Daisy Award Nomination

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Want to say thank you to your nurse for demonstrating extraordinary service!

This person should exceed your expectation of a clinical skill and/or professionalism with the utmost expertise and compassion. They exemplify the kind of nurse that our patients, their families and staff recognize as an outstanding role model for going above and beyond to serve a patient, family or visitor going above and beyond in their work.

Nominations must be a:

Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Nurse Leader (Manager, Supervisor or in Lead Role)
Nurse Educator (Formal or Nurse teaching patients or other staff or students)

Each Daisy award honoree will be recognized at a small ceremony in their clinic and will receive a Daisy Award, pin and certificate acknowledging their outstanding service to Franciscan Medical Group, our patients and our community.

We thank you for your time in nominating staff and completing this form.

Email *

What is your name? *

What clinic is the candidate located in? *

Which award are you nominating the nurse for?

Daisy Award (General - RN or LPN in direct patient care)

Nurse Leader (Manager or Supervisor, or Designated Lead Position within Clinic)

Nurse Educator (Formal Position or Nurse taking on students or new hires for training)

Other:

Clear selection

Please describe a specific situation or story involving the nurse you are nominating that clearly demonstrates he/she/they provided extraordinary care/service to you or your loved one. *

Our values are compassion, inclusion, integrity, excellence and collaboration. In your experience with the candidate, which value or values were exemplified in your interaction with them? *

I am a *

Patient

Employee (Provider, Medical Assistant, Ancillary staff, Manager, Volunteer, etc.)

Patient's Family Member or Friend/Caregiver

Please tell us your name (first and last), email or phone number we may contact you at and if an employee which clinic you are from. *

Send me a copy of my responses.

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