Registration. Nurse/Midwife Unit Manager Current Classification. Speciality Area for which you are applying

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1 Please attach a copy of your supporting documentation and bring your portfolio to interview. Applications for CNS will be considered by South West Healthcare (SWH) twice a year and will remain open for 14 days when advertised. You will be required to attend an interview to support your application. Clinical Nurse Specialist Means a Registered Nurse: (i) appointed to the grade with either post basic qualifications and 12 months experience working in the clinical area of her/his specified post basic qualification and is responsible for clinical nursing duties. OR minimum of four years post registration experience, including three years experience in the relevant specialist field and who meets the criteria set out at Appendix 2 in the EBA and as set out below. Personal Details Family Name : First Name : AH phone numbers: Work Details Employee Number Department/Ward/Unit Commencement Next Increment Date (if applicable) 1 VHIA 2012 Mobile Year of Initial Registration Name of Nurse/Midwife Unit Manager Current Classification Speciality Area for which you are applying You must provide EVIDENCE of achievement as demonstrated in one criterion from each of the three points below: 1. Clinical Skill o Higher level of skill demonstrated in clinical decision making in particular in problem identification and solution, and analysis and interpretation of clinical data o Maintenance and improvement of clinical standards 2. Professional Behaviour: o Positive role model o Act as a mentor or preceptor to less experienced nurses, including graduate nurses o Support of, and contribution to, quality improvement and research projects within the area of practice and ward/unit/department o Acting as a resource person to others in relation to clinical practice. 3. Professional Development o Membership of relevant professional body, and ability to demonstrate and document: Learning from a journal article, or attendance at a conference or seminar, or reflection on seminar or conference papers: or Participation in effective learning activities relevant to their learning needs; or membership of a sub-grouping of the professional association relevant to their area of practice; o Contribution to the education of other professionals, for example, being willing to provide at least one in-service education program each year; o Undertaking own planned professional development and competence through various forms of continuing education, for example, conferences, study days, formal study, reading. Please note that in interview you will need to be able to discuss recent examples and provide a copy of your portfolio.

2 1 Clinical Skill tick criterion you are responding to: Higher level of skill demonstrated in clinical decision making in particular in problem identification and solution, and analysis and interpretation of clinical data Knowledge of scope of practice when delegating care Knowledge of decision making framework eg Restraint legalities, documentation, abuse negligence consideration etc Maintenance and improvement of clinical standards. Development / implementation or review of policy / guideline relative to practice eg. Pain Management 2 VHIA 2012

3 2 Professional Behaviour - tick criterion you are responding to Positive role model What do you see as a positive role model, ie attributes how have you reflected this to be a positive role model. Act as a mentor or preceptor to less experienced nurses, including graduate nurses List staff you have mentored or preceptor Give examples of clinical teaching/perceptoring and the outcomes, what was positive, what was challenging. Support of, and contribution to, quality improvement and research projects within the area of practice and ward/unit/department Audits / quality projects you have been involved in or responsible for. What was the project and what were the outcomes. Involvement in working parties / committees. Acting as a resource person to others in relation to clinical practice. Examples of evidence: Reflect on clinical practice, and how this has resulted in you being a resource person to others. Use an example from your practice where advanced skills has resulted in your knowledge being a resource to others and or / decision making. 3 VHIA 2012

4 3 Professional Development - tick criterion you are responding to Membership of relevant professional body, and ability to demonstrate and document: o Learning from a journal article, or attendance at a conference or seminar, or reflection on seminar or conference papers: or o Participation in effective learning activities relevant to their learning needs; or membership of a sub-grouping of the professional association relevant to their area of practice; Outline what active participation / involvement you have had over the last 12 months with the relevant professional body. What changes have you made following leanings / conference attendance etc. What have you planned for the next 12 months. Contribution to the education of other professionals, for example, being willing to provide at least one inservice education program each year; Indicated what education you have provided to other professionals. Outline the inservice you provided and attach a copy of the presentation. What inservice will you provide in the next 12 months. Undertaking own planned professional development and competence through various forms of continuing education, for example, conferences, study days, formal study, reading Example of evidence: Outline what professional development you have completed, ie in line with registration at least 20 hours (do not include mandatory education). Reflecting on this education what have you changed in practice from these learning s. 4 VHIA 2012

5 Complete B or C B: 12 months experience working in the clinical area of her/his specified post basic qualification and is responsible for clinical nursing duties Commencement Date Date Ended (or current) Hospital /Organisation Post Basic Qualifications Year Qualification and Institution C: minimum of four years post registration experience, including three years experience in the relevant specialist field Commencement Date Date Ended (or current) Hospital /Organisation Applicant Signature Applicant full name Date Office use only Date received Approved by DON (post interview) Date Have you attached your supporting evidence? 5 VHIA 2012