The DAISY Award for Extraordinary Nurses Nomination Form - CCI

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. A branch of the DAISY Award, the DAISY Nurse Leader Award, is the Competency and Credentialing Institute's (CCI's) most prestigious clinical leadership recognition and is awarded annually at the AORN Expo meeting of CCI's Board of Directors.

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 perioperative nurse leader made a difference in and impacted the delivery of perioperative nursing practice through their work and/or volunteerism with CCI.

All Competency & Credentialing Institute staff RNs and volunteer RNs are eligible to be nominated or apply for The DAISY Nurse Leader Award for Extraordinary Nurses - CCI. The DAISY Nurse Leader Award for Extraordinary Nurses is CCI's most prestigious clinical leadership recognition and is awarded annually at the AORN Expo meeting of CCI's Board of Directors. The award program is managed by CCI's Recognition Committee. The annual recipient will be selected by the CCI Board of Directors based on the totality of the criteria below.

Selection criteria include:

• Promotes a shared vision and enthusiasm to achieve better patient outcomes through exemplary perioperative nursing practice
• Promotes continuous professional development and certification excellence
• Recognized as a mentor to CCI staff and/or volunteers
• Accessible, available, and responsive to the needs of CCI staff, volunteers, and those we serve
• Encourages critical thinking and problem-solving for individuals and teams to promote CCI's vision
• Role model for attributes of trust, mutual respect, and ethical behavior
• Personifies compassionate nursing care, empathy and caring in action
• Promotes and enhances the image of nursing within the organization, the community, and the profession

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

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

3. Name of the department, committee, or group with which the nurse performs a majority of their work or volunteerism.*

4. City where your nurse works:*

5. State where your nurse works:*

6. Country where your nurse resides:*

7. Please describe a specific situation or story that clearly demonstrates how this nurse made a meaningful difference in the delivery of perioperative nursing practice. 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 you are nominating yourself and are a staff member, please enter your supervisor's name. If you are nominating yourself and are a volunteer, please enter the name of the CCI staff member or volunteer with whom you have volunteered most closely):*

10. Email (If nominating yourself and you are a staff member, please enter your supervisor's email. if nominating yourself and you are a volunteer, please enter the email of the CCI staff member or volunteer with whom you have worked most closely.):*

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.