REGIONAL PDRP APPLICANT CONSENT FORM
Name: Organisation:
Please complete the form by ticking the appropriate boxes and signing.
Include this form in your portfolio.
Thank you for submitting your Professional Portfolio and completed workbook for assessment at
Level.
Please complete the following:
- CONSENT FOR PORTFOLIO TO LEAVE PREMISES
I am willing for my portfolio and associated documentation to be removed from my organisation’s premises if required and kept as securely as possible. I understand that all steps will be taken to maintain the safety and privacy of my portfolio and that I can request its return at any time.
Yes
No
- RETURN OF PORTFOLIO
At the end of the assessment process your portfolio can be collected from the PDRP office or you may wish to have it sent via internal mail. This would be at your own risk.
- MODERATION OF SUBMITTED PORTFOLIOS
The PDRP requires portfolios to be moderated to maintain consistency and objectivity of the process. One in every 10 portfolios will be reviewed by one of the PDRP Assessors who will moderate the original assessor(s) of your portfolio. All new assessors will have their assessments moderated initially. The moderation process does not affect the outcome of your assessment. Your portfolio may be selected for this process.
I understand and agree with the moderation process.
Yes
No
I understand that if a new assessor evaluates my portfolio, that a senior assessor will also assess my portfolio. The new assessor may use their assessment of my portfolio as an example of work completed in their Open Polytechnic studies. I agree to have a new assessor evaluate my portfolio.
Yes
No
The assessment will be carried out as soon as possible and should take no longer than
10 weeks.
All assessors have undertaken a recognised national qualification which requires objectivity, consistency and fairness. It is preferable that the assessor(s) do not know you, or recognise you through your portfolio. Attached is a list of all assessors for the Regional PDRP. To assist us with the selection process, could you please download this list, cross out any person you have worked closely with, been a line manager of, or who has been a personal friend.
It is not unusual for your assessor(s) to contact you for clarification or for extra evidence before a decision is made. This contact is generally by phone, but you may request a meeting.
When your portfolio assessment has been completed, you will be contacted with the decision, which will be one of the following:
Decisions
Endorsement of Progression
This means criteria for the applied level have been successfully met.
ReservedDecision
This means that the assessor is confident that you are practising at the level you have applied for, but further documented evidence is needed. You are given a timeframe of
6 weeks to provide this.
Non-Progression
This means that your assessor is confident that the criteria for that level have not yet been met. Guidelines may have not been adhered to or there are clear gaps in evidence that prevent a fair decision. Your assessor will clearly tell you which areas require further development and make some suggestions. If you wish to appeal the decision or the process, this procedure is outlined on the website or in the PDRP Policy.
Appeals
All applicants will have feedback from their assessment, if you disagree with the decision, you should write a letter of appeal to the PDRP Coordinator. The appeal should be lodged within 7 working days of the decision using an Appeal Notification Form (A6). On receipt of this letter, the PDRP Coordinator will request two new assessors to re-assess the portfolio.
The new assessors will not be told of the original outcome. If the decision by the new assessors is that you have been unsuccessful, you may decide to continue with the appeal. An Appeals Panel will be formed and those present will interview you and the assessors. On completion of this process, a written report outlining recommendations will be sent to you with copies to the PDRP Assessors, PDRP Advisory Committee and the Nurse Coordinator -PDRP.
The decision of the Appeals Panel is final and binding.
NB: The assessment will not be able to proceed until this this form has been completed.
Please ensure that all sections of this form are completed and signed. Details of your PDRP application are loaded onto our database to assist with our reports to Nursing Council to remove you from their audit process. Details are also updated and placed on the payroll system for each organisation to ensure information is correct for payment processing if appropriate.
