Literature Review Nursing

8/6/2019 Literature Review Nursing

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MeaningfulRecognition 1

LiteratureReviewonMeaningfulRecognitioninNursingPsychologicalAssociatesandDAISYFoundation

Copyright Psychological Associates [2009]


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TABLEOFCONTENTSAbstract..Page3

LiteratureReviewonMeaningfulRecognitioninNursing.Page4

PositiveOutcomesWhenRecognitionisPresent...Page8

NegativeOutcomesWhenRecognitionisAbsent..Page11

SuccessofMeaningfulRecognitionPrograms..Page17

ReferencesPage23

Table1:CriticalElementsofMeaningfulRecognitionasOutlinedinthe

AACNStandardsforaHealthyWork

Environment..................Page29

Table2:AComparisonofNursesPerceptionsofTheirWork

EnvironmentsinanAACN2006SurveytoaFollowupAACNSurveyin

2008.Page30

Figure1:AbrahamMaslowshumanneedstheory...Page31

AboutPsychologicalAssociatesPage32


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Abstract

MeaningfulrecognitioncontributestohealthyworkenvironmentsandhasbeendelineatedbytheAmerican

AssociationofCriticalCareNurses(2005)asoneofthekeystoestablishingandmaintaininghealthywork

environmentsfornurses.Thisliteraturereviewrevealsthatmeaningfulrecognitionhasbeenlinkedtosuch

positiveoutcomesasjobsatisfaction,organizationalandcareercommitment,cohesionandcollaboration,and

perceivedorganizationalsupport.Alackofmeaningfulrecognitionhasbeenlinkedtonegativeoutcomessuch

asabsenteeismandturnover,stressandburnout,anddecreasedqualityofpatientcare.Researchonhowto

bestconductrecognitionprogramsisprovided.Oneexampleisoffered,theDAISYAwardforExtraordinary

Nurses.Moreresearchisneededonthelinkbetweenrecognitionandnursesjobsatisfaction.


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LiteratureReviewonMeaningfulRecognitioninNursing

Itprobablywouldnttakefancyresultsofformal,scientificresearchtosellnursesontheideathat

they,andtheircolleagues,appreciatebeingrecognizedwhentheydoagoodjob.Itmightalsoseemintuitive

thatreceivingrecognitionforworkinghardcanhelpincreasejobsatisfaction.Yetformanynurses,italso

doesnttakelongtothinkofexampleswhentheirorganizationseitherdidntrealizethis,oriftheydid,they

didnttakethetimeormaketheeffort.Theresearchdoesexistthough,andwithoutadoubtitshowsthat

recognitioncontributesdirectlytojobsatisfaction(Cronin&Becherer,1999;Lu,While,&Barriball,2005).Yet

asintuitiveasthismayseem,theAmericanAssociationofCriticalCareNurses(AACN)stillfelttheneedin

2005tospecifythatmeaningfulrecognitionisoneofthesix,keystandardsnecessarytoestablishandsustaina

healthyworkingenvironment(Shirey,2006).Thisservesasagiantcluethattoomanynursesstillmusttolerate

unhealthyworkenvironmentsandtoolittlemeaningfulrecognition(Bylone,2008).Theshortageofnursesis

criticalandisaworldwideproblem(Tourangeau&Cranley,2006).Jobsatisfactionisstronglyassociatedwith

intentiontoremainattheorganization(Larrabee,Janney,Ostrow,Withrow,Hobbs,&Burant,2003;Sourdif,

2004).Thisliteraturereviewwillreciteandrevealtheresearchshowingthatmeaningfulrecognitioninhealthy

workenvironmentswillproduceremarkableoutcomesfornurses,andperhapsmostimportantly,fortheir

patients.

TheAACNfeltthattherewasenoughevidencetoshowthatunhealthyworkenvironmentscontribute

tomedicalerrors,conflictandstressamonghealthprofessionals,andineffectivedeliveryofpatientcare.

