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- 30 Nursing Literature Review Ideas Many of the future nurses have major difficulties choosing the right nursing literature review topics. There are lots of nursing literature review ideas available and it is up to you to pick the one that will suit you the best. If you use the wrong one you will have a hard time writing and waste a lot for your precious time. Here you can see different nursing literature review topics as well as some advice that will be helpful to your writing. Here is the list:
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- 27. First aid: what can a nurse do 28. Are the nurses treated lesser among the other hospital staff? 29. Nursing practice and its effect of future nurses 30. Nurses uniform colors and their practicality in the hospital Tips that will make your writing faster Choose nursing literature review topics that you are familiar with as this will ensure that you will spend less time doing the research hand more time writing. Nursing is a serious occupation and you need to be as much professional as you can. Nursing literature review ideas can be pretty difficult to come up with, but the previous list will give you the inspiration you need. You can even modify the so that they fit you perfectly.
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literature review on meaningful recognition in nursing
- Literature Review on Meaningful Recognition in Nursing
Author: doanh
Post on 29-Dec-2016
Embed Size (px) 344 x 292 429 x 357 514 x 422 599 x 487
Meaningful Recognition 1
Literature Review on Meaningful Recognition in Nursing
Psychological Associates and DAISY Foundation
Copyright Psychological Associates® [2009]
Meaningful Recognition 2
TABLE OF CONTENTS
Abstract………………………………..……………………………………………………Page 3
Literature Review on Meaningful Recognition in Nursing…….Page 4
Positive Outcomes When Recognition is Present...………………Page 8
Negative Outcomes When Recognition is Absent………………..Page 11
Success of Meaningful Recognition Programs……………………..Page 17
References…………………………………………………………………………………Page 23
Table 1: Critical Elements of Meaningful Recognition as Outlined in the AACN Standards for a Healthy Work Environment……………………………………………………………..................Page 29
Table 2: A Comparison of Nurses’ Perceptions of Their Work Environments in an AACN 2006 Survey to a Follow‐up AACN Survey in 2008………………………………………………………………………………………….Page 30
Figure 1: Abraham Maslow’s human needs theory…………….……..Page 31
About Psychological Associates…………………………………………………Page 32
Meaningful Recognition 3
Abstract
Meaningful recognition contributes to healthy work environments and has been delineated by the American
Association of Critical‐Care Nurses (2005) as one of the keys to establishing and maintaining healthy work
environments for nurses. This literature review reveals that meaningful recognition has been linked to such
positive outcomes as job satisfaction, organizational and career commitment, cohesion and collaboration, and
perceived organizational support. A lack of meaningful recognition has been linked to negative outcomes such
as absenteeism and turnover, stress and burnout, and decreased quality of patient care. Research on how to
best conduct recognition programs is provided. One example is offered, the DAISY Award for Extraordinary
Nurses. More research is needed on the link between recognition and nurses’ job satisfaction.
Meaningful Recognition 4
Literature Review on Meaningful Recognition in Nursing
It probably wouldn’t take fancy results of formal, scientific research to sell nurses on the idea that
they, and their colleagues, appreciate being recognized when they do a good job. It might also seem intuitive
that receiving recognition for working hard can help increase job satisfaction. Yet for many nurses, it also
doesn’t take long to think of examples when their organizations either didn’t realize this, or if they did, they
didn’t take the time or make the effort. The research does exist though, and without a doubt it shows that
recognition contributes directly to job satisfaction (Cronin & Becherer, 1999; Lu, While, & Barriball, 2005). Yet
as intuitive as this may seem, the American Association of Critical‐Care Nurses (AACN) still felt the need in
2005 to specify that meaningful recognition is one of the six, key standards necessary to establish and sustain a
healthy working environment (Shirey, 2006). This serves as a giant clue that too many nurses still must tolerate
unhealthy work environments and too little meaningful recognition (Bylone, 2008). The shortage of nurses is
critical and is a worldwide problem (Tourangeau & Cranley, 2006). Job satisfaction is strongly associated with
intention to remain at the organization (Larrabee, Janney, Ostrow, Withrow, Hobbs, & Burant, 2003; Sourdif,
2004). This literature review will recite and reveal the research showing that meaningful recognition in healthy
work environments will produce remarkable outcomes for nurses, and perhaps most importantly, for their
patients.
The AACN felt that there was enough evidence to show that unhealthy work environments contribute
to medical errors, conflict and stress among health professionals, and ineffective delivery of patient care.
Efforts were needed to spell out how healthy work environments could be created and sustained. They
delineated six essential standards including: skilled communication, true collaboration, effective decision
making, appropriate staffing, meaningful recognition, and authentic leadership (American Association of
Critical‐Care Nurses, 2005). Regarding the meaningful recognition standard, the AACN (2005) defined it as an
Meaningful Recognition 5
acknowledgment process that: is ongoing and builds on itself, is relevant to the person being recognized, is
congruent with the person’s contributions, and doesn’t occur automatically but is a response to the value they
add. The AACN (2005) wrote that “recognition of the value and meaningfulness of one’s contribution to an
organization’s work is a fundamental human need and an essential requisite to personal and professional
development. People who are not recognized feel invisible, undervalued, unmotivated, and disrespected” (p.
32). The critical elements of meaningful recognition as delineated by the AACN are listed in Table 1.
Other researchers have defined recognition as well. For instance Blegen, Goode, Johnson, Maas,
McCloskey, and Moorhead (1992) defined recognition as head nurse behaviors that acknowledge, with a show
of appreciation, staff nurse performance and achievement. The American Organization of Nurse Executives
(AONE) also realized the importance of a healthful work environment, and in 2004, indicated that nine
elements support it. Of the nine elements, two specifically address recognition (i.e., Element 8 – Recognition of
the Value of Nursing’s Contribution, and Element 9 – Recognition by Nurses for Their Meaningful Contribution
to Practice) (American Organization of Nurse Executives, 2004).
Recognition is important because it serves as a form of feedback. Feedback helps inform employees of
how well they are performing. Research has demonstrated that the value of feedback is so important to
individuals that they will actively monitor and seek feedback information from their environment, especially
when they aren’t formally receiving it (Ashford & Cummings, 1983). Organizations need to create performance
management systems that place a strong emphasis on providing and soliciting feedback (Piskurich, 2006; Prue
& Fairbank, 1981). Feedback seeking has been found to be necessary for accurate self‐assessment (Fletcher,
1999). Receiving positive feedback can increase an employee’s self‐esteem; and having a positive self‐identity
can lead to satisfaction at work. Brook (1991) reported that self‐identity (operationalized as the distance
between the actual‐self and ideal‐self) had a moderating role in how individuals perceived their success and
attitudes towards life. Specifically, they showed that positive self‐evaluation (low actual‐self vs. ideal‐self
discrepancy) was very strongly associated with paid employment that was seen as varied, challenging, and goal
oriented. Those individuals with high self‐esteem reported that they were happy with their performance in life.
Meaningful Recognition 6
Blegen et al. (1992) wrote “job satisfaction is thought to be a result of need fulfillment and recognition is
thought to satisfy by meeting higher‐order needs for self‐esteem” (p. 58).
Human beings have basic needs that require fulfillment and when their needs are not met, there is a
sense of frustration that occurs (Latham, 2007). One of the most influential theories of human needs is the
Hierarchy of Needs as introduced by Abraham Maslow. Maslow proposed that there were five human needs
arranged in a hierarchy. Each need requires fulfillment and attending to upper‐level needs can be frustrated by
not achieving the lower‐level needs first (Maslow, 1970). Two of these needs are important with regards to
receiving recognition. The first is called Social (Belonging) and the other is Ego (Esteem). The theory is shown in
Figure 1 (University of Tasmania, 2009). Social (Belonging) indicates our need to belong to a group and have
acceptance and a ‘give‐and‐take’ with others. Humans need to be needed. The second is Ego (Esteem) which
indicates our need to be competent and achieve mastery of our tasks, as well as our need for attention and
praise once we have attained our sense of competency. Fulfilling both of these higher level needs is critical in
order for a person to attain the highest level, which is Self Actualization. Self Actualization indicates our need
to maximize our potential, be peaceful with ourselves and our surroundings, and know that we are good.
Achieving a sense of self‐fulfillment is rewarding and will lead to true satisfaction with both careers and life
(Maslow, 1970).
An understanding that a person has achieved competency (and subsequently self‐actualization)
requires self awareness which is provided by feedback and recognition. McCarthy and Garavan (1999)
reported that the concept of self‐awareness plays a vital role in the context of career development. A smart
nursing manager will provide feedback recognition and include staff nurses in a collaborative effort. This is
important because collaborative leadership styles directly affect staff nurse satisfaction (Lucas, 1991). Lucas
(1991) reported that of 505 staff nurses who were surveyed, most were experiencing an authoritative style of
leadership but highly desired a participative management style with more two‐way communication and
cooperation. Authoritative leaders may request, and/or provide, smaller amounts of feedback. Management
style was strongly related to job satisfaction with a correlation of r = .61. Interestingly, nurses with greater
Meaningful Recognition 7
tenure reported more participative styles and hence more satisfaction than newer hires, but it was clear that
the older nurses were given more communication and more decision authority due to their experience.
Communication, especially about performance and achievement, was important. McNeese‐Smith (1997)
reported that in semi‐structured interviews with 30 nurses, the most appreciated leadership behavior
managers could demonstrate was recognition of a job well done. Manager support was cited as a reason for
both perceived job satisfaction and organizational commitment. The nurses reported that job satisfaction was
most influenced by the manager giving praise, recognition, and thanks. In the discussion of the results,
McNeese‐Smith (1997) indicated that nurse leaders need to create and find easy ways to thank the nurses
under their supervision.
Chan and Morrison (2000) reported in a survey of 113 nurses, that collegial cooperation and
recognition were among the factors that led directly to their decision to stay versus leave the organization.
Nearly 80% reported that recognition was a factor in deciding to stay, but over 70% of the respondents
reported that they had received no recognition for the work they had done!
Ulrich, Lavandero, Hart, Woods, Leggett, Friedman, D’Aurizio, and Edwards (2009) reported on results
of a 2008 survey of 5,562 nurses conducted by the AACN and compared the results to a similar survey the
AACN conducted in 2006. Nurses at both survey administrations rated the health of their individual work units
higher than the health of their organization as a whole. The efforts of the AACN to promote healthy work
environments may be helping though. As can be seen in Table 2, the amount of meaningful recognition that
nurses perceived as occurring has increased slightly from 2006 to 2008. However, Ulrich et al. (2009) also
wrote “although the huge majority of the responses were positive, some RNs with various lengths of practice
said that they had never received meaningful recognition from their organizations” (p. 98). Shirey and Fisher
(2008) reported in a national survey of nurses that 65% reported receiving no recognition for gaining
membership in professional nursing associations. Obviously recognition is important, and highly desired by
nurses, yet many nurses still perceive they aren’t getting it at work.
