Daisy Award Nomination
The Daisy Award for Extraordinary Nurses:
This nurse's clinical skill, and especially his/her/their compassionate care, exemplify the kind of nurse our patients, their families and our staff recognize as an outstanding role model.
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1.
Name of Nurse (RN/LPN) you would like to nominate:
(Required.)
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2.
Which unit/department do they work in:
(Required.)
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3.
Please describe a situation in which the nurse demonstrated compassionate care towards patients and families ( using details to support your nomination):
(Required.)
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4.
Thank you for taking the time to nominate this extraordinary nurse. Please provide your contact information so we can include you in the award celebration if your nominee is chosen.
Date of nomination:
(Required.)
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5.
Your name:
(Required.)
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6.
Unit:
(Required.)
CPAR/Meyerhoff
Pakula
Capital Region
Outpatient
Other (please specify)
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7.
Phone number:
(Required.)
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8.
Email:
(Required.)
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9.
I am ( please choose one):
(Required.)
Patient
Family/Visitor
Provider
Staff
Volunteer
Other (please specify)