Effortswereneededtospellouthowhealthyworkenvironmentscouldbecreatedandsustained.They

delineatedsixessentialstandardsincluding:skilledcommunication,truecollaboration,effectivedecision

making,appropriatestaffing,meaningfulrecognition,andauthenticleadership(AmericanAssociationof

CriticalCareNurses,2005).Regardingthemeaningfulrecognitionstandard,theAACN(2005)defineditasan


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acknowledgmentprocessthat:isongoingandbuildsonitself,isrelevanttothepersonbeingrecognized,is

congruentwiththepersonscontributions,anddoesntoccurautomaticallybutisaresponsetothevaluethey

add.TheAACN(2005)wrotethatrecognitionofthevalueandmeaningfulnessofonescontributiontoan

organizationsworkisafundamentalhumanneedandanessentialrequisitetopersonalandprofessional

development.Peoplewhoarenotrecognizedfeelinvisible,undervalued,unmotivated,anddisrespected(p.

32).ThecriticalelementsofmeaningfulrecognitionasdelineatedbytheAACNarelistedinTable1.

Otherresearchershavedefinedrecognitionaswell.ForinstanceBlegen,Goode,Johnson,Maas,

McCloskey,andMoorhead(1992)definedrecognitionasheadnursebehaviorsthatacknowledge,withashow

ofappreciation,staffnurseperformanceandachievement.TheAmericanOrganizationofNurseExecutives

(AONE)alsorealizedtheimportanceofahealthfulworkenvironment,andin2004,indicatedthatnine

elementssupportit.Ofthenineelements,twospecificallyaddressrecognition(i.e.,Element8Recognitionof

theValueofNursingsContribution,andElement9RecognitionbyNursesforTheirMeaningfulContribution

toPractice)(AmericanOrganizationofNurseExecutives,2004).

Recognitionisimportantbecauseitservesasaformoffeedback.Feedbackhelpsinformemployeesof

howwelltheyareperforming.Researchhasdemonstratedthatthevalueoffeedbackissoimportantto

individualsthattheywillactivelymonitorandseekfeedbackinformationfromtheirenvironment,especially

whentheyarentformallyreceivingit(Ashford&Cummings,1983).Organizationsneedtocreateperformance

managementsystemsthatplaceastrongemphasisonprovidingandsolicitingfeedback(Piskurich,2006;Prue

&Fairbank,1981).Feedbackseekinghasbeenfoundtobenecessaryforaccurateselfassessment(Fletcher,

1999).Receivingpositivefeedbackcanincreaseanemployeesselfesteem;andhavingapositiveselfidentitycanleadtosatisfactionatwork.Brook(1991)reportedthatselfidentity(operationalizedasthedistancebetweentheactualselfandidealself)hadamoderatingroleinhowindividualsperceivedtheirsuccessand

attitudestowardslife.Specifically,theyshowedthatpositiveselfevaluation(lowactualselfvs.idealself

discrepancy)wasverystronglyassociatedwithpaidemploymentthatwasseenasvaried,challenging,andgoal

oriented.Thoseindividualswithhighselfesteemreportedthattheywerehappywiththeirperformanceinlife.


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Blegenetal.(1992)wrotejobsatisfactionisthoughttobearesultofneedfulfillmentandrecognitionis

thoughttosatisfybymeetinghigherorderneedsforselfesteem(p.58).

Humanbeingshavebasicneedsthatrequirefulfillmentandwhentheirneedsarenotmet,thereisa

senseoffrustrationthatoccurs(Latham,2007).Oneofthemostinfluentialtheoriesofhumanneedsisthe

HierarchyofNeedsasintroducedbyAbrahamMaslow.Maslowproposedthattherewerefivehumanneeds

arrangedinahierarchy.Eachneedrequiresfulfillmentandattendingtoupperlevelneedscanbefrustratedby

notachievingthelowerlevelneedsfirst(Maslow,1970).Twooftheseneedsareimportantwithregardsto

receivingrecognition.ThefirstiscalledSocial(Belonging)andtheotherisEgo(Esteem).Thetheoryisshownin

Figure1(UniversityofTasmania,2009).Social(Belonging)indicatesourneedtobelongtoagroupandhave

acceptanceandagiveandtakewithothers.Humansneedtobeneeded.ThesecondisEgo(Esteem)which

indicatesourneedtobecompetentandachievemasteryofourtasks,aswellasourneedforattentionand

praiseoncewehaveattainedoursenseofcompetency.Fulfillingbothofthesehigherlevelneedsiscriticalin

orderforapersontoattainthehighestlevel,whichisSelfActualization.SelfActualizationindicatesourneed

tomaximizeourpotential,bepeacefulwithourselvesandoursurroundings,andknowthatwearegood.

