EmailMe Form - ASPMN Clinical Practice Award

Name of Nominee *

First Last

Academic/Professional Credentials *

Title *

Employer *

Phone *

### - ### - ####

Email *

Nominee is a current ASPMN Member *

Yes

No

Currently practicing clinically in pain management 50% or more of the time. *

Yes

No

ASPMN Involvement: *

List Board or committee involvement.

If not addressed in the letter of recommendation, please describe how the nominee demonstrates the following:

1. Maintains standards of clinical pain nursing practice.

2. Uses creative techniques in patient care and/or education.

3. Serves as a patient advocate.

4. Promotes collegiality through demonstration of collaborative efforts with other healthcare team members.

5. Serves as a role model by creating an atmosphere of mutual respect among healthcare team members.

6. Maintains an outstanding skill level and knowledge in managing patients with pain.

7. Stimulates nursing colleagues to improve patient care.

8. Initiates outstanding contributions to improving the image and clinical practice of pain management nursing. *

Nominee's current cv *

Letter of Recommendation *

Letters of recommendation should not exceed two pages and should describe the characteristics in the previous question.

Nominated by: *

First Last

Phone *

### - ### - ####

Email *