Signature: ___ Date: ______
List of PDRP Assessors as at January2018
(Please cross out names of staff you may know and/or work closely with)
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CDHB
Margaret Burns
Stephanie Cook
Janette Dallas
Jo Greenlees-Rae
Becky Hickmott
Jacinda King
Rebecca Heyward
Cathy King
Sharon Pryor
Ashburton and Rural
Lisa Campbell
Heather Cullimore
Hayley Creighton
Amanda Van Asperen
Burwood Hospital
Helen Bloomer
Fiona Davie
Kerry Jones
Dinesh Lal
Karen Marshall
Rachel Marshall
Kirstie Ross
Karen Stenhouse
Lynda Te Momo
Sue Williamson
Diane Wood
Stella Yaxley
Ren Xiaoyong
Jane Clarke
Sarah Maxted
Medical Surgical
Heather Anderson
Amanda Berry
Anna Bush
Karen Collins
Tina Cook
Sharron Ellis
Courtney Ford
Pip Francis
Ulrich Frank
Jacqui Gapes
Gretta Moffatt
Lucia Fenwick
Maggie Glasgow
Joanne Gore
Faye Greenwood
Carmel Harris
Neil Hellewell
Yvonne Hill
Kirsty Humm
Tina Knutson
Carol Lechte
Julie Livesey
Charlotte Matthews
Rhonda Mikoz
Jill Oetgen
Nichola Olds-Read
Linda Payne
Stephanie Pegg
Bronwyn Perry
Rommel Principe
Sandy Richardson
Jo Saunders
Fran Smith
Jenny Stewart
Olivia Strachan
Louise Sue
Lorraine Trebilcock
Felicity Turner
Esther Vallance
Robyn Van der Lely
Judy Ward
Janeen Williams
Pam Eaden
Malinda McMillan
Specialist Mental Health
Belinda Dennehy
Tanya Ewart
Gail Houston
Tania Freeman
Debora Anderson
Sharon Isherwood
Carolyn Murray
Helen O’Connor
Jane Patterson
Gail Phillips
Sam Rees
Claire Roelink
Cassandra Staps
Heather Symes
Simone Verburg
Jason Watson
Karen Willis
Mary Woods-Morgan
TPMH
Sue Holland
Helen Lloyd
Yvonne Marr
Women and Children’s
Tracey Bruce
Edna Byron
Patricia Connell
Victoria Cullens
Anthea Franks
Linda King
Aimee MacKey
Donna Murray
Nicola Scott
Nurse Maude
Karen Jones
Rose McConchie
Philippa Sarjeant
Josie Tait-Jamieson
Jeannie Randles
South Canterbury DHB
Anneke Clarke
Judy Cooper
Karen Foster
Ally Hale
Sue Morrow
Jane Procter
Megan Stark
Tracey Foster
St. George’s Hospital
Marilyn Casey
Sue Claridge
Wendy Davie
Alison Fleetwood
Aimee Librado
Kate Goodrick
Oxford Women’s Health
Debra Parr
Kate Hibbert
West Coast DHB
Kas Beaufill
Chris Black
Kayla Brown
Diane Longstaff
Elaine Neesam
Diane Pollard
Julie Ritchie
Cheryl Mundy
Helen Rodger
Department of Corrections
Christina Dupont
Kirsty Fraser
Fiona Irving
Cushla Mckay
Lyn McIntyre
Stephanie Muir
Linzi Sargant
Kay Sloan
Healthcare NZ
Kelly Robertson
Juliet Nelson
Pegasus Health
Anne-Marie Baird
Gill Currie
Di Bos
Gemma Hewison
Sue Hart
Louise Weatherall
NMDHB
Wendy Adams
Sue Addison
Ingrid Archibald
Jocelyn Archer
Jan Boyd
Bridgett Baldwin
Pippa Babb
Anne-MarieBallagh
Carolyn Bennison
Jane Besley
Mary Bezant
Carol Biggs
Emma Bonnington
Margie Burt
Andrea Chapman
Tricia Colling
Dee Emmet
Debbie Hawkey
Getrudie Bulaya
Morag Fisher
Roberta Melville
Jan Gould
Sharon Hawken
Lyn Yu
Liz Runnalls
Jane Heather
Jessica Irvine
Ruth Jarman
Jenny Kane
Sue Lush
Glenis McAlpine
Sandy McLean-Cooper
Diane McLeod
Gill Quarmby
Shirley Roberts
Diane Wade
Rosalie Adamson
Hilma Schieving
Pamela Shadlock
Sue Smart
Angela Taylor
Melanie Terry
Annie Wallace
Susannah Visscher
SDHB
Jenny Bishop
Trish Bloxsom
Maria Baynes
Jacqui Cooke
Katherine Clarkson
Christine Crawford
Justine Dahlenburg
Kerry Davis
Jo Dobson
Nicola Dowling
Mary Fahey
Annette Farr
Sheree Ferrari
Richelle Fogarty
Lara Gleeson
Linda Grady
Mike Hammond
Chris Hayde
Rhonda Johnson
Robyn Kelly
Allison Lang
Cynthia Langford
Jillene Lee
Christine Lundy
Laurie Mahoney
Shelley McDonald
Katherine Martin
Shirley McKewen
Prue Muschamp
Sue O’Brien
Rowena Paterson
Mel Rackham
Glenda Rickerby
Grant Ritchie
Sharon Sandilands
Linda Smillie
Chris Still
Jo Robertson Smith
Pauline Stringer
Julie Symons
Helen Thompson
Jenni Topliss
Carolyn Upston
Rosalie Wright
Rannerdale Veteran’s
Care
Charmaine Diver
Kaupapa Maori & Pacific NGO Collective
Diana Adams
Elly Grant
Dianne Oakley
Forte Health
Jane Barnett
Malinda McMillan
Intus
Cathy Long
Jess Wolfenden
Nelson Bays Primary Health
Emma Bonnington
Andrea Chapman
Riccarton Clinic
Danica Gilmore
Kieran Smith
CHCH PHO
Sandi Malcolm
Waipuna Hospice
Fiona Holmes
Ultimate Care Group (Bishop Selwyn)
Gene Ruiz
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