Achievingasenseofselffulfillmentisrewardingandwillleadtotruesatisfactionwithbothcareersandlife

(Maslow,1970).

Anunderstandingthatapersonhasachievedcompetency(andsubsequentlyselfactualization)

requiresselfawarenesswhichisprovidedbyfeedbackandrecognition.McCarthyandGaravan(1999)

reportedthattheconceptofselfawarenessplaysavitalroleinthecontextofcareerdevelopment.Asmart

nursingmanagerwillprovidefeedbackrecognitionandincludestaffnursesinacollaborativeeffort.Thisis

importantbecausecollaborativeleadershipstylesdirectlyaffectstaffnursesatisfaction(Lucas,1991).Lucas

(1991)reportedthatof505staffnurseswhoweresurveyed,mostwereexperiencinganauthoritativestyleof

leadershipbuthighlydesiredaparticipativemanagementstylewithmoretwowaycommunicationand

cooperation.Authoritativeleadersmayrequest,and/orprovide,smalleramountsoffeedback.Management

stylewasstronglyrelatedtojobsatisfactionwithacorrelationofr=.61.Interestingly,nurseswithgreater


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tenurereportedmoreparticipativestylesandhencemoresatisfactionthannewerhires,butitwasclearthat

theoldernursesweregivenmorecommunicationandmoredecisionauthorityduetotheirexperience.

Communication,especiallyaboutperformanceandachievement,wasimportant.McNeeseSmith(1997)

reportedthatinsemistructuredinterviewswith30nurses,themostappreciatedleadershipbehavior

managerscoulddemonstratewasrecognitionofajobwelldone.Managersupportwascitedasareasonfor

bothperceivedjobsatisfactionandorganizationalcommitment.Thenursesreportedthatjobsatisfactionwas

mostinfluencedbythemanagergivingpraise,recognition,andthanks.Inthediscussionoftheresults,

McNeeseSmith(1997)indicatedthatnurseleadersneedtocreateandfindeasywaystothankthenurses

undertheirsupervision.

ChanandMorrison(2000)reportedinasurveyof113nurses,thatcollegialcooperationand

recognitionwereamongthefactorsthatleddirectlytotheirdecisiontostayversusleavetheorganization.

Nearly80%reportedthatrecognitionwasafactorindecidingtostay,butover70%oftherespondents

reportedthattheyhadreceivednorecognitionfortheworktheyhaddone!

Ulrich,Lavandero,Hart,Woods,Leggett,Friedman,DAurizio,andEdwards(2009)reportedonresults

ofa2008surveyof5,562nursesconductedbytheAACNandcomparedtheresultstoasimilarsurveythe

AACNconductedin2006.Nursesatbothsurveyadministrationsratedthehealthoftheirindividualworkunits

higherthanthehealthoftheirorganizationasawhole.TheeffortsoftheAACNtopromotehealthywork

environmentsmaybehelpingthough.AscanbeseeninTable2,theamountofmeaningfulrecognitionthat

nursesperceivedasoccurringhasincreasedslightlyfrom2006to2008.However,Ulrichetal.(2009)also

wrotealthoughthehugemajorityoftheresponseswerepositive,someRNswithvariouslengthsofpractice

saidthattheyhadneverreceivedmeaningfulrecognitionfromtheirorganizations(p.98). ShireyandFisher

(2008)reportedinanationalsurveyofnursesthat65%reportedreceivingnorecognitionforgaining

membershipinprofessionalnursingassociations.Obviouslyrecognitionisimportant,andhighlydesiredby

nurses,yetmanynursesstillperceivetheyarentgettingitatwork.


