2015 EN L2 Personal Classification Application Package
advertisement
Application Package Enrolled Nurse Level 2 Personal Classification If electronic submission is not possible, applications (marked CONFIDENTIAL) may be sent by mail to: Professional Development Co-ordinator Nursing & Midwifery Office Level 3, Building 6 Canberra Hospital PO Box 11 Woden ACT 2606 Contact: Professional Development Co-ordinator Nursing and Midwifery Office Telephone: 6244 2147 Email: NMO@act.gov.au Page 1 of 13 Enrolled Nurse Level 2 Personal Classification Title: Family Name: Given Name: Home Contact Details Postal Address: Telephone: Mobile: Email: Work Contact Details Postal Address: Telephone: Mobile: Email: Are you an Australian citizen YES / NO OR Are you a permanent resident of Australia? YES / NO (If Yes please provide evidence) Please note – if you are not an Australian citizen or permanent resident you are not eligible to apply for an Enrolled Nurse Level 2 Personal Classification position. Page 2 of 13 Registration Do you have a current unconditional practicing certificate? YES / NO (Please provide evidence) Australian Health Practitioner Regulation Agency (AHPRA) Registration Number: ________________________ Details of employment Current position: ___________________________________________________________________________ Position Number: __________________________________________________________________________ (This is NOT your AGS number so check with your manager if you are unsure) Current area of practice and work unit:__________________________________________________________ Length of time in current position (years/months): ________________________________________________ Employment status (permanent/ casual/ fixed term contract): _______________________________________ Employment hours (full-time/ part-time):________________________________________________________ Declaration The information I have provided in my application is my own work, is true and correct. Applicant name: ................................................................................................................................................. Signature: .......................................................................................................................................................... (Sent from work email, serves as an electronic signature) Date: ................................................................................................................................................................. Page 3 of 13 Enrolled Nurse Level 2 Personal Classification Generic Selection Criteria Applicants, are asked to respond to the below selection criteria. Mandatory: 1. Registered or eligible for registration as an Enrolled Nurse with the Australian Health Practitioner Regulation Agency (AHPRA). 2. An enrolled nurse with a minimum of three years full-time equivalent (FTE) post registration experience, including six months experience in the relevant field of practice Essential: 3. Proven ability to deliver competent nursing care under the guidance of a registered nurse in accordance with the ANMC National Competency Standards for the Enrolled Nurse and the Competency Standards for the advanced enrolled nurse. 4. Demonstrated knowledge and understanding of relevant legislation, rights of individuals and groups in the health care setting, clinical standards and guidelines pertaining to the enrolled nurse level 2 role and scope of practice. 5. Applies effective communication and interpersonal skills to work within a team and to support the achievement of team goals and objectives. 6. Demonstrated ability to collaborate with others in education and training to provide support and preceptor-ship to enrolled nurses and student enrolled nurses under the supervision of a registered nurse. 7. Demonstrated commitment to professional development, evidenced by post enrolment training, education and/or qualifications related to the field of practice. 8. Demonstrated knowledge, leadership and commitment to high quality Customer Service, Equity and Diversity, Occupational Health and Safety and Industrial Democracy principles, practices and relevant legislation relating to these areas and an understanding of and commitment to the organisation's values. Page 4 of 13 Enrolled Nurse Level 2 Personal Classification Application CNC/CMC REPORT and RECOMMENDATION (to be completed by CNC/CMC in support of application. An alternate supervisor ie: ADON/RN/RM Level 3 may complete this report following discussion with the CNC/CMC. The Nursing and Midwifery Office is to be advised if this change occurs). *Note: CNC/CMC report cannot be used as the Referee report Applicant’s name:…………………………............ (Surname) …..……………………………………… (First name) Date commenced in current position:………………………… FTE:……………… Substantive Position Number:...........…............. Clinical area where position is being applied for:…………………………………….. Please summarise this evidence in dot points where relevant for each criteria: 1. Registered or eligible for registration as an Enrolled Nurse with the Australian Health Practitioner Regulation Agency (AHPRA) and any other registration required by the specific field. Yes No 2. An enrolled nurse with a minimum of three years full-time equivalent (FTE) post registration experience, including six months experience in the relevant field of practice Yes No Page 5 of 13 3. Proven ability to deliver competent nursing care under the guidance of a registered nurse in accordance with the ANMC National Competency Standards for the Enrolled Nurse and the Competency Standards for the advanced enrolled nurse ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……............................................................................................................................................ 4. Demonstrated knowledge and understanding of relevant legislation, rights of individuals and groups in the health care setting, clinical standards and guidelines pertaining to the enrolled nurse level 2 role and scope of practice.. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……............................................................................................................................................ 5. Applies effective communication and interpersonal skills to work within a team and to support the achievement of team goals and objectives. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………............................. ................................................................................................................................................... Page 6 of 13 6. Demonstrated ability to collaborate with others in education and training to provide support and preceptor-ship to enrolled nurses and trainee enrolled nurses under the supervision of a registered nurse. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………........................ 7. Demonstrated commitment to professional development, evidenced by post enrolment training, education and/or qualifications related to the field of practice. ………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………. .……………………………………………………………………………………………………………………………………………… ..…………………………………………………………………………………………………………………………………............. ..................................................................................................................................................... 8. Demonstrated knowledge, leadership and commitment to high quality Customer Service, Equity and Diversity, Occupational Health and Safety and Industrial Democracy principles, practices and relevant legislation relating to these areas and an understanding of and commitment to the organisation's values. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………. ..……………..................................................................................................................................... ..................................................................................................................................................... Page 7 of 13 Is there clear documentary evidence to support the claims made by the applicant? Yes No I have reviewed the written application, sighted a list of the supporting documentation, checked that the applicant is 100% compliant with essential training and I have completed an ACTPS Performance Plan with the applicant. Yes No I have informed the Director of Nursing that I support this application and that it is progressing to the Nursing and Midwifery Office for consideration at the next advancement round. Yes No Name …………………………………………………Contact Ph No:……………………………… Position…………………………………………………………… Date: ………………. Signature …………...……………........................................... (If sent from work email, serves as an electronic signature) Page 8 of 13 REFEREE to complete in support of applicant* (please print): * Note: CNC/CMC cannot also be named as referee, 2 separate reports are required Applicant’s name:………………………… …..……………………………………… (Surname) (First names) Date commenced in current position:………………………… Clinical area where position is being applied for:…………………………………….. Please summarise this evidence in dot points where relevant for each criteria: 1. Registered or eligible for registration as a General Nurse with the Nursing and Midwifery Board of Australia and any other registration required by the specific field. Yes No 2. An enrolled nurse with a minimum of three years full-time equivalent (FTE) post registration experience, including six months experience in the relevant field of practice Yes No Page 9 of 13 3. Proven ability to deliver competent nursing care under the guidance of a registered nurse in accordance with the ANMC National Competency Standards for the Enrolled Nurse and the Competency Standards for the advanced enrolled nurse ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……............................................................................................................................................ ................................................................................................................................................. 4. Demonstrated knowledge and understanding of relevant legislation, rights of individuals and groups in the health care setting, clinical standards and guidelines pertaining to the enrolled nurse level 2 role and scope of practice.. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……............................................................................................................................................. .................................................................................................................................................. 5. Applies effective communication and interpersonal skills to work within a team and to support the achievement of team goals and objectives. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………............................. .................................................................................................................................................... Page 10 of 13 6. Demonstrated ability to collaborate with others in education and training to provide support and preceptor-ship to enrolled nurses and student enrolled nurses under the supervision of a registered nurse. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………........................ 7. Demonstrated commitment to professional development, evidenced by post enrolment training, education and/or qualifications related to the field of practice. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………......................................................... ............................................................................................................................................... 8. Demonstrated knowledge, leadership and commitment to high quality Customer Service, Equity and Diversity, Occupational Health and Safety and Industrial Democracy principles, practices and relevant legislation relating to these areas and an understanding of and commitment to the organisation's values. ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… ………………………………………………………………................................................................................... .......………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… Page 11 of 13 I have reviewed the written application and there is clear evidence available to support the claims made by the applicant Yes No Referee Name: ……………………………………… Position:……………………………… Contact Ph No:……………………………… Referee Signature ……………………….................... Date:……………………. Page 12 of 13 Check list for Enrolled Nurse Level 2 application. Prior to submitting an application, ensure you have provided all of the following documentation: Cover letter Completed application Addressed selection criteria Copy of curriculum vitae/resume ACTPS Performance Plan Completed Supervisor Report to support application Completed Referee Report to support application Signed declaration (page 3 of application) Please Note: Incomplete applications will not be considered. It is the responsibility of the applicant to ensure all documentation is attached and provided to support your application and to assist the panel in making a decision. Completed applications and any questions, guidance or assistance should be directed by email to: NMO@act.gov.au , or by mail to: Professional Development Co-ordinator Nursing and Midwifery Office Level 3, Building 6 Canberra Hospital PO Box 11 Woden ACT 2606 Page 13 of 13
