The DAISY Award for Extraordinary Nurses Nomination Form - IHCNO

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. Name of the Organization where your nurse works:

4. City where your nurse works:

5. State where your nurse works:

6. Country where your nurse works:

7. 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.

Please tell us about yourself:

8. I am a:

9. Your name: (If nominating yourself, please enter your Supervisor's name)

10. Email: (If nominating yourself, please enter your Supervisor's email)

Example Story:

"The past 12 weeks have been difficult for us as we seldom are ill - even with a cold. Christy, when you came into our lives, we didn't know how long it would be as the doctor at the wound clinic had said my husband's injury from the fall off the ladder "looked like a two-season one" or "until my seventeen-year-old son graduates from college." Your competence was impressive as you always could respond to our questions. You were masterful in cleaning and dressing the wound in addition to teaching me more then I ever wanted to know about sterile procedures and packing a wound. The day you spotted the second infection and made ten calls to get my husband the referral he needed to begin another regimen of antibiotics shortened the healing time. Thank you for your perseverance. With each visit, you brought smiles, happiness, and encouragement into our home. You assured us when we thought we had done something to cause that second infection. All your patients are blessed to have such an energetic, competent, and compassionate nurse at their side, helping them during their healing process

We are forever grateful. May the wind be at your back, and watch out for cops who get in your way as you maintain your busy schedule.


11. 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.