Program application

The following is an application form for participation in the Nurse Practitioner Peer Support Program. Spaces are limited. In the event your application is not successful for this intake, you will be added to a wait list for the next round. Please complete all fields and submit.

The outcome of your application will be sent by email within 10 days following the submission deadline. If successful, you will be given access to this site.

Note: you will be unable to save your progress, so it is important to put aside sufficient time to complete the application in one session.

All fields are mandatory

Personal details

Preferred pronouns

First name

Last name

AHPRA number

Mobile number

Login

Email address

Password

Primary clinic/Practice

Clinic/Service/Practice name

Street address

Suburb

Postcode

Background information

Are you currently treating people with opioid dependence? Yes No

How many people with opioid dependence are you currently treating?

How long have you been working as an NP in the opioid dependent treatment space?

Why have you chosen to work in this area?

0 of 150 words

Do you currently have supervision available? Yes No

Where else do you access support and/or guidance?

How supported do you feel in your role, on a scale of 1 to 10?

Not at all confident

Completely confident

What areas of treatment do you find to be the most challenging?

0 of 150 words

What do you want to achieve by participating in this program?

0 of 150 words

How would you rate your confidence in treating people with opioid dependence on a scale of 1 to 10

Not at all confident

Completely confident

Patient Assessment

What aspects of patient assessment do you feel most confident with?

0 of 150 words

What aspects of patient assessment do you feel you could improve on?

0 of 150 words

What is your comfort level with developing a rapport with new patients during an initial assessment?

Not at all comfortable

Completely comfortable

What is your comfort level with avoiding stigmatising language in your patient interactions?

Not at all comfortable

Completely comfortable

Treatment Initiation

What aspects of treatment initiation do you feel most confident with?

0 of 150 words

What aspects of treatment initiation do you feel you could improve on?

0 of 150 words

What is your comfort level with discussing treatment with patients?

Not at all comfortable

Completely comfortable

What is your comfort level with establishing treatment goals and outcomes with patients?

Not at all comfortable

Completely comfortable

What is your comfort level with initiating daily treatment options?

Not at all comfortable

Completely comfortable

What is your comfort level with initiating long-acting treatment options?

Not at all comfortable

Completely comfortable

Physical Health

What physical comorbidities do you feel most confident with managing?

0 of 150 words

What physical comorbidities do you feel least confident with managing?

0 of 150 words

What is your comfort level with undertaking a comprehensive physical health assessment of patients presenting for treatment of opioid dependence?

Not at all comfortable

Completely comfortable

What is your comfort level with identifying the impact physical comorbidities are having on your patient's treatment for opioid dependence?

Not at all comfortable

Completely comfortable

What is your comfort level with managing physical health conditions among patients you are treating for opioid dependence?

Not at all comfortable

Completely comfortable

Mental Health

What mental health comorbidities do you feel most confident with managing?

0 of 150 words

What mental health comorbidities do you feel least confident with managing?

0 of 150 words

What is your comfort level with undertaking a comprehensive mental health assessment of patients presenting for treatment of opioid dependence?

Not at all comfortable

Completely comfortable

What is your comfort level with identifying the impact mental health comorbidities are having on your patient's treatment for opioid dependence?

Not at all comfortable

Completely comfortable

What is your comfort level with managing mental health conditions among patients you are treating for opioid dependence?

Not at all comfortable

Completely comfortable

Psychosocial Factors

What psychosocial factors do you feel most confident with managing?

0 of 150 words

What psychosocial factors do you feel least confident with managing?

0 of 150 words

What is your comfort level with assessing the impact of psychosocial factors on your patients' wellbeing?

Not at all comfortable

Completely comfortable

What is your comfort level with linking patients to the appropriate services to address their psychosocial needs?

Not at all comfortable

Completely comfortable

Commitment

If your application is successful, you will be advised of the program dates. You will be asked to either confirm your commitment to attending all scheduled sessions or defer your enrolment.

Support network

Creation of a support network is an important component of this program. To facilitate this, we would like to share the name, phone number and email address of each participant on the secure program portal.