The Power of Meaningful Recognition in a Healthy Work Environment

Abstract

It’s working day in and day out for years and years; you forget what impact you make on people you work with and the patients—it’s special to be recognized.—Staff Nurse, Children’s Hospital Los AngelesWhen the American Association of Critical-Care Nurses (AACN) published AACN Standards for Establishing and Sustaining Healthy Work Environments in 2005, Standard 5 was Meaningful Recognition: Nurses must be recognized and must recognize others for the value each brings to the work of the organization.1 At the time, The DAISY (an acronym for Diseases Attacking the Immune System) Foundation was just starting. Our family had created this not-for-profit organization to express our gratitude to nurses for the extraordinary compassion and skill they bring to patients and families every day. Although we were not aware of AACN’s and the nursing profession’s evidence-based understanding of the importance of a formal recognition process in ensuring an environment conducive to patient and staff safety and nurse retention and recruitment, the lives of our family were forever changed by extraordinary nurses.Thirteen years ago, our 33-year-old son, Patrick, was unexpectedly hospitalized for 8 weeks with the autoimmune disease idiopathic thrombocytopenia purpura. During Patrick’s hospitalization, the nurses who cared for him and us truly practiced patient- and family-centered care. To our family, the excellent clinical skill nurses applied to Patrick was not surprising; after all, we expected he would be well cared for in a hospital setting. What we did not expect was the humanity Patrick’s nurses brought to his bedside and to our hearts: the way they touched Patrick and the way they talked to him, even when he was fully sedated and being treated with mechanical ventilation. The way they explained his condition and treatment to us, ensuring that every question was answered, no matter how many times the same question may have been asked. The way they understood the dynamics of our family and knew how to approach, comfort, and encourage each member. The way they treated Patrick not as a dreadfully sick patient but as a vibrant young man whom they expected would return to a healthy, fulfilling life. Finally, when Patrick became increasingly ill, and it became apparent that he would not survive idiopathic thrombocytopenia purpura, it was the way his nurses supported us through the process of his death. All this and more touched the Barnes family profoundly and inspired us to establish The DAISY Award as a way to recognize the profession of nursing for helping us through the worst 8 weeks of our lives.Fast forward 13 years later, and more than 1400 health care facilities are committed to honoring the compassion and skill of their nurses with The DAISY Award. Month in and month out, these facilities provide patients, family members, and colleagues of nurses the opportunity to share their stories of extraordinary nursing by nominating a nurse for The DAISY Award. More than 35 000 nurses from the United States and 6 other countries have been honored as recipients of The DAISY Award, while more than 200 000 have been nominated and recognized for their extraordinary nursing.Unbeknownst to the Barnes family, creating The DAISY Foundation was like breathing life into meaningful recognition, as The DAISY Award affords nursing with the means to formally acknowledge the contributions of nurses as individuals and collectively as a profession. The DAISY Award also provides nurses and leaders with a consistent source of data that recognizes all of the amazing nursing care occurring in their health care facilities. As one nurse leader employing The DAISY Award in her hospital explained, “It recognizes what nurses bring to health care and calls out what it means to be a nurse and what nurses do in small and big ways every day without thinking about it. It influences the spirit and influences the environment.”By definition, meaningful recognition acknowledges another’s contribution with feedback that is relevant to what he or she accomplished and is equal to the person’s contribution.1 This type of acknowledgment is not syrupy sweet, over the top, or gushing. Instead, meaningful recognition is positive feedback describing the impact a person had on another and how and why their actions and behaviors made a difference.1,2 As a family member recognizing her nurse stated, “She gave Grandma, me, and my family that invaluable gift of peace and comfort, both physically and emotionally. I will always be grateful for that.”Although the previous quote is powerful, it contains an element of subjectivity. Because of the subjective nature associated with this kind of feedback, meaningful recognition is often considered a soft skill. The perception that positive feedback is soft, coupled with nurses who, upon receiving acknowledgment for their amazing contributions, often reply, “I was just doing my job,” serves to diminish the power of