For most of the questions below, please use this scale to self-report on your competencies and experience.

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5.	Quality Improvement: Experience and understanding of the quality assurance and quality improvement programs and assessments in health care, and experience in developing tools that enable meaningful feedback and continuous improvement.

1 2 3 4 5

6.	Professional Standards & Professional Ethics: Knowledge and experience of the standards of practice and standards of professional ethics at regional, provincial, national and international levels.

1 2 3 4 5

7.	Education Curriculum: Experience with program/advanced education changes; trends and innovation; developing, implementing, and evaluating curriculum, including representation from diverse post-secondary institutions offering nursing education.

1 2 3 4 5

8.	Human Resources Experience: Experience in talent management, professional development, continuous learning and education outside of the healthcare environment.

1 2 3 4 5

9.	Health Spectrum: Lived experience accommodating or navigating a spectrum of physical, mental health or cognitive abilities, the knowledge of which can enhance relevant, thoughtful decisions that protect the public.

1 2 3 4 5

10.	Health Care Terminology: Knowledge and understanding of the common terminology, acronyms and phrases used in health care.

1 2 3 4 5

11.	Health Professions Regulation: Understanding of the role and philosophy of health profession regulators; the public protection mandate of CARNA; the applicable legislation, regulations, bylaws and policies; and the core work of CARNA and its committees.

1 2 3 4 5

12.	International Health Professional/Graduate: Understanding of the process for becoming a health professional in Canada with foreign credentials, ideally, have experience in navigating that process.

1 2 3 4 5

13.	Administrative Justice/Fairness: Knowledge and experience of the principles of natural justice and administrative fairness and how to apply this to analysis and decision making.

1 2 3 4 5

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14.

Committee/Panel Leadership: Experience in facilitating meetings, developing a positive culture, conflict resolution and fostering effective decision making. Demonstrates skills and ability to solve problems, adapt and manage change, innovate, and achieve results. Able to encourage divergent thinking and dissent from others, and to build consensus.

1 2 3 4 5

15.	Leadership: Experience in a senior leadership position in a health care administrative setting

1 2 3 4 5

16.

Cultural Safety: Have an ongoing learning, appreciation and respect for unique perspectives, cultural contexts, power imbalances and biases in deliberation and decision-making, and recognition of the role CARNA plays in fostering culturally safe, humble, respectful and quality health care, through its cultural safety and humility commitments

1 2 3 4 5

17.	Information Analysis & Judgement: Able to carefully review voluminous material within set timelines, assess implications, identify patterns, make connections and narrow the issues to support good decision-making

1 2 3 4 5

18.	Public Interest: Demonstrated understanding and appreciation of, and commitment to, the public protection mandate and the time required to execute the role diligently

1 2 3 4 5

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19.	Visible Diversity

Yes No

20.	First Nation/Indigenous

Yes No

21.	Preferred Pronouns

	He/Him
	She/Her
	They/Them
	Other:

22.	Rural/Urban

Rural Urban

23.

Region

North Central South

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24.	Post-Secondary Education

Yes No

25.

Degree #1

26.

Degree #2

27.

Other

28.	Governance Designation

	(Select all that apply)
	ICD.D
	C.Dir
	Pro.Dir
	Other:

29.	Other Relevant Education

Yes No

30.	Other (Specify)

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31.	Critical Care

Yes No

32.	Emergency Care

Yes No

33.	Long-term Care

Yes No

34.	Mental Health Care

Yes No

35.	Pediatric Care

Yes No

36.	Primary Care

Yes No

37.	Public Health

Yes No

38.	Rural Health Care

Yes No

39.	Women’s Health Care

Yes No

40.

Education

Yes No

41.

Other

	Yes
	No
	Other:

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42.	Accountability, Honesty and Integrity: Please describe a situation where you took responsibility for a decision remaining true to your ethics and values.

43.	Adaptability: Please provide an example of where you have been able to adapt to a changing situation in an effort to benefit the outcome.

44.	Committee Leadership: Please outline your specific experience as a member of a committee where you have demonstrated leadership and how you did so.

45.	Information Analysis and Judgement: Please describe a time when you had to tackle a large volume of information, summarize and formulate a conclusion.

46.	Quasi-Judicial Panel Experience: Please describe a time you worked with a quasi-judicial panel or administrative tribunal.

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