DAISY Award Nomination Form

Please complete the following information about the person you would like to nominate.

Nominee's Name:

Nominee's Unit/Department:

Nominee's City/Campus:

Additional info:

Please consider including any additional information that may help us identify the nominee (for example: date of visit, patient’s name, etc.)

I would like to nominate this person as a deserving recipient of The DAISY Award. This nurse's compassionate care and clinical skill exemplify the kind of nurse that our patients, their families, and our staff recognize as an outstanding role model. They consistently meet all of the following criteria:

Role Model: Demonstrates extraordinary talent in the delivery of compassionate care.
Empathetic: Relates to patients and families with a caring attitude.
Advocate: Champions the needs of patients and families.
Communicator: Listens to the patient and family & caregiver team with openness and positivity.
Heartfelt: Establishes a special connection with patients and families.

Please share a story involving the nurse you are nominating that clearly demonstrates how they meets the criteria for The DAISY Award:

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 should the nurse you nominated be chosen.

Your Name:

Unit/Department (employees only):

Phone:

Email:

My role (please check one):

Family/Visitor

Patient

Children's MN staff

Other

Is it okay to share this nomination (this may include our Children’s Minnesota internal webpage, the DAISY Foundation webpage, and/or displayed on unit)?

Yes

Yes but do not include my name