Meaningful Recognition 8
Positive Outcomes When Recognition is Present
The number one positive outcome of increased recognition of nurses’ performance is that it
contributes directly to higher job satisfaction (Blegen, 1993; Gelsema, van der Doef, Maes, Akerboom, &
Verhoeven, 2005; Goode & Blege, 1993; Hampton & Hampton, 2004; Hurst, Croker, & Bell, 1994; Lu et al.,
2005; Mills & Blaesing, 2000; Tourangeau & Cranley, 2006; Qaseem, Shea, Connor, & Casarett, 2007). Tett and
Meyer (1993) defined job satisfaction as an affective attachment to a job that can be viewed as an overall,
global perception, or it can be viewed in regards to particular aspects or facets of the job. An investigation of
the literature shows that there is a strong relationship between job satisfaction and the amount of recognition
one receives. For instance, Gelsema et al. (2005) reported on the results of a survey of 807 nurses in the
Netherlands that showed the relationship between support from their supervisor and job satisfaction was
significantly correlated at r = .38 and the relationship between support from their colleagues and satisfaction
was significantly correlated at r = .27. Multiple regression analysis also showed that the support shown from a
supervisor was a significant predictor of job satisfaction (β = .12). Hierarchical regression analysis showed that
reward was a significant predictor of job satisfaction (β = .23).
Schmalenberg and Kramer (2007) reported on survey results from 698 nurses working in intensive care
units and found that the nurses in neonatal intensive care units scored significantly higher in professional job
satisfaction than other types of intensive care units and neonatal intensive care units also scored significantly
higher on the components of a healthy work environment than the other types. Interestingly, these were the
same group of nurses who had the highest nurse‐assessed quality of patient care, which suggests the positive
link between satisfaction and job performance.
Mills and Blaesing (2000) reported on results from a survey conducted during the last nursing shortage
in 1989. The survey of 3298 Missouri nurses showed a serious problem then between how much support they
Meaningful Recognition 9
received from managers versus their career satisfaction. Apparently 20 years ago support and recognition was
as important to nurses as it is today, yet researchers today must still inculcate this message to get it heard.
Not only have quantitative studies clearly shown the strong relationship between recognition and job
satisfaction, qualitative studies too have shown this relationship. Qaseem et al. (2007) reported that an
analysis of the themes that emerged from semi‐structured interviews showed that of the 22 themes that
emerged, nine of these had to do with working relationships and support. Themes such as respect from others,
feeling valued as part of the team, emotional support from coworkers, and feedback on performance clearly
showed how important recognition was to the nurses who were interviewed.
Tourangeau and Cranley (2006) reported on the results of a survey of 8456 nurses that showed the
importance of praise and recognition. The obvious importance of recognition in their study was so apparent
that the authors wrote “priority should be placed on implementation of strategies that promote satisfaction in
the areas of praise and recognition, relationships with co‐workers, and with social interaction opportunities”
(p. 505). Job satisfaction is just one positive outcome from meaningful recognition. Another positive outcome
is commitment. Lu et al. (2005) reviewed the research on nurses’ job satisfaction and indicated that in
summary, both organizational commitment and career commitment were highly related to job satisfaction.
Meyer and Allen (1991) demonstrated three forms of commitment (affective, normative, and continuance). Of
the three types defined by Meyer and Allen (1991), the one most likely to be related to meaningful recognition
is affective commitment, and it is defined as the strength of a person’s involvement and identification with
their organization. Tett and Meyer (1993) found that job satisfaction and commitment were not the same
construct, but they were related, and each contributed uniquely to turnover intention.
Rusbult and Farrell (1983) reported results of a survey of nurses that showed that rewards (which
included feedback and coworker relations) were significantly related to both job satisfaction and commitment.
What was interesting in this study is that it was conducted as a longitudinal study and it compared the results
of employees who stayed in the organization with those who left. The results showed that the relationship
between rewards and job satisfaction for those employees who stayed ranged between r = .76 and .85
Meaningful Recognition 10
between time1 and time4. Furthermore, the results showed that correlations between rewards and job
commitment for those employees who stayed ranged between r = .53 and .62 between time1 and time4. Job
rewards exerted influence on satisfaction and commitment from the beginning and continued to be important
going forward. Those employees who left the job reported perceiving rewards as being lower. For those
employees who left the job, the correlations were reported as lower, and decreasing over time. This supports a
process where declining rewards distinguish between those who stay and those who leave. Perceptions of
declining rewards seemed to lead to declining commitment and declining job satisfaction.
Another positive outcome from nurses being satisfied with their job is work group cohesion and
collaboration. Tourangeau and Cranley (2006) reported that the level of teamwork, which they used as an
indicator for collaboration and workgroup cohesion, was a significant predictor of intention to remain
employed. Ingersoll, Olsan, Drew‐Cates, DeVinney, and Davies (2002) reported that in a survey of 1853 nurses
the relationship between job satisfaction and satisfaction with their interaction with peers was r = .81.
Furthermore, the nurses who intended to stay at their organization reported significantly higher levels of
satisfaction with their group interaction than those who indicated they were going to leave.
Larrabee et al. (2003) reported that job satisfaction was significantly related to group cohesion r = .35.
