Student Daisy Award

I would like to nominate (name of student)*

from the (unit/department)*

This student’s clinical skill and especially his/her compassionate care exemplify the kind of nurse that our patients, their families, our guests, and staff recognize as an outstanding role model. She/he consistently meets all of the following criteria:

• Provides the highest quality, compassionate care and services to patient, families, and other guests.

• Has a positive attitude and outstanding customer service skills.

• Provides safe, reliable, care.

• Has a strong sense of advocacy in supporting patients and families.

• Strives to make every patient and family member’s experience exceptional.

• Serves as a student role model by continuous learning and upholding excellence in standards of practice 
  

• Displays integrity, collaboration, professionalism, individual growth and synergy.

• Embraces cultural diversity, integrating the patient’s personal preferences and beliefs.

Please describe a situation involving the student you are nominating that clearly demonstrates he/she meet the criteria:*

Thank you for taking the time to nominate an extraordinary nurse for the DAISY 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*

Address*

Phone*

Email*

I am a (please check one):