Daisy Award For Extraordinary Nurses Nomination

HealthPlus Network of Specialty Centers

Thank you for taking the time to thank your nurse!

Question Title

* 1. Details:

Your Name:

Phone:

Email:

Question Title

* 2. Please contact me if my nurse is chosen as a DAISY Honoree so that I may attend the celebration.

Yes

Question Title

* 3. I am (Please check one)

Patient

Family/Visitor

Staff

Volunteer

Question Title

* 4. Date of nomination?

Choose a date

Date

Question Title

* 5. Name of the nurse you are nominating.

Question Title

* 6. I would like to thank my nurse and share my story of why this nurse is so special:

Each DAISY Award Honoree will be recognized at a public ceremony in her/his unit and will receive: a beautiful certificate, a DAISY Award pin, and a hand-carved stone sculpture entitled A Healer’s Touch. Additionally, everyone in the unit will celebrate with cinnamon rolls – a favorite of Patrick’s during his illness. The Barnes Family asks that whenever and wherever nurses smell that wonderful cinnamon aroma, they stop for a moment and think about how special they are.

The DAISY Award was established by the DAISY Foundation in memory of J. Patrick Barnes who died at 33 of ITP, an auto-immune disease. The Barnes Family was awestruck by the clinical skills, caring and compassion of the nurses who cared for Patrick, so they created this international award to day thank you to nurses everywhere.