DAISY Leader Nomination Form

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Share Your Story to celebrate your Nurse Leader!

The DAISY (Diseases Attacking the Immune SYstem) Award is an international recognition program that honors and celebrates the skillful, compassionate care nurses provide every day. RUHS is honoring our nurse leaders during nurse’s week this year and is looking for a patient-driven story of a nurse leader providing extraordinary care. Examples of Nurse Leaders include: Charge Nurses, Preceptors, Assistant Nurse Managers, Nurse Directors, Case Managers, Nurse Educators, Nurse Coordinators, Executive Nurse Directors, Nurse Directors, Nurse Practitioners, Nursing House Supervisors, Code Team, Diabetes Team, Wound Care Team, Throughput Team, PICC Team, Code BERT Team, or any nurse who may not provide direct patient care but provides extraordinary service that indirectly impacts patients and families. Share your story of how this nurse leader has affected patients and their families either with direct involvement or indirectly through their actions.

This Nurse Leader impacts staff and/or the patient care they manage by:

Role modeling extraordinary behavior

Creating an environment where attributes of trust, compassion, mutual respect, continued professional development and ethical behavior are modeled and supported Motivates staff with a shared vision and enthusiasm to achieve better outcomes for themselves and for their patients

Promotes and enhances the image of nursing within the organization, the community and the profession

Please describe in detail this Nurse Leader, their story, and the outcomes:

More space on back to continue your story

Thank you for taking the time to nominate an extraordinary nursing leader for this award.

Name of Nurse Nominated __________________________ Unit/Area Nominated Nurse Works __________________

Your Name ________________________ Date of nomination Phone __________________________

 Please contact me if the nurse leader I have nominated is chosen as a DAISY Nurse Leader Award Honoree so that I may attend the celebration if available.

I am (please check one):

Please submit your nomination form to:

Email_________________________
 Patient  Visitor  RN  MD  Staff  Volunteer © DAISY Foundation 2018
A1005
26520 Cactus Ave Moreno Valley,
92555
Riverside University Health System Attn: DAISY Coordinator
Staffing Office
CA

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DAISY Leader Nomination Form by Riverside University Health System - Issuu