Example DAISY Nomination Form

This is only an example nomination form. Your own IT team will need to build you a similar form with your own criteria for your website or intranet. Please do not submit any nominations here as this form is not monitored.

DAISY Information

About The DAISY Foundation

The DAISY Foundation is a not-for-profit organization, established in memory of J. Patrick Barnes, by members of his family. Patrick died at the age of 33 in late 1999 from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease. (DAISY is an acronym for Diseases Attacking the Immune System.) The care Patrick and his family received from Nurses while he was ill inspired the creation of The DAISY Award® for Extraordinary Nurses, an evidenced-based means of providing Nurse recognition and thanking Nurses for making a profound difference in the lives of their patients and patient families. In addition to the DAISY Award for Extraordinary Nurses, the Foundation expresses gratitude to the nursing profession internationally in thousands of healthcare facilities and schools of nursing with recognition programs for nurses wherever they practice, in whatever role they serve, and throughout their careers. Learn more at https://www.daisyfoundation.org

Who Can Nominate?

Anyone may nominate a nurse or nursing team within Cedar Hills Healthcare System! Patients, Families, and Staff are encouraged to submit their story.

What Happens To My Nomination?

Each nomination will be blinded and submitted to our DAISY Committee for evaluation. Nominations will be scored based on our predetermined criteria. The Honoree is selected based on this process.

What Do Nominees (Those Nominated But Not Selected For The DAISY Award) Receive?

Every nominee will receive a copy of their nomination, a thank you from leadership, and a DAISY Nominee pin.

Will I Be Notified If My Nurse Is Selected?

Yes! If your nurse is selected to receive a DAISY Award, we will let you know and invite you to the presentation.

Type of DAISY Nomination?

Please select the award offering from the drop-down menu below that best fits your story and/or the gratitude you want to express.

Type of Award

Criteria

Individual Award/ The DAISY Award

For any nurse who demonstrates extraordinary, compassionate care at the bed-side.

Made a special connection with the patient and family
Included patients and families in the planning of their care
Did an excellent job educating patients and their families
Worked well with the healthcare team to meet patient and family needs
Made patients and their families feel comfortable
Went above and beyond

Criteria

DAISY Team Award

A team of two or more people, led by a nurse.

Teams must be led by a nurse or group of nurses
Teams must be comprised of 2 or more individuals
Team members exemplify your organization’s values and embody your mission
Team members are role models of collaboration and teamwork that make a difference in the lives of patient, families, employees, the community
The Team’s project should be described in detail, including outcomes.

Criteria

DAISY Nurse Leader Award

Nominations for The DAISY Nurse Leader Award are typically from their staff who describe the impact leaders have on their ability to provide quality, compassionate care.

Creating an environment where attributes of trust, compassion, mutual respect, continued professional development and ethical behavior are modeled and supported
Being accessible, available, and responsive to the needs of their team
Problem-solving and encouraging critical thinking
Advocating for their teams
Ensuring that the needs of the teams are communicated to organization leadership and organizational priorities and directions are communicated to their teams
Being compassionate leaders

Criteria

DAISY Nurse Educator Award

To Honor the extraordinary work nurse educators do in improving practice and advancing patient care through teaching, precepting, and mentoring.

Has empathy and compassion which fosters deep connections and creates a safe and supportive environment.
Possesses effective communication skills including active listening, and the ability to articulate ideas and present information in a clear and concise manner.
Serves as a role model and mentor for nursing by leading by example and nurturing leadership qualities that will assist in continued professional development.
Is adaptable and flexible, embracing change and able to modify teaching methods to meet a diverse range of needs.
Models a love of learning and is committed to lifelong learning and professional development.
Establishes clear learning outcomes and provides constructive feedback.
Builds collaborative working relationships.

Criteria

DAISY Student Award

For Student Nurses in our organization.

Demonstrates commitment to compassionate care of patients and families.
Makes a connection with patients, families, and peers by building trust and respect.
Advocates strongly for patients and families.

Criteria

DAISY Health Equity Award

For contributions within our healthcare facility or in vulnerable communities at large. Nurses in any practice setting or role whose work contributes to improving health equity and providing compassionate, quality healthcare are eligible for consideration.

Ability to address social needs
Integration of social care into overall care
Strong Communication Skills

Criteria

DAISY Health Equity Team Award

Teams of two or more people, led by a nurse. This award honors contributions within our healthcare facility or in vulnerable communities at large. Nurses in any practice setting or role whose work contributes to improving health equity and providing compassionate, quality healthcare are eligible for consideration.

Ability to address social needs
Integration of social care into overall care
Strong Communication Skills

Criteria

DAISY Ethics Award

Consistently demonstrates professional and ethical standards as defined in the ANA Code of Ethics for Nurses
Prioritizes ethical awareness and ethical decision making to address inequities and uphold ethical norms and values
Substantially contributes to a healthy and ethical practice environment through positive interactions, compassionate action, and leadership
With courage, promotes initiatives that advance ethical behavior within nursing and/or healthcare
Is accountable for professional decisions, actions, and consequences
Exemplifies respect for the inherent dignity and humanity of self and others by maintaining personal health, wellbeing, and integrity
Applies evidence (such as research or EBP) to ethical issues to inform decisions, guide priorities, and/or budget allocations
Protects human welfare and reduces health disparities of those providing and those receiving health care services

Criteria

DAISY Lifetime Achievement Award

The DAISY Lifetime Achievement Award was created to recognize those nurses who have devoted their life's work to the compassionate care of others. Recipients of this award are nominated for their dedication to nursing through active mentoring, role modeling, advocating for their patients and promoting the positive image of nursing. They serve as a beacon of inspiration to those at all stages of their career and in the various and important roles of nursing.

Distinguished career as a nurse in clinical practice, administration, education, and/or research that promote a positive image of professional nursing
Demonstrates and actively engages in the professional development of self and others in the nursing profession
Serves as a role model and advocate for nursing practice and the advancement of nursing as a professional
Advocates for the improvement of patient care and serves as an exemplar for enhancing the patient experience
Recognized by the broader nursing community as a transformational nursing leader
25+ years of service

About Your Nurse

Nurse's First Name:

Nurse's Last Name:

Unit/ Room Number/ Clinic Name (if applicable)

Date(s) of Visit (if applicable):

About Your Team

All Team Members You Would Like To Nominate (List full names as much as you can):

Team Unit (If Applicable):

Your Room Number/ Clinic Location (if applicable):

Date(s) of Visit (if applicable):

Nomination Story

Please Tell Us Why You Are Nominating This Nurse And What Makes Them So Special. Please Provide As Much Detail As Possible.

Nomination Story:

About You:

Your First Name:

Your Last Name:

Your Email:

Phone Number:

Today's Date:

Acknowledgement

By selecting "Yes" and submitting this online form, you agree to Cedar Hills Healthcare, The DAISY Foundation and/or its partners, collecting and storing the information you submit, including your personal contact information, in accordance with the DAISY Foundation Privacy and applicable law. The DAISY Foundation or Cedar Hills Healthcare may contact you with questions about your submission. To learn more, please read our Privacy Policy.

Yes

Contact Information