DAISY Nurse Leader Award Nomination Form

Please list the name of the nurse leader you are nominating:	The nominee should be a Manager, Director, Senior Director, Clinical Supervisor or CNO
Role models extraordinary behavior?:	Provide examples
Creates an environment where attributes of trust, compassion, mutual respect, continued professional development and ethical behavior are modeled and supported:	Provide examples
Motivates staff with a shared vision and enthusiasm to achieve better outcomes for themselves and for their patients:	Provide examples
Promotes and enhances the image of nursing within the organization, the community and the profession:	Provide examples
Additional Comments:
Your Name:
Unit:
Phone:	Second three digits Last four digits (xxx) xxx - xxxx
Email:
I am a(n):

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