Mitigating the Madness Workshop #1 & 2 Registration Form

Mitigating the Madness Workshop #1 & 2 Registration Form

Our Mitigating the Madness EBP Workshop Series has changed from a full-day workshop to:

Online presentations and coaching followed by a 4-hour in-person coached session to work on your project.

Choose the date(s) you want to attend the virtual session(s).
If your manager approves, our department will send you the information for the required online pre-work presentations and other needed information.

After you complete the online coursework and attend the online session, you will earn 7+ hours of CE for the completion of the workshop!

We look forward to learning more about your project!

-The Mitigating The Madness Planning Team

First Name*

Last Name*

Duke email address*

Please select your work title within the drop down list:*

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If other, please describe:

Please select your highest degree from the drop down list:*

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List career ladder and certification designations:*

Unit/Clinic*

Identify your work unit or clinic:

Facility*

Please select from the drop down list:

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Mitigating the Madness Workshop*

Which workshop would you like to attend?

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Date Preference*

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What is the project problem?*

Briefly describe the problem you want to impact on your unit or in your practice.

What is the target population?*

Briefly describe who the project will impact.

Why is the project important?*

Briefly describe why this project is important or matters to your unit metrics or practice.

What goal do you hope to achieve?*

Describe potential outcomes and how your project might be successful.

Which strategic plan pillar(s) does your project identify with?*

Click here to see definitions of each strategic plan pillar definition.

Select

Nurse Manager Project Approval

Does your nurse manager/supervisor know about your project and approve of your participation in this workshop? If yes, check this box.

Nurse Manager Name*

Provide your nurse manager/supervisor's name:

Provide your nurse manager's email address:*

Send me a copy of my responses