Nurses Helping Nurses Volunteer Form

It is increasingly apparent that nurses are feeling the emotional and mental impact of COVID-19, especially those who are in acute care settings. In partnerships with the Kentucky Nurses Association and the International Society of Psychiatric Nurses, we are developing online mental health and wellness resources and an online volunteer support mechanism for nurses in Kentucky. The program will be called “Kentucky Nurses Helping Nurses” and will be available on all the KNA platforms – Newsletter, website, Facebook page and their email news update. All of the platforms are available to every Kentucky nurse except the email news updates. The program will contain resources to support mental wellbeing and provide resources specifically focused on COVID and mental health self-care and care for others. We would like this effort to be led by mental health nurses for nurses.

We are reaching out to you to see if you or some psychiatric mental health nurses you know might be interested in volunteering in the effort. We are contacting PMH nurses (currently working and retired), advanced practice PMH nurses (currently working and retired), and advanced practice PMH students who might be interested in being part of the project focused on three key areas:

1) Education: Advanced practice PMH nurses to develop and present information for those who use the website (webinars, power points, blogs etc.)

2) Volunteer peer support: Advance practice PMH nurses, RN psychiatric nurses with experience, advanced practice PMH nursing students, and PMH nurse retirees to be a part of the interactive volunteer (peer) support component (work with nurses who contact the site and wish to talk to reduce stress, share feelings and get support). The volunteer support service IS NOT professional therapy nor psychiatric services.

3) Service provision: When professional therapy and/or psychiatric resources are indicated, we would like to develop a list of advance practice PMH nurses who have the interest and availability to take patients who might be referred through this program. If you are able please indicate your availability (how many patients you can take and when).

* Denotes field is required

*Name

First NameLast Name

*Email

example@example.com

*Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

*Highest Level of Education

*License and Certification

License Number/State

Membership: select all that apply

KNAAPNAIPNAOther

Are you currently working

yesno

*Practice area (inpatient, outpatient, facility,etc.)

*Practice address

*Please indicate in what capacity you are willing to volunteer. Select all that apply.

EducationVolunteer peer supportService provision

Education: If you are interested in education please indicate topic(s)

and format

Volunteer peer support:

Please indicate day and times of availability

Service provision: Please indicate: 1. How many new patients can you manage, 2. How soon are you able to see new patients, 3. Payor information (cash only or insurance), 4. If cash only are you willing to see patients pro bono or at a discounted rate?

Please attach a current photo. The photo will not be published.