Joan Lesmond IEN of the Year- Nomination Form

This is a self-nomination? *

Name of Nominee: *

Name of Nominator(s)/ Endorser(s):

Role and Relationship of Nominator(s) with Nominee:

Nominee’s Current Place of Employment: *

Under which professional registration category is the Nominee currently applying for this award? *

RN
RPN
RN(EC)

How long has the Nominee been working at the current place of nursing employment under this professional registration category?

If less than one year, please list previous employer(s):

Is the Nominee a member of CARE Centre for Internationally Educated Nurses?

Joan Lesmond Award Nomination Form Rating Scale

Categories are based on CARE values- Respect, Teamwork, Accountability, Professionalism, Compassion, Diversity. 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

Showing Respect in all of his/her dealings with his/her colleagues and clients

Encouraging Teamwork that clearly values collaboration & input towards organizational success.

CATEGORY TWO: Accountability, Professionalism

Emphasizing Accountability at both the client and team level.

Focusing on Professionalism in all he/she does.

CATEGORY THREE: Compassion, Diversity

Showing understanding and Compassion to all those he/she works with and those he/she serves.

Championing Diversity of his/her clients by contributing to the building of a culturally competent care provision and working environment.

Total Scores

Comments:

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.

File Upload

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

ENDORSER:1

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.

Name:

Date:

Organization:

Position:

Signature:

Phone:

ENDORSER:2

Name:

Date:

Organization:

Position:

Signature:

Phone:

Are you willing to participate in an evaluation about this Award Process in the future?

Phone *

Email *

PERSONAL ESSAY BY NOMINEE *

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.

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