The DAISY AwArD for exTrAorDInArY nurSeS

Thank you for taking the time to nominate an extraordinary nurse for this award. Please also tell us about yourself, so that we may include you in the celebration of this award should the nurse you nominated be chosen.

Your name ____________________________________ Unit _______________

Phone ________________ Email __________________ Pager _____________

I am (please check one): ____RN/LPN ____Patient ____Family/Visitor

____MD ____Staff ____Volunteer

Date of nomination: _____________________

Where to submit nominations

Please submit nominations to the manager of the nominee OR at the hospital’s information desk in the main lobby. Nominations may also be filled out and submitted online at camc.org/daisy or on CAMnet.

Representatives from each hospital will review nominations quarterly and present awards as follows:

Deadline to submit nomination Award month

Feb. 15, 2014 March

May 15, 2014 June

Aug. 15, 2014 September

Oct. 15, 2014 November

26092-A14

I acknowledge that this nurse is an RN or LPN and is in good standing without disciplines. Awards will be presented quarterly.

Nurse manager signature: ______________________________________________

Please elaborate on what makes your nominee deserving of this award. The story you tell about your nominee will be very important in evaluating your nomination. Please do not write the nominee’s name in your statement.

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about the DaisY FounDationThe DAISY Foundation was established in 1999 by the family of J. Patrick Barnes who died of complications of the auto-immune disease Idiopathic Thrombocytopenia Purpura (ITP) at the age of 33. (DAISY is an acronym for disease attacking the immune system.) During Pat’s nine-week hospitalization, his family was awestruck by the care and compassion his nurses provided not only to Pat but to everyone in his family. So one of the goals they set in creating a Foundation in Pat’s memory was to recognize extraordinary nurses everywhere who make an enormous difference in the lives of so many people by the super-human work they do every day.

What is the DaisY aWarD?The DAISY Award is an international program that rewards and celebrates the extraordinary clinical skill and compassionate care given by nurses every day. CAMC is proud to be a DAISY Award partner, recognizing our exceptional RNs and LPNs with honor.

Each quarter, DAISY Award honorees will be recognized by the Nursing Management Council, at their hospital’s manager’s meeting and on their unit. Honorees will also receive an award certificate, DAISY Award pin, and a hand-carved stone sculpture entitled “A Healer’s Touch.” Additionally, everyone in the awardee’s unit will celebrate with Cinnabon® iced 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 and the incredible impact they have on the lives of patients and their families every day.

nominate an extraorDinarY nursePatients, visitors, nurses, physicians and employees are encouraged to nominate a deserving nurse (RN or LPN) for the DAISY Award. Nominations may also be completed online at camc.org or CAMnet.

I would like to nominate ___________________________________ from the

____________________ unit/department at _________________________ Hospital (General, Memorial, Women and Children’s) as a deserving recipient of The DAISY Award. This nurse’s clinical skill and compassionate care exemplify the kind of nurse that CAMC’s patients, their families, and staff recognize as an outstanding role model. She/he consistently meets all of the following criteria:

1. Committed to focusing on the goals of the patient, family and institution. 2. Serves as a patient advocate.3. Demonstrates outstanding clinical skills and decision-making capabilities.4. Serves as role model in professional nursing as demonstrated by exceptional core values, proactive leadership, mentoring, and interpersonal skills with patients, families, peers and colleagues. 5. Collaborates with multidisciplinary teams to coordinate plan of care including: assessment, outcome identification, planning, implementation and evaluation.