MedWest | Daisy Award form

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 Cinnabon 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.

How to Nominate An Extraordinary Nurse

Patients, visitors, nurses, physicians, and employees may nominate a deserving nurse by filling out this form.

Nominations will remain up for consideration for 1 year from the date of receipt.

Name of Nominee: *

Unit/Department of Nominee *

My nominee is a deserving recipient of The DAISY Award. This nurse’s clinical skill and especially her/his compassionate care exemplifies the kind of nurse that our patients, their families, and our staff recognize as an outstanding role model. She/He consistently meets all following criteria: MedWest Nursing Values; Professionalism, Service, Quality, Teamwork, Respect .

Yes

Thank you for taking the time to nominate an extraordinary nurse for this award. Please 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: *

Your Unit/Department: *

Your Email: *

I am:

RN
Patient
Staff
MD
Family/Visitor
Volunteer

Date of Nomination: *

Please describe a situation involving the nurse you are nominating that clearly demonstrates she/he meets the criteria for The Daisy Award. Provide specific examples of how this nurse embodies the MedWest nursing values of Professionalism, Quality, Respect, Service, and Teamwork: