The DAISY Award for Extraordinary Nurses Nomination Form

The DAISY Award is an international recognition program started in memory of J. Patrick Barnes. Pat’s family experienced first-hand the difference his nurses made in his care through clinical excellence and outstanding compassionate care. The family created The DAISY Award to express gratitude to nurses and to enable other patients, families, and staff to thank and honor their special nurses.

Please visit DAISYFoundation.org to learn more about Pat's story and how The DAISY Award recognizes Extraordinary Nurses.

Complete this form to share your story of how a nurse made a difference in your care or that of someone you know:

1. First name of the nurse you are nominating:*

2. Last name of the nurse you are nominating:

3. If you would like to nominate multiple team members for The DAISY Team Award, please list each names separated by a comma- e.g. Jane, Joe:

4. Name of organization where your nurse works.*

5. Unit and/or Room Number, or Clinic Name where care was provided by this nurse:*

6. City where your nurse works:*

7. State where your nurse works:*

8. Please describe a specific situation or story that clearly demonstrates how this nurse made a meaningful difference in your care. (See example story at bottom of nomination form) Note: If using a mobile device to enter this E-Nomination you can easily enter your story by selecting the microphone button on your device and dictating your story instead of typing.*

9. Where did you learn about DAISY?

Please tell us about yourself. We may contact you if we need more information about your nomination or if your nurse has been selected to receive The DAISY Award.

10. Your name:

11. Phone:

12. Email:

13. I am a:

Example Story:

"Our 88 year old mother was a patient for 2 weeks. Mom was on a roller coaster, we never knew what to expect. Everything was new and frightening to us as we watched her struggle to live. Through it all, Tami was there, working tirelessly, diligently, helping Mom and us understand issues and ramifications. She patiently explained things to us, sometimes more than once, until we got it. Of utmost importance to her was Mom's comfort. Tami was also concerned-expressed repeatedly-about each of us, Mom's family, as we went through our own emotional and exhausting roller coaster rides. We looked forward each day to seeing Tami. She obviously cared deeply for Mom. Tami became like family to us. I wanted to hug her hello and goodbye. Everyday her knowledge and skills were evident. Such as, for one tiny example, the day 02 saturation was dropping, chest tubes were in, Tami analyzed the best position to put mom into with those tubes in order to maximize 02 saturation. It worked. Tami's tireless, devoted, and skilled passion for our mother's well being made a huge impression on us. She stood out as a nurse willing and able to go beyond the normal call of duty."

By selecting "Yes" and submitting this online form, you agree to 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 the organization where your nurse works may contact you with questions about your submission. To learn more, please read our Privacy Policy.*

Please click the "Submit" button when you are finished entering your DAISY E-Nomination.