Finally, Sourdif (2004) reported in a survey of 108 nurses from Montreal that organizational commitment was
related to satisfaction with administration (r = .60) and satisfaction with their job (r = .43). Workgroup
cohesion was related to satisfaction with administration (r = .51), satisfaction with their job (r = .39), and
organizational commitment (r = .49). Each of these correlations was significant at the .01 level (two‐tailed).
Past research has also made the link between perceived organizational support and satisfaction.
O’Driscoll and Randall (1999) reported that perceived organizational support and satisfaction with rewards
appeared to be strong predictors of job involvement and employees’ affective attachment to the organization.
Employees who felt their organization supported them were more likely to score high on affective
commitment. Perceived organizational support was defined as the belief that their organization values their
Meaningful Recognition 11
contribution, considers their goals and interests, makes help available to solve problems, and cares about their
work satisfaction.
It is interesting to see that the research is very clear that organizations that support their employees
can garner many important outcomes such as job satisfaction, commitment, and a workforce that is
collaborative and cohesive. One way to demonstrate support is to give praise and recognition. Organizations
that make the effort to provide meaningful recognition should enjoy these positive outcomes; however
organizations that do not provide praise and recognition may also reap many negative outcomes that can be
detrimental to achieving their goals and mission.
Negative Outcomes When Recognition is Absent
The number one negative outcome when recognition for job performance is not given is dysfunctional
job turnover (Cartledge, 2001; Contino, 2002; Hayes, O’Brien‐Pallas, Duffield, Shamian, Buchan, Hughes,
Laschinger, North, & Stone, 2006; Hausknecht, Rodda, & Howard, 2009; Ingersoll et al. 2002; Janney,
Horstman, & Bane, 2001; Larrabee et al. 2003; Lu et al. 2005; Rusbult & Farrell, 1983; Takase, Maude, &
Manias, 2005; Tourangeau & Cranley, 2006; Sourdif, 2004). Contino (2002) reported that some organizations
report nursing turnover rates as high as 40%. She reported that while no quick fixes existed, targeted efforts at
creating cultures with two‐way communication and instilling a clear understanding of expectations could make
a difference. Contino (2002) wrote “to create innovative programs to retain staff, leaders must be able to
identify their employee’s best qualities and exalt them” (p. 13). She also reported that organizations have to
measure the costs involved in turnover including: separation and vacancy costs, recruitment costs, and
education costs. Once programs are implemented to reduce turnover (such as improved feedback and
recognition programs) the efficacy of the programs can be clearly computed by comparing the cost of
implementing the program versus the savings realized in reduced turnover, thus providing chief financial
officers with quantifiable proof of the program’s efficacy.
Some turnover can be functional and revitalize an organization (Larrabee et al., 2003). For instance,
nurses who retire may have a long tenure and therefore higher salaries than their newly graduated
Meaningful Recognition 12
replacements. Furthermore, some turnover may include nurses who were not satisfied with the organization
or their commute, and fresh faces can bring fresh ideas and new energy. High voluntary turnover can quickly
have negative consequences and become dysfunctional including: recruitment and new orientation costs, loss
of experienced nurses, periods of overtime due to shortage of staff, use of temporary agency nurses who may
be unfamiliar with the organization, and the potential for adverse patient outcomes (Larrabee, 2003). Hayes et
al. (2006) reviewed 130 articles on nursing turnover and indicated that over and over the biggest predictor of
turnover was job dissatisfaction. Hayes et al. (2006) reported that turnover is largely a result of low job
satisfaction and commitment, and that praise and recognition was one satisfaction factor, as was job
embeddedness. The Job embeddedness construct focuses on the accumulated reasons why a person stays in a
job. One of the largest contributors to dissatisfaction was nurses’ reported feelings of being undervalued
(Hayes et al., 2006).
Tourangeau and Cranley (2006) reported that job satisfaction was a direct predictor of nurse turnover,
and nurse manager support was an indirect predictor, in that support mediated the relationship between job
satisfaction and intent to remain. Tourangeau and Cranley (2006) wrote “nurses who were more satisfied with
the praise and recognition they received at work were more likely to remain employed at their current
hospitals” (p. 504). Sourdif (2004) reported that satisfaction at work was the variable that explained the most
intent to stay and it accounted for over 22% of the variance.
Takase et al. (2005) used person‐environment fit theories to investigate nurse behaviors and turnover
intention. The authors used polynomial regression to analyze the results of 346 questionnaires. The authors
were able to show that due to high levels of professionalism, nurses work hard to provide quality care even in
environments where they receive little support; yet these negative environments directly impacted their
intention to quit. Takase et al. (2005) wrote “while nurses’ job performance was explained by a curvilinear
relationship with their perception of the environmental characteristics, the results showed that nurses’
intention to quit their jobs was linearly related to their perceived environmental characteristics” (p. 895). This
article undertook a qualitative study as well as a quantitative study by conducting focus groups. One of the
Meaningful Recognition 13
themes that emerged from the qualitative analysis supported the quantitative results. More specifically, due to
professionalism the nurses tried to continue to provide quality care, but lack of support and recognition led to
an intention to leave.