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PositiveOutcomesWhenRecognitionisPresent

Thenumberonepositiveoutcomeofincreasedrecognitionofnursesperformanceisthatit

contributesdirectlytohigherjobsatisfaction(Blegen,1993;Gelsema,vanderDoef,Maes,Akerboom,&

Verhoeven,2005;Goode&Blege,1993;Hampton&Hampton,2004;Hurst,Croker,&Bell,1994;Luetal.,

2005;Mills&Blaesing,2000;Tourangeau&Cranley,2006;Qaseem,Shea,Connor,&Casarett,2007).Tettand

Meyer(1993)definedjobsatisfactionasanaffectiveattachmenttoajobthatcanbeviewedasanoverall,

globalperception,oritcanbeviewedinregardstoparticularaspectsorfacetsofthejob.Aninvestigationof

theliteratureshowsthatthereisastrongrelationshipbetweenjobsatisfactionandtheamountofrecognition

onereceives. Forinstance,Gelsemaetal.(2005)reportedontheresultsofasurveyof807nursesinthe

Netherlandsthatshowedtherelationshipbetweensupportfromtheirsupervisorandjobsatisfactionwas

significantlycorrelatedatr=.38andtherelationshipbetweensupportfromtheircolleaguesandsatisfaction

wassignificantlycorrelatedatr=.27.Multipleregressionanalysisalsoshowedthatthesupportshownfroma

supervisorwasasignificantpredictorofjobsatisfaction( =.12).Hierarchicalregressionanalysisshowedthat

rewardwasasignificantpredictorofjobsatisfaction( =.23).

SchmalenbergandKramer(2007)reportedonsurveyresultsfrom698nursesworkinginintensivecare

unitsandfoundthatthenursesinneonatalintensivecareunitsscoredsignificantlyhigherinprofessionaljob

satisfactionthanothertypesofintensivecareunitsandneonatalintensivecareunitsalsoscoredsignificantly

higheronthecomponentsofahealthyworkenvironmentthantheothertypes.Interestingly,thesewerethe

samegroupofnurseswhohadthehighestnurseassessedqualityofpatientcare,whichsuggeststhepositive

linkbetweensatisfactionandjobperformance.

MillsandBlaesing(2000)reportedonresultsfromasurveyconductedduringthelastnursingshortage

in1989.Thesurveyof3298Missourinursesshowedaseriousproblemthenbetweenhowmuchsupportthey


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receivedfrommanagersversustheircareersatisfaction.Apparently20yearsagosupportandrecognitionwas

asimportanttonursesasitistoday,yetresearcherstodaymuststillinculcatethismessagetogetitheard.

Notonlyhavequantitativestudiesclearlyshownthestrongrelationshipbetweenrecognitionandjob

satisfaction,qualitativestudiestoohaveshownthisrelationship.Qaseemetal.(2007)reportedthatan

analysisofthethemesthatemergedfromsemistructuredinterviewsshowedthatofthe22themesthat

emerged,nineofthesehadtodowithworkingrelationshipsandsupport.Themessuchasrespectfromothers,

feelingvaluedaspartoftheteam,emotionalsupportfromcoworkers,andfeedbackonperformanceclearly

showedhowimportantrecognitionwastothenurseswhowereinterviewed.

TourangeauandCranley(2006)reportedontheresultsofasurveyof8456nursesthatshowedthe

importanceofpraiseandrecognition.Theobviousimportanceofrecognitionintheirstudywassoapparent

thattheauthorswrotepriorityshouldbeplacedonimplementationofstrategiesthatpromotesatisfactionin

theareasofpraiseandrecognition,relationshipswithcoworkers,andwithsocialinteractionopportunities

(p.505).Jobsatisfactionisjustonepositiveoutcomefrommeaningfulrecognition.Anotherpositiveoutcome

iscommitment.Luetal.(2005)reviewedtheresearchonnursesjobsatisfactionandindicatedthatin

summary,bothorganizationalcommitmentandcareercommitmentwerehighlyrelatedtojobsatisfaction.

MeyerandAllen(1991)demonstratedthreeformsofcommitment(affective,normative,andcontinuance).Of

thethreetypesdefinedbyMeyerandAllen(1991),theonemostlikelytoberelatedtomeaningfulrecognition

isaffectivecommitment,anditisdefinedasthestrengthofapersonsinvolvementandidentificationwith

theirorganization.TettandMeyer(1993)foundthatjobsatisfactionandcommitmentwerenotthesame

construