two (2) endorsements are required in the form of signatures from any of the following:

• Manager and/or Administrator
• Team Leader, Clinical Educator or Preceptor
• Peers (nurses, health care discipline team members - physicians and allied health professionals)
• Patients and Families
• CARE Centre Case Manager


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 the nominee’s personal commitment to nursing and courage, resilience, and passion as an IEN, displaying these with anecdotal evidence from the IEN’s nursing practice that demonstrates the following values: Respectful, Collaborative, Compassionate, Accountable, Professional, Inclusive. Your “story” will also be assessed as part of this nomination. The essay should be copied into the online nomination form above. 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.