Takase et al. (2005) reported this exchange from one of the focus groups:
[first focus group member] I think there is more effect on job satisfaction if you’re in an environment
where you’re not getting support and you’re just not being praised or you’re not being recognized,
overall the job satisfaction is decreased but not performance … [second focus group member] yes, if
you do have an awful workplace, you may eventually leave. (p. 896)
Janney et al. (2001) reported on one organization’s efforts to increase nurse satisfaction and retention. One of
the main factors that was reported during focus groups was the respect and recognition that nursing managers
provided. A series of retreats were conducted to get feedback from the staff nurses. Based on the feedback
received, a program was implemented that included listening to staff nurses, getting feedback on decisions,
and implementing formal and informal recognition programs. The authors reported that the organization
realized a turnover drop from 12% to 6.2%, as well as a 75% decrease in overtime. Cartledge (2001) reported
on results of a qualitative study to investigate reasons for turnover of intensive care nurses in the UK. She
reported that four themes emerged from interviews regarding reasons for turnover including: stress,
professional development, recognition and the respect of others, and the implications of shift work. The lack of
recognition led to the nurses feeling undervalued and not recognized for the contributions they were making.
Finally, Brady‐Schwartz (2005) reported that the Magnet® Recognition Program, which recognizes
excellence in long‐term or acute care nursing facilities, contributes to job satisfaction and this is related to a
decrease in turnover. In a survey of 470 RNs comparing non‐Magnet designated hospitals (n = 297) to Magnet
designated hospitals (n = 173), nurses from Magnet facilities reported significantly higher overall job
satisfaction scores and were also more likely to stay in their current position. Lacey, Cox, Lorfing, Teasley,
Carroll, and Sexton (2007) also reported that in a survey of 3,337 registered nurses, those from sites that had
achieved Magnet status (as well those nurses from Magnet‐aspiring sites) were more satisfied with their jobs
Meaningful Recognition 14
and they were more committed to their organization than nurses from non‐Magnet sites. In the process of
achieving Magnet status, nursing support features are put in place and these features appear effective in
influencing satisfaction and commitment, which in turn affects their intent to stay. In order to gain Magnet
status, a facility must demonstrate their ability to create a healthy work environment. Nurses want to continue
their employment in these healthy work environments.
Decreasing turnover is important because large rates of turnover are especially problematic given the
concurrent nursing shortage. What is becoming apparent is that some of the recent turnover includes the
nurses who have the most experience. Ingersoll et al. (2002) reported results from 1,853 nurses who
completed questionnaires. Overall satisfaction with their job was significantly higher for nurses who intended
to stay at the same employer in the same job compared to nurses who intended to stay at the same employer
but change jobs, and nurses who intended to change employers completely F(5, 1851) = 16.4, p < .0001; many
of the most satisfied and committed nurses reported their intent to leave nursing within the next five years.
Ingersoll et al. (2002) wrote “this exodus appears to be related primarily to the aging and retirement plans of
this group of nurses” (p. 256). This means that efforts should be made now to formally and informally
recognize the efforts of nurses who perform well, so the field appears attractive to newcomers. Attracting new
students to the field of nursing should be a dire critical mission for nurse executives. Attracting new recruits to
nursing can go hand in hand with efforts to retain nurses.
Before retention efforts are conducted it is important is to understand if retention factors for high
performers are the same as for low performers. Some research is reporting different retention factors for high
performers compared to low performers (Hausknecht et al., 2009). Hausknecht et al. (2009) reported that the
retention reasons most often mentioned by all survey respondents included: job satisfaction (51%), followed
by extrinsic rewards (41%), constituent attachments (34%), organizational commitment (17%), organizational
prestige (13%), lack of alternatives (10%), investments (9%), advancement opportunities (8%), location (8%),
organizational justice (7%), flexible work arrangements (7%), and non‐work influences (3%). When looking at
job performance levels though, it became apparent that reasons for staying given by high performers and non‐
Meaningful Recognition 15
hourly workers included advancement opportunities and organizational prestige, whereas the reasons given by
low performers and hourly employees most often included extrinsic rewards. This shows that if the goal is to
retain high performing employees, human resource management practices should attempt to target what is
valued most by this high‐performing group. Turnover is only one negative outcome seen in organizations that
don’t recognize employees; another is absenteeism. Lu et al. (2005) reported that job satisfaction was related
to absenteeism.
Demerouti, Bakker, Nachreiner, and Schaufeli (2000) reported that having too few resources (which
included performance feedback, job control, task variety, support from supervisors, rewards, and participation
in decision‐making) led to disengagement from work. They tested the results of surveys from 109 German
nurses using structural equation modeling. The final model that they tested showed nominally acceptable fit
indices including: χ2(80, N = 109) = 100.67, p = .059, and a GFI = .88, AGFI = .83, RMR = .05, NFI = .78, and CFI =
.94. Having too few resources contributed to disengagement because of stress and burnout. Stress and
burnout is another possible negative outcome from lack of support and recognition.
Demerouti et al. (2000) reported that high job demands alone did not predict stress among nurses, but
stress and burnout was found among nurses who were exposed to a demanding work environment with too
few job resources to combat the demands. Lu et al. (2005) reported that job satisfaction was related to stress
with a strong, negative correlation reported in the literature (r = ‐.61). Gelsema et al. (2005) reported that
rewards are important in the stress process. Rewards can act as a buffer by compensating for high effort. In
particular, social support of supervisors is important.
The final negative outcome that occurs when support and meaningful recognition are absent can
potentially affect everyone, especially those people most dependent on nurses’ performance, their patients.
