The DAISY Award Nomination Form

Through the DAISY Award, we honor the super-human work nurses do for patients and families every day wherever they practice. Nurses can be nominated by anyone in the organization - patients, family members, other nurses, physicians, other clinicians and staff - anyone who experiences or observes extraordinary compassionate care being provided by a nurse.

This form is specifically for nominating nurses employed by Jersey City Medical Center.

If the nurse you would like to nominate is a nurse educator, please submit your nomination using the DAISY Nurse Educator Award Nomination Form.

If the employee you would like to nominate is a non-nursing healthcare staff member, please submit your nomination using the BEE Award Nomination Form.

Nomination Criteria

The DAISY criterion incorporates the IOM six aims of safety, patient-centeredness, effectiveness, efficiency, timeliness, and equity. These aims have been embraced by Jersey City Medical Center to ensure the best care possible.

The nominee should exemplify at least one of the following criteria:

Demonstrates the importance of communication in the delivery of quality and safe patient care as evident by working in conjunction with the multidisciplinary team in providing quality safe patient care
Demonstrates commitment to the development and implementation of organizational goals, priorities, and strategies as evident by committee, council or initiative involvement
Demonstrates excellence in the delivery of individualized patient care
Delivers quality and safe patient care guided by policies, procedures, and standards
Implements current evidence-based practice by developing policy, educational material for patients and families, and/or co-workers
Promotes, designs, develops, and implements patient safety and quality initiatives or programs that increase safety and quality care, such as reduction in nosocomial wounds, falls, failure to rescue and/or maintaining 95% or higher compliance in core measures
Initiates or participates in research with outcomes related to patient safety and quality
Promotes safety and quality patient care by contributing to committees at the local, state, and or national level

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* Who are you nominating? (Must be a nurse)

First Name

Last Name

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* What department or floor does the nurse work on?

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* Please describe the reason you feel your nurse is a super-human nurse:

Thank you for taking the time to nominate an extraordinary nurse for this award!

Please tell us about yourself, so that we may inform you should the nurse you nominated be chosen for the award. If you wish to be anonymous, feel free to leave the following boxes blank.

The DAISY Award Nomination Form

Question Title

* Who are you nominating? (Must be a nurse)

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* What department or floor does the nurse work on?

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* Please describe the reason you feel your nurse is a super-human nurse:

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* What is your name?

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* What is your email?

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* I am a/an: