Ghana Nurse Leaders Program APPLICATION FOR ADMISSION COHORT II The program consists of 2 weeks of instruction with action learning periods between each program week. 2-6 June 2014* Training week 1 in Accra, Ghana 8-12 September 2014* Training week 2 in New York City, USA June 2015 Program completion *Dates subject to change Program participants must be able to travel to New York City and have a valid passport through April 2015. The Colleges of Nursing of New York University and the University of Ghana, Legon, Mujeres Por Africa Foundation of Spain, and the Ghana Ministry of Health seek to enroll ten female nurses to participate in the second cohort of a year-long leadership development program. This women s leadership program is designed to promote participant s abilities to lead in the innovation of patient care services and the strengthening of Ghana s health system. At the completion of the Ghana Nurse Leaders Program participants will be able to: Identify personal strengths and weaknesses as a leader Create a personal action plan to improve leadership effectiveness Effectively manage teams Provide effective performance feedback to promote clinical practice excellence Apply principles, practices, and models of organizational change Use quality and safety principles and methods to improve clinical care Apply the chronic care model to clinical practice settings Evaluate the outcomes of a clinical change project ELIGIBILITY The Ghana Nurse Leaders Program is open to women nurses working in the public healthcare system in Ghana. The ideal program participant has established herself as a leader in either a formal management position or through professional activities. Applicants should hold a first degree; hold the rank of senior nursing officer (S.N.O.) or principal nursing officer (P.N.O.); and have approximately 10-15 more career years in the health service. Proficiency in written and spoken English is essential for participation in the Ghana Nurse Leaders Program. Interested nurses who meet the above criteria may follow the instructions below to submit their applications. 1 P age
Directions: Type application using 12 point font. Incomplete applications will not be reviewed. Submit a resume and letters of support from (1) the highest ranking nurse officer and (2) direct supervisor with your application. I. GENERAL INFORMATION NAME: DATE OF BIRTH: Surname First Name Middle (name/initial) MARITAL STATUS: Single Married NUMBER OF CHILDREN (0-18 years) OR DEPENDENTS LIVING AT HOME: HOME ADDRESS: PREFERRED MAILING ADDRES: PHONE NUMBER: CELL NUMBER: EMAIL ADDRESS: POSITION/TITLE: ORGANIZATION NAME: ORGANIZATION ADDRESS: TELEPHONE: FAX NUMBER: TYPE OF ORGANIZATION: Community Health Center Rural Health Center District Hospital Regional Hospital PolyClinic Teaching Hospital Maternity Home Other (specify): SECTOR: Ghana Health Service Quasi-Government Hospital Other (specify): 2 P age
HEALTH SYSTEM ADMINISTRATIVE REGION/GEOGRAPHIC LOCATION (where you work): Greater Accra Volta Central Western Eastern Ashanti Brong-Ahafo Northern Upper West Upper East WORK HOURS PER WEEK/SHIFT WORKED: II. WORK EXPERIENCE & RESPONSIBILITIES BRIEFLY DESCRIBE THE ORGANIZATION IN WHICH YOU WORK. (117 words) WHAT IS THE TITLE OF THE PERSON TO WHOM YOU REPORT? WHAT IS THE NUMBER OF PEOPLE WHO REPORT TO YOU? BRIEFLY DESCRIBE YOUR CURRENT RESPONSIBILITIES, INCLUDING YOUR LEVEL IN THE ORGANIZATION. (118 words) ESTIMATE YOUR TOTAL YEARS OF EXPERIENCE IN NURSING: IF YOU ARE IN A FORMAL MANAGEMENT POSITION, ESTIMATE THE NUMBER OF YEARS YOU HAVE BEEN A MANAGER: 3 P age
III. EDUCATION AND PROFESSIONAL TRAINING NURSE TRAINING PROGRAM: School Name Location Graduate Date BACHELORS DEGREE PROGRAM: School Name Location Graduate Date MASTERS DEGREE PROGRAM: OTHER DEGREE PROGRAM: School Name Location Graduate Date School Name Location Graduate Date MEMBERSHIP IN PROFESSIONAL/CIVIC/RELIGIOUS ORGANIZATIONS (Name up to 4 organizations, dates and role, if any in the organization) Have you attended a leadership development program in the past? Yes No If yes, briefly describe the program including the place, dates, and key features of the program. (118 words) 4 P age
Have you previously attended a study-abroad session? Yes No If yes, briefly describe the program including the place, dates, and key features of the program. (72 words) IV. PERSONAL STATEMENT 1) Please state your goals and objectives as they relate to attending the Ghana Nurse Leaders Program. Also describe what you think other program participants may learn from you (e.g.: skills, expertise, perspectives). No more than 2 paragraphs. (180 words) 2) Briefly describe your leadership style and approach. No more than 2 paragraphs. (180 words) 5 P age
3) Describe a situation in which you took a leadership role and helped to affect change. No more than 2 paragraphs. (180 words) 4) In a one paragraph summary, please describe your current leadership challenge(s) especially in relation to your role as a leader. (265 words) 6 P age
V. CHANGE PROJECT STATEMENT An important part of the Ghana Nurse Leaders Program is the opportunity to design and implement a service change project in your organization. In one page or less, briefly describe a project that you would like to undertake for the program. Describe the problem that you seek to address, the project goals, and the intended service improvements that you seek to realize. (500 words) 7 P age
PARTICIPATION AGREEMENT By submitting this application, I agree to commit the time required and offer my full participation and engagement if I am selected to participate in the Ghana Nurse Leaders Program. If selected, participants are responsible for obtaining a visa to travel to New York City for the second week of the program. I understand that if accepted, I am responsible for securing appropriate work-release time for all training events. I understand that if accepted, this program is designed for individuals who intend to continue their employment in Ghana in the health sector for at least 3 years from the end of their participation in the Ghana Nurse Leaders Program. Applicant signature Date TRAVEL AND EXPENSES The program will cover all travel and living expenses associated with the training week in New York City, U.S.A. Lodging and meals will be covered by the program during the training week in Accra, Ghana. Participants are responsible for domestic travel to Accra. Tell us how you learned about this opportunity: (Type or write below) PLEASE RETURN THIS APPLICATION BY 15 MARCH 2014. YOU CAN SUMBIT YOUR APPLICAITION IN THE FOLLOWING WAYS: BY EMAIL: To: na35@nyu.edu Subject: Attention: Ghana Nurse Leaders Application Submission BY MAIL: Ms. Benny Ghanson New York University Accra Ghana Nurse Leaders Program PMB C84 Cantonments Accra HAND DELIVERED: Ms. Benny Ghanson New York University Accra Ghana Nurse Leaders Program 3rd Norla Street No. 8, North Labone Accra For queries on the status of your submitted application, please contact Ms. Benny Ghanson Email: bhgmcathe@gmail.com. Phone: 0302-761528. 8 P age