Research has clearly shown that the quality of patient care can be jeopardized by unhealthy work
environments (Hayes et al., 2006; Lacey, Teasley, Henion, Cox, Bonura, & Brown, 2008). Hurst et al. (1994)
proposed that if staff members were satisfied with their organization and the amount of recognition they were
receiving, they should be better able to focus their energy on increasing the quality of patient care. McDaniel
Meaningful Recognition 16
and Patrick (1992) reported that levels of nursing turnover was highly related to patients’ perception of
satisfaction (r = ‐.98). Hampton and Hampton (2004) reported that rewards were more highly related to
professionalism than to job satisfaction in their model, supporting their hypothesis that professionalism can be
enhanced by a reward system that reinforces professional behavior. It is important to realize that there are
significant and positive relations between rewards, professionalism, and market orientation of nurses. Hayes
et al. (2006) reported in their review of the literature that patient satisfaction was linked to nurses’ job
satisfaction and most importantly, manager and organizational support for nurses was related to nurses’
assessments of quality care. Leiter, Harvie, & Frizzell (1998) wrote:
Patients on units where nurses found their work meaningful were more satisfied with all aspects of
their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more
frequently expressed the intention to quit were less satisfied with the various components of their
care. (p. 1611)
The quality of patient care has a direct impact of the wellness of patients. Zimmerman, Gruber‐Baldini, Hebel,
Sloane, and Magaziner (2002) reported that turnover rates of nurses were related to the infection and
hospitalization rates of residents in nursing homes. The authors used a sample of 2,285 residents from a
stratified, random sample of 59 nursing homes in Maryland between 1992 and 1995. The authors reported
that with each proportionate loss of a nurse (a full time nursing employee/100 beds) the risk of infection
increased almost 30% and the risk of hospitalization increased more than 80%. Some of the reasons given for
the relationship between nurse turnover and infection included that turnover: makes it more difficult to
establish and maintain effective control policies, may reduce the familiarity between staff and resident making
a change in resident status and detection of health changes harder to detect, may lead to inconsistent
supervision and training of staff, and may affect the climate of collaboration and professional nursing care. The
data also indicated that high rates of hospitalization for infection were associated with lack of administrative
emphasis on staff satisfaction.
Meaningful Recognition 17
Takase et al. (2005) indicated, as cited earlier, that nurses will strive to maintain professionalism and
patient care, even in toxic environments, but that turnover was directly affected. It could well be that the
nurses who remain try hard to continue to provide quality care, but when poor job satisfaction drives nurses to
find a better environment to work in, patient care is affected by short staff and possibly burnout among the
remaining nurses. The literature is clear that efforts to create healthy work environments with such programs
as meaningful recognition are important and have value to both nurses and their patients. There are many
great examples of such programs that have been implemented.
Success of Meaningful Recognition Programs
As reviewed above, lowered turnover rates and higher job satisfaction for nurses can be achieved with
meaningful recognition. Before implementing retention programs though it is important to understand what
nurses want. Lacey (2003) reported that surveys of nurses in 87 hospitals in North Carolina showed that
positive collegial environment and recognition programs were mentioned by 11% of the nurses who
responded. The number one factor in retention mentioned by the nurses was competitive wages (24%),
followed by flexible schedules (16%), opportunity for decision‐making input (15%), comprehensive benefits
(12%), professional development opportunities (11%), collegial environment (6%), recognition programs (5%),
bonus programs (5%), adequate staffing (4%), and a host of other reasons mentioned with small frequency.
Blegen et al. (1992) surveyed 341 nurses regarding the meaningfulness of recognition behaviors and wrote:
It is more important for head nurses to recognize outstanding performance than competent
performance or achievement. The most meaningful recognition that head nurses can provide is salary
increases commensurate with performance levels, private verbal feedback to the staff nurses, and
written acknowledgment of the staff nurses’ contributions. (p. 63)
Hensinger, Parry, Calarco, and Fuhrmann (2008) reported on a survey of 727 RNs regarding which Nurses’
Week celebrations and awards are most meaningful. The results show that nurses identify recognition and
acknowledgment as fundamental to Nurses’ Week. Providing educational events and opportunities were
considered the most meaningful types of recognition.
Meaningful Recognition 18
Cronin and Becherer (1999) proposed that reward programs should have cost savings due to:
improved recruitment, decreased turnover, increased job satisfaction, and increased motivation (which should
lead to better performance). While their study did not specifically assess the return on investment for
recognition programs, Cronin and Becherer (1999) did report an interesting finding from their survey of 287
staff nurses and 55 nurse managers. In the survey, nursing managers believed that staff nurses would most
highly value recognition from managers and supervisors; however staff nurses actually ranked recognition
from patients and families as the highest source of recognition. Staff nurses also rated recognition from
coworkers as second highest. Recognition from managers and supervisors was only ranked third. Ulrich et al.
(2009) reported that in their follow‐up survey, most of the meaningful recognition came from patients and
families (48.9%) and from other RNs (27.0%), whereas nurse administrators were less, only (8.5%), as were
front‐line nurse managers (7.7%), physicians (4.6%), and other healthcare colleagues (3.3%).
It is important that employees realize that recognition is given as a special reward for exemplary
service and performance. If employees see recognition programs as a normal part of the organization’s system,
or a requirement of managers, recognition can become an entitlement instead of an extra gesture of
appreciation (Graham & Unruh, 1990; McConnell, 1997). Furthermore, communication regarding why the
recognition was given should be clear to all. McConnell (1997) wrote “when employees see a peer recognized,
they need to be able to think: if I achieve the same kinds of results, I can be similarly honored” (p. 90). This can
increase everyone’s performance and contribute to the organization’s success.
