Nomination Form

I would like to nominate from the unit/department as a deserving recipient of The DAISY Award. This nurse's clinical skill and especially her/his compassionate care exemplify the kind of nurse that our patients, their families, and our staff recognize as an outstanding role model. She/he consistently meets all of the following criteria:

  • Demonstrates professionalism in the work environment
  • Job performance exemplifies the mission, vision and values of Mercy
  • Uses critical thinking skills in the delivery of extraordinary care
  • Demonstrates excellent interpersonal skills with peers and co-workers
  • Consistent focus on meeting patient and family goals
  • Excellent educator for patients and their families

Please describe a situation involving the nurse you are nominating that clearly demonstrates he/she meets the criteria for The DAISY Award:

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.

My name: I am: Email:

Unit: Phone: Pager: