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DAISY Nurse Leader Award Nomination Form
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DAISY Award: Nominate a Nurse
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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:
(xxx) xxx - xxxx
Email:
I am a(n):
RN
Patient
Family/Visitor
MD
Staff
Volunteer