Hurst et al. (1994) cited literature that reported savings from public posting recognition programs
ranging from $600 to $105,000 per year. Return on investment will be easier to achieve with cheaper
recognition programs. Programs do not have to be expensive though. Graham and Unruh (1990) reported in a
survey of 175 medical technologists that a manager giving verbal praise was the top‐rated motivation
technique, with written praise a close second and public recognition also near the top. Bylone (2008) reported
on the success of a simple solution where a bulletin board was hung with notes that nurses had received from
patients and families thanking a staff member for going the extra mile. Blank note cards were also placed next
Meaningful Recognition 19
to the bulletin board so that patients and families could write and post thank‐you notes. The article mentioned
some touching notes that had been left. Webb, Tour, Hurt, and van Kammen (1992) reported on the success of
a recognition program where during each quarter there is a week designed as ‘ratings week’ where entire units
can be recognized for their excellence. The program consists of an engraved brass trophy which is presented to
the winner by the previous winner. Breakfast and dinner parties are also held with remarks by the Medical
Center Director and Chief of Staff. Photographs are taken and a display is prepared by the public relations
office. The program has been credited with improving productivity and decreasing turnover. The authors make
a very valid point; recognition should take place more than just once per year.
Keyes (1994) reported that a career ladder program had been implemented with little success. Career
ladder programs reward nurses who achieve some type of professional development by increasing their career
progression rate. The staff nurses indicated that there were several probable reasons for the failure of the
career ladder program including: those who participated were not necessarily the outstanding nurses, those
who participated were mostly driven by the potential for salary increases, one of the criteria for being
rewarded required extracurricular work and committee work which caused those nurses to leave the floor, the
heavy paperwork for the program took time away from the nurses working with patients, once awarded in the
career ladder program annual renewal was assured, animosity developed and a negative aura began to
surround the program so that winners hid or downplayed receiving the reward because of negative feelings
from peers. With less than 10% of the nurses participating, the program was scrapped and a new recognition
program was implemented. The new program’s development utilized significant involvement and input from
the staff nurses in its design, it required unit specific peer assessment where the nurses themselves participate
in the selection of the winners, and the program rank ordered the nurses in the unit to ensure that the best
nurses were being rewarded. The new system has been successful. Keyes (1994) reported that two years into
the program 75% of the staff nurses participated, approximately 25% of the nurses are being recognized,
nurses are now proud of the award, units feel empowered to make changes to the program when needed, and
there is never any difficulty finding members to participate in the committee.
Meaningful Recognition 20
Goode and Blegen (1993) reported on another successful recognition program for outstanding
performers. Five types of recognition were incorporated including: private written feedback, public
acknowledgment, written acknowledgment, opportunities for growth and participation, and compensation.
Logs kept by head nurses showed that the most often used type of recognition was opportunities for growth
and participation. One important outcome was that retention of nurses increased from a pre‐program
turnover rate that ranged between 8% and 10%, to a new, lower range of 2% to 4%. Alspach (2007) reported
on an unusual approach for peer recognition where nurses can give recognition to a peer by requesting that
should they themselves become critically ill, their chosen peer will be their nurse. Alspach (2007) wrote “I
cannot think of a more straightforward and elegant way for one critical care nurse to recognize another than
by placing his or her life in the other’s hands (and heart and mind)” (p. 8).
Meraviglia, Grobe, Tabone, Wainwright, Shelton, Miner, and Jordan (2009) reported on the Nurse‐
Friendly Hospital Project which assisted 30 rural and small hospitals in Texas with creating a positive work
environment. Twelve nurse friendly criteria were developed. One of the criteria was nurse recognition where
the facilities would invest in an ongoing nurse recognition program with achievement awards, special
acknowledgements, and developmental incentive opportunities. The nurses responded to surveys at time1,
and 6‐9 months later at time2. Nurses’ perceptions of receiving recognition increased significantly during that
time, as did their perceptions of quality initiatives to improve patient care.
Robbins (2005) reported on rewards and recognition programs specifically designed to increase safety.
The steps he suggested would apply for any type of recognition program including recognition programs
designed to reward excellent performance, increase job satisfaction, or decrease turnover. The key is to be
sure that the right steps are taken. The first step is to create a campaign that addresses how its performance
will be measured and it should include a marketing plan with objectives, tactics, budgets, roles,
responsibilities, timelines, and return on investment measures. Next, be sure to set clear and realistic goals. Be
sure to get buy in from everyone in the organization from the top executives, to the staff nurses. Employee
focus groups can uncover potential pitfalls before implementation begins and this helps ensure buy in.
Meaningful Recognition 21
Consider a team approach. Once the program begins, be sure to communicate well using varied approaches
such as posters, meeting announcements, e‐mails, and newsletters. Consider the role of emotion and include
fun and creativity in the program. Hold impromptu parties with fun ways to generate laughs and a positive
aura around the program. Robbins (2005) also mentioned the need for meaningful recognition to be more
than just compensation. It is critical that the program be seen as fair. It shouldn’t be just a popularity contest.
Carefully consider the rewards that will be used. Monitor the campaign and analyze the results. If the program
doesn’t appear to be working, find out why by asking staff for their input. Finally, present the program with
passion. Robbins (2005) wrote: “Sincerity and recognition go a long way toward making people feel
appreciated for their effort and for making others mindful that management cares” (p. 50).
