DAISY Award for Extraordinary Nurses
Colleague Nomination Form
Nominations received by the 15th of the month will be considered as a nominee for the following month’s award.
I nominate , RN from 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:
Quality of Care
Interdisciplinary Relationships
Nurse as Teacher
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:
Autonomy
Nursing Leadership
Achievement of Departmental and Organizational Goals
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:
Image of Nursing
Professional Development
Anyone can nominate an RN for the DAISY Award.
Your Name: Credentials Unit
Relationship to Nominee:
Phone: Pager: E-Mail: Date:
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