The DAISY Award for Extraordinary Nurses Nomination Form - AAACN

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.

AAACN/DAISY Ambulatory Nurses are recognized for the extraordinary acts of compassionate care and clinical excellence they demonstrate every day in their work with ambulatory patients, families and their teams

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 an Ambulatory nurse made a difference in your care or that of someone you know that meets this criteria:

• Demonstrates effective interpersonal relationships through compassion, respect for person, integrity, and professionalism in delivery of care to ambulatory patients and families
• Engages patients and members of the interprofessional team in improving health outcomes that address disparities and social determinants of health
• Delivers person-centered, high quality, safe and effective evidence-based carePromotes interprofessional collegial working relationships
• Promotes and encourages active participation in AAACN

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

2. Last name of the ambulatory nurse you are nominating:

3. Name of organization where your ambulatory nurse works.*

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

5. City where your ambulatory nurse works:*

6. State where your ambulatory nurse works:*

7. Please describe a specific situation or story that clearly demonstrates how this ambulatory nurse made a meaningful difference in your care or in the care of others. 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.*

8. 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/AAACN Award.

9. Your name:

10. Phone:

11. Email:

12. I am a:

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.