Daisy Award Nomination Form

The DAISY Award for extraordinary nurses recognizes the super-human work nurses do everyday. It was established by the DAISY Foundation™ a foundation for the elimination of Diseases Attacking the Immune System in memory of J. Patrick Barnes. Mr. Barnes' parents established the foundation in Patrick's memory, because they had experienced first hand the skills as well as the caring and compassion of many nurses. The award program is in almost 2,000 hospitals across the United States and in 14 other countries.

The award will be given monthly to an outstanding nurse and consists of a hand-carved "Healers Touch" sculpture, a DAISY Award pin, and a personalized "Extraordinary Nurse" certificate. The nursing unit where the recipient works will also receive cinnamon buns or a container of cinnamon to add to their own recipes as a nod to Patrick’s favorite treat – Cinnabon® cinnamon rolls.

Please nominate someone who portrays the characteristics of a caring and compassionate nurse. Patients and their families may also nominate a staff nurse. Please note, DAISY nominations are for licensed nurses only.

 

I would like to nominate: 
First Name  *
Last Name  *
Hospital (If it's a practice, select the closest hospital and enter the practice name below).  *
Practice Name 
Unit/Department  *
City  *
Date of Encounter 
Examples of their extraordinary commitment to patient-centered care:  *
  
Thank you for taking the time to nominate an extraordinary nurse for this award. Please tell us about yourself, so that we may include you in the celebration of this award in the event the nurse you nominated is chosen for this honor. 
Your Name  *
Your Phone  *
E-mail Address 
I am a(n):