DAISY Award for Extraordinary Nurses

Colleague Nomination Form

The DAISY Award For Extraordinary Nurses recognizes the compassionate care of extraordinary Registered Nurses (RN). It was established by the DAISY Foundation– a foundation for the elimination of Diseases Attacking the Immune System in memory of J. Patrick Barnes. The Barnes family established the foundation in their son Patrick’s memory because they had experienced first hand the skills, caring and compassion of many nurses. The award is given to recognize outstanding nurses at Arkansas Children’s Hospital.

Nominations received by the 15th of the month will be considered as a nominee for the following month’s award.

I nominate (First Name) (Last Name) , RN from (Department) as a deserving recipient of the DAISY Award. This person consistently meets all of the following criteria (review criteria and enter comments where required).

Compassionate, Quality, Family-Centered Care

Quality of Care

Provides high-quality, family-centered, and compassionate care while upholding the ACH safety and behavioral standards

Supports evidence-based practice while promoting achievement of positive patient outcomes

Develops and supports an environment in which high quality care is provided

Interdisciplinary Relationships

Promotes positive interdisciplinary relationships and views them as essential to exceptional
patient care

Collaborates with health care team members and promotes a sense of mutual respect among all disciplines

Nurse as Teacher

Incorporates teaching into all aspects of patient care and recognizes its importance in the
development of other nurses as well as in the provision of quality family-centered care
Communication

Models excellent interpersonal skills, has a positive attitude and exhibits outstanding customer service skills

Encourages and values feedback

Describe how the nurse meets the above criteria:

Leadership

Autonomy

Displays independent clinical judgment within the context of an interdisciplinary approach to care and consistent with professional practice standards

Nursing Leadership

A leader who is knowledgeable and a risk taker who exudes the ACH mission on giving care, love and hope

Takes initiative and conveys a strong sense of advocacy in supporting the staff, patients and families Quality Improvement

Participates in the quality improvement process and perceives the process as one that is essential in improving the quality of patient care

Achievement of Departmental and Organizational Goals

Promotes the achievement of departmental and organizational goals in delivering excellent care

Abides by ACH principles and values, is in good standing, and has no disciplinary action

Describe how the nurse meets the above criteria:

Professionalism

Image of Nursing

Serves as a role model by representing the profession of nursing and upholding excellence in standards of practice

Demonstrates that caring and compassion are integral to providing patient care

Professional Development

Values personal and professional growth and development. For example, mentors/precepts fellow staff, teaches others, participates in research activities, publications and presentations, or continues formal education

Strives for clinical advancement and maintains clinical competency

Describe how the nurse meets the above criteria:

Your Name:

Credentials:

Unit:

Relationship to Nominee:

Phone

Pager

Date

Arkansas Children's Hospital
1 Children's Way
Little Rock, AR 72202-3591

Call: 501-364-1100