Education Request (Provincial Travel Nurse Team)

Mandatory site-specific or specialty education requirements will be reviewed for consideration by the Provincial Travel Nurse Team Program. These continuing ed. Requirements may include, but are not limited to: ACLS, ACoRN, BLS, CTAS, ECG, EPICC Trauma +/- Foundations, EPR Order Entry, FHS and NRP. Staff are required to explore all available education options within their permanent home unit/EFT before seeking support through the PTNT program.

Standardized continuing education will be considered under one or both of the following conditions:

Nurse has worked a minimum of 6 months( with the demonstration of regular shifts worked within the designated time period)
Nurse has worked 465 hours within the program

Submitted requests will be responded to within 10 business days. Recertifications will be supported when relevant to the area(s) of practice in which the nurse consistently works.

PTNT Education Request

"*" indicates required fields

Step 1 of 5

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URL

This field is for validation purposes and should be left unchanged.

Process acknowledgement*

All staff must register for education through their home unit (where they hold a permanent or casual position) where applicable.

If the approved education conflicts with a scheduled shift, staff must formally request time off for education and notify both PTNT and the site they were scheduled to work.

I acknowledge this statement and agree to follow the process as outlined above.

Your name*

First Last

Email (work)*

Phone (preferred)*

Home address*

Street Address City Province Postal Code

Is the above home address different than the mailing address?*

Yes

Mailing address*

Street Address City Province Postal Code

Indicate your nursing designation*

LPN

RPN

Indicate your EFT within PTNT*

Full Time Permanent

Part Time Permanent

Casual

Do you hold a permanent or casual position with an alternate employer?*

Yes

Home / Alternate Employer*

Region

Site

Unit

EFT

Please indicate where you hold an active permanent or casual position and the associated region.

To add more than one Employer above, please use the to the right of the row of fields.

Select the course that you are requesting approval for:*

(Each course request requires a separate submission. Multiple requests within a singular submission will be declined.)

Acute Care of at Risk Newborns (ACoRN) – Initial

Advanced Cardiovascular Life Support (ACLS) – Initial

Advanced Cardiovascular Life Support (ACLS) – Renewal

Basic Life Support (BLS) – Initial

Basic Life Support (BLS) – Renewal

Canadian Triage + Acuity Scale (CTAS)

ECG Rhythms

Emergency National Pediatric Course (ENPC) – Initial

Emergency National Pediatric Course (ENPC) – Renewal

Emergency Nursing Orientation – ENO Level 1 (Low Acuity)

Emergency Nursing Orientation – ENO Level 2 (Monitoring)

Emergency Nursing Orientation – ENO Level 3 (Resus)

Emergency Nursing Orientation – ENO Level 4 (Triage)

Emergency Practice, Interventions + Care Canada (EPICC) – Foundations

Emergency Practice, Interventions + Care Canada (EPICC) – Trauma

EPR with Order Entry

Fetal Heart Surveillance (FHS)

Neonatal Resuscitation Program (NRP) – Initial

Neonatal Resuscitation Program (NRP) – Renewal

Pediatric Advanced Life Support (PALS) – Initial

Pediatric Advanced Life Support (PALS) – Renewal

Point of Care Testing – On Site Training

Safe Patient Handling – In Person

Trauma Nursing Core Course (TNCC) – Initial

Trauma Nursing Core Course (TNCC) – Renewal

Other

Other course(s)*

Heart & Stroke ID*

I have previously submitted a copy of my certification?*

Yes

Certification copies*

Drop files here or

Accepted file types: jpg, jpeg, png, gif, doc, docx, pdf, Max. file size: 1 MB, Max. files: 3.

Indicate the Site & Unit the training is required for:*

(you may choose up to 3 options)

IERHA Cancer Care

IERHA Dialysis

IERHA Emergency

IERHA Endoscopy / PACU / OR

IERHA Home Care

IERHA LTC / PCH

IERHA Medicine

IERHA Obstetrics

IERHA Out Patient Clinic

NHR Ambulatory Care Clinics

NHR Cancer Care

NHR Dialysis

NHR Emergency

NHR Home Care

NHR LTC / PCH

NHR Medicine

NHR Mental Health

NHR Obstetrics

NHR OR / PACU / Day Surgery

NHR Pediatrics

NHR Surgery

PMH Cancer Care

PMH Dialysis

PMH Emergency

PMH Intensive Care Units

PMH Medicine

PMH Mental Health

PMH Obstetrics

PMH Operating Room

PMH PACU / Day Surgery / Endoscopy

PMH PCH / LTC

PMH Pediatrics

PMH Rehab

PMH Surgery

Shared Health Children’s Emergency

Shared Health Surgery

Shared Health Mobile MRI

SH-SS Chemotherapy

SH-SS Dialysis

SH-SS Emergency

SH-SS Medicine

SH-SS Obstetrics

SH-SS OR / PACU / Day Surgery

SH-SS Pediatrics

SH-SS Rehab

SH-SS Surgery

WRHA Critical Care

WRHA Home Care

WRHA Manitoba Home Nutrition Program

WRHA Medicine

WRHA Surgery

Do you need to take the requested course at a specific site and/or on a specific date?*

Yes

Specific date (dd-mm-yyyy)

DD dash MM dash YYYY

Specific Site