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■Ihank yoo for taking the time to thank your

nurse!

Your Name

Phone _

Email

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□ Please contact me if my nurse is chosen so that I may attend the cefebration if available.

I am: □ RN □ MD □ Patient □ Staff □ Volunteer □ Famity/Yisitor

Datę of nomination_

if you have any questions, please contact:

Sample Nomination Story:

"Our 88-year-old mother was a patient for 2 weeks. Mam was on a roiler coaster, we never knew what to expect. Everyth.ng was ncw and frightenlng to u* as we watched her strugglc to live. Through it all. Tami was there, working tirelessly, dihgently. helping Mom and us understand issues and ramifications. She patiently expla ned things to us, scmetimes morę than once, until we got it. Of utmost importance to her was Mom's comfort Tami was also concerned about each of us as we went through our own emotional and cxhausting roiler coastcr rides. We locked forward each day to seeing Tami She obwously cared decply for Mom Tam. became like famiły. i wanted to hug her hello and goodbye Everyday her knowledge and skills were evident. Such as, for 1 t.ny example, the day 02 saturation was dropping, chest tubes were in-Tami analyied the best pos.tion to put mom into with those tubes m order to maxim.:c 02 saturation. It worked Tami's t.reless, devotcd, and skillcd passton for our mother's we!l being madę a huge impress*on on os. She stood out as a nurse willing and abie to go beyond the normal cali of duty.*

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Want to Say Thank You To Your Nurse?

Share Your Story!

The OAtSY (Oiseases Attackmg the immunc SYstem) Award is an International recognition program that honors and celebrates the skillful, compassionate care nurses prov»de every day. The DAISY Foundation was establ.shed by the famiły of J. Patrick Barnes after he died from complications of the auto-immune disease fTP in 1999 Durlng his hospitaliration, they deeply appreciated the care and compassion shown to Patrick and his entire famiły When he died, they felt eompelled to say "thank you* to nurses in a very public way To leam morę, vtsit PAiSYfoundłtion.org

Please say thank you by sharing your story of how a nurse madę a difference you will never forget!

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The DAISY Award for Extraordinary Nurses

To Nominate an Extraordinary Nurse:

Anyone may thank a deserving nurse by filling

out this form and submitting It to    - -

[Add in electronic nomination form URL if avai labie]

Name of the nurse you are nominating:

Unit where this nurse works:

Please share your story of why your nurse is so special, prowiding as much detail as possible. See reverse side for sample nomination.

£ DAISY Foundation 2019