The DAISY Award for Extraordinary Nurses in Patient Safety Nomination Form

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Nominate Your DAISY Honoree for The DAISY Award for Extraordinary Nurses in Patient Safety, presented in collaboration with the Institute for Healthcare Improvement and sponsored by Hill-Rom!


On behalf of The DAISY Foundation and the Institute for Healthcare Improvement we would like to invite your organization to submit your DAISY Award Nurses and DAISY Team Award Recipients as nominees for the 2021 DAISY Award for Extraordinary Nurses in Patient Safety.


The award will be presented during the IHI Annual Patient Safety Congress in May.

To be eligible for this award, nominees must be DAISY Award or Team Award recipients, recognized during the January 1, 2019 to June 30, 2020 time period. They must be registered with The DAISY Foundation and have a DAISY Spotlight on our website.

 

The deadline to submit nominations is Monday, November 16th, at 5:00pm Pacific time. 


General questions can be sent to cynthiasweeney@DAISYfoundation.org and technical questions can be directed to christinajohnson@DAISYfoundation.org


Please provide the following information:


Who is the Nominee?







Where Does This Nominee Work?









Tell Us More About Your Nominee

Please tell us how your Nominee demonstrates her/his/their commitment to patient/workplace safety by providing statements of support from the Nominee's CNO plus either the Nurse Manager or a patient/family member. This award is highly competitive, so details that create compelling evidence of safety will serve your Nominee well.   At least 2 of the following must be submitted, one of whom needs to be the nominee's CNO:

- The Nominee's CNO (required)

- The Nominee's Nurse Manager

- A patient or family member who was cared for by your Nominee




Who Should We Contact About This Nominee Should We Have Questions?






Please Tell Us About Your CNO