American Society for Pain Management Nurses

Excellence in Nursing Award for Pain Management-Older Adult

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

The ASPMN Excellence in Nursing Award for Pain Management of the Older Adult, established in 2005 by the American Society for Pain Management Nursing and the Nurse Competence in Aging Project of the American Nursing Associate, Specialty Nursing Association Partners Grant, is presented to a nurse in recognition of outstanding contribution to the care of older adults with pain. Self-nominations are encouraged.

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

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): *

Nominee's Current CV: *

Nominated By: *

Nominator's Phone Number: *

Nominator's Email Address: *