One exciting recognition program is the DAISY Award for Extraordinary Nurses. Details about this
inspiring award can be found at their website www.DAISYfoundation.org. The following information, taken
from their website, reports that in 2009 over 5,000 nurses have already received the award. Well over 400
hospitals participate and the number is growing. The award is given monthly at large hospitals or quarterly at
smaller hospitals. DAISY is actually an acronym that stands for diseases attacking the immune system. The
foundation was started by two parents who were moved by the dedication of the nurses who helped them
when their son developed idiopathic thrombocytopenic purpura, a disease of the immune system. The DAISY
Award recipients each receive a certificate, a DAISY Award winner’s pin, a hand‐carved Shona sculpture
entitled A Healer’s Touch which is carved by artists of the Shona Tribe in Zimbabwe, and a presentation
ceremony where Cinnabons® cinnamon rolls are served. The DAISY Foundation asks that nurses remind
themselves whenever they eat or smell a Cinnabon® roll to reflect on how nurses make a difference in people’s
lives. Nominations for the DAISY Award can be written by coworkers, patients, families, physicians, or staff.
Nurses who receive a nomination also get a pin.
More research needs to be done on the topic of meaningful recognition in nursing. While the AACN did
a remarkable job of explaining the critical elements in meaningful recognition (see Table 1), more research on
the link between meaningful recognition and job satisfaction must be done. With both the AACN and the
Meaningful Recognition 22
AONE reporting that meaningful recognition is important to maintaining healthy work environments, an
improved understanding of the outcomes of meaningful recognition is needed. Daehlen (2008) wrote “a key
area for further research on nurses’ job retention seems to be the relationships between their reasons for
leaving the workforce, job satisfaction and the determinants of job satisfaction” (p. 1798). While meaningful
recognition should improve nurses’ job satisfaction, more research is needed on the link. Given the projected
shortage of nurses, and the importance that nurses make to society, this research should be deemed critical.
Meaningful Recognition 23
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Meaningful Recognition 29
Table 1
Critical Elements of Meaningful Recognition as Outlined in the AACN Standards
for a Healthy Work Environment
Critical Elements
The healthcare organization has a comprehensive system in place that includes formal processes and structured forums that ensure a sustainable focus on recognizing all team members for their contributions and the value they bring to the work of the organization.
The healthcare organization establishes a systematic process for all team members to learn about the institution’s recognition system and how to participate by recognizing the contributions of colleagues and the value they bring to the organization.
The healthcare organization’s recognition system reaches from the bedside to the board table, ensuring that individuals receive recognition consistent with their personal definition of meaning, fulfillment, development, and advancement at every stage of their professional career.
The healthcare organization’s recognition system includes processes which validate that recognition is meaningful to those being acknowledged.
Team members understand that everyone is responsible for playing an active role in the organization’s recognition program and meaningfully recognizing contributions.
The healthcare organization regularly and comprehensively evaluates its recognition system, ensuring effective programs that help move the organization toward a sustainable culture of excellence that values meaningful recognition.
Taken from American Association of Critical‐Care Nurses (2005)
Meaningful Recognition 30
Table 2
A Comparison of Nurses’ Perceptions of Their Work Environments in an AACN 2006 Survey to a Follow‐up AACN Survey in 2008
Statement 1: RNs are recognized for the value each brings to the organization:
Strongly Agree Agree Disagree Strongly Disagree
In the RN’s organization, 2006 10.8 46.2 32.5 10.5
In the RN’s organization, 2008 10.9 48.6 32.1 8.3
In the RN’s work unit, 2006 17.8 46.9 25.6 9.7
In the RN’s work unit, 2008 18.3 48.1 25.9 7.7
Statement 2: RNs recognize others for the value they bring to the work of the organization:
In the RN’s organization, 2006 8.2 58.5 28.7 4.6
In the RN’s organization, 2008 9.7 60.0 26.4 3.8
In the RN’s work unit, 2006 15.8 57.9 22.0 4.3
In the RN’s work unit, 2008 17.6 58.2 20.7 3.4
Taken from Ulrich et al. (2009)
Meaningful Recognition 31
Figure 1. Abraham Maslow’s human needs theory.
Taken from http://www.ruralhealth.utas.edu.au/comm‐lead/leadership/maslow‐diagram.htm
Meaningful Recognition 32
ABOUT PSYCHOLOGICAL ASSOCIATES®
Psychological Associates is a firm of behavioral scientists who apply behavioral science principles to the work
place to improve staff performance. Their fifty years of experience has proven that increasing synergy,
collaboration, candor, and trust to business practices/strategies leads to better business outcomes. In their
health care practice, PA offers a variety of services to create and sustain a healthy work environment. They
help health care executives hone the people skills that contribute directly to successful outcomes. They
transform nurses into nurse‐leaders equipped to meet challenges in health care today — leaders who can
focus the energy and enthusiasm of others on the mission and vision of an organization. They develop leaders
“from the bedside to the boardroom.” PA’s health care team members have worked in hospitals for many
years as physicians, nurses and leaders. As each member has walked in the shoes of a health care provider,
they know what works and what will not.
This literature review was conducted for The DAISY Foundation as a donation from PA to help us understand
the impact recognition has on nurses’ workplace and commitment to their work and colleagues. Our profound
gratitude to Dr. Cindy Lefton, RN, PhD, and Rick Breugger, M.A. for their fine work.
For more information about PA, please visit www.q4solutions.com
Reward & Recognition. Objective To assist you in implementing a reward and recognition program that will be meaningful to your Employee/ Channels and
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