American Society for Pain Management Nurses

Clinical Practice Award

Please complete the application below, including uploading additional required attachments.

The ASPMN Clinical Practice Award is presented to an ASPMN member who has made outstanding contributions to the field of clinical pain practice.

First Name *

Last Name *

Email *

Name of Nominee: *

Nominee Academic/Professional Credentials: *

Nominee Job Title: *

Nominee Current Employer: *

Nominee Phone Number: *

Nominee Email Address: *

Is the Nominee a Current Member of ASPMN? *

Yes

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

Yes

Nominee's 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. *

Letter of Recommendation (Should not exceed two pages and should describe the characteristics in the previous question): *

Nominee's Current CV: *

Nominated By: *

Nominator's Phone Number: *

Nominator's Email Address: *