Application/Agreement to engage in the Collaborative Mental Health & Addictions Credentialing Programme for PHC Nurses (RN) February 2024 – Ko Awatea , Middlemore hospital Your name: _________________________________________________ Contact ph.___________________________ Email (preferably non-work email): ___________________________________________________________________ Name of general practice / organisation (include PHO): __________________________________________________ Name of practice manager / clinical manager: ________________________Email.________________________ Our practice/organisation commits to supporting the nurse to attend 45 hours of learning, which includes 5 study days (37.5 hours) and 7.5 hours of online learning. We also support the nurse to clinically apply learning from the Mental Health and Addictions Credentialing Programme_______________________________________
I/we agree to attend the 5 full day study days from 0830-1600, required to complete the credentialing process and engage in 7.5 hours of online learning: Dates: 29th February, 28th March, 2nd May, 30th May, 27th June. I/we agree to attend five group supervision sessions (monthly between training days) the time to be arranged with the Nurse and Supervisor as a core component of the Mental Health & Addictions Credentialing Programme.
I/we agree, on completion of the programme, to submit an application to Te Ao Māramatanga: NZ College of Mental Health Nurses, for credentialing purposes.
Information supplied may be used by Te Ao Māramatanga: NZ College of Mental Health Nurses, for credentialing purposes, on-going programme evaluations and Primary Care Mental Health Liaison Nurses to support professional development for credentialed nurses
Please answer the following questions: 1. Do you hold a current Annual Practice Certificate which is not subject to any enquiries, suspensions or restrictions related to registration or nursing practice? Yes No (if no please provide details) 2. How many hours / week do you work in your general practice/organisation? 3. How many clinical face-to-face hours / week do you work in your general practice/organisation?
4. Do you have more than 2 years post registration experience? Yes No (please note: Nurses undertaking the NETP programme are not eligible for this programme) 5. How many years have you been working as a Primary Health Care Nurse? 6. What is your ethnicity? ____________________ .7. Please state if you have dietary requirements: _______ Signature of practice / clinical manager: _____________________________________Date______________________ Signature of primary health care nurse: _____________________________________Date______________________ Please return completed confirmation to ldowse@comprehensivecare.co.nz as soon as able to secure place.