meaningful recognition. For decades, nurses have explored the hard skills, clinical aspect of care delivery to determine improvement opportunities.3 Although this action certainly represents best practice, little time is devoted to understanding what nurses are doing right and how it affects patients, their families, and nurses’ colleagues. The emphasis on correcting care delivery inefficiencies with hard science interventions and a lack of leveraging what nurses do well, combined with misperceptions about the impact of soft skills and nurses who perceive their contributions “as just doing my job,” may account for the lack of research on the power of meaningful recognition.The recognition of this gap and the desire to put “some science behind The DAISY Award” led The DAISY Foundation to partner with organizational behavior consultants from Psychological Associates to better understand the cultural impact of meaningful recognition on health care organizations and individual nurses. We began this research project 3 years ago by reviewing more than 2000 nominations for The DAISY Award from patients, their family members, and nurse colleagues and then interviewing nurse leaders and nurse honorees (The DAISY Award recipients) at 20 different health care organizations across the country.4 Content analyses of the nominations and honoree and nurse leader interviews revealed that every day, every minute—maybe even every second—extraordinary nursing is occurring in health care organizations across the country. Going beyond patients’ feelings about food temperature and convenient parking, the data from The DAISY Award nominations provided rich detail and insight regarding what patients, families, and colleagues value and find meaningful about their interactions with nurses. In turn, we found that feeding this data back to staff by formally and consistently celebrating all the “right going on” served to elevate the value of nursing contributions.4 As an honoree describing her experience of receiving The DAISY Award explained, “When I heard what Bonnie Barnes said about the compassion, she remembered this compassionate person holding her hand. Healing is not just medicine—that nurses are smart, are part of the process, and do make independent decisions, and I saw it [nursing] was all of this.”In addition, shining the spotlight on the impact of nursing, we found that meaningful recognition via The DAISY Award also increased nurses’ self-awareness of the difference they made in the lives of others and helped others reconnect with why they became nurses.4 As another honoree explained, “You have that kind of feeling that your chosen profession is fulfilling; it reinforces that.”The results of this research also indicated that receiving meaningful recognition via The DAISY Award promoted pride and nourished team spirit. From the nurse leader’s perspective, recognizing the actions of The DAISY Award exemplars provided these leaders with opportunities not only to reinforce those behaviors valued by patients, their family members, and nurse colleagues, but also to demonstrate to nurses the difference they make in the lives of those they serve.4Leveraging the power of meaningful recognition, imagine performance/quality improvements and/or mortality and morbidity meetings that included patient feedback data from your hospital’s DAISY Award nominations. During each meeting, the team dissects the strengths articulated in each nomination, so the team members can better understand the attributes associated with this type of performance. When The DAISY Award nominations identify trends of extraordinary nursing, a root cause analysis of “all the right going on” occurs, and team members develop strategies aimed at creating more opportunities for extraordinary care to occur. Do you think this concept sounds crazy? Recall how the critical care nurses reacted when AACN released the Healthy Work Environment Standards, and through their presidential addresses to thousands of nurses, Connie Barden, Dorrie Fontaine, Kathy McCauley, and Debbie Brinker introduced the idea that critical care clinical excellence has expanded to encompass nurses who are skilled communicators and true collaborators, contribute to effective decisions, lead with authenticity, staff their units by matching nursing skill levels to patient acuity/clinical needs, and recognize colleagues in meaningful ways. These 6 elements of a healthy work environment are a regular part of many daily conversations in critical care areas. Not convinced? Just ask the Barnes family if they imagined and dreamed 13 years ago when The DAISY Foundation began that 1 day they would receive AACN’s Pioneering Spirit Award for their work in recognizing the extraordinary work of nurses in a meaningful way. The evidence is clear: Patients, their families, and our colleagues want not only to acknowledge us for our work but also to empower us to recognize ourselves. The time has come for critical care nurses to embrace the power of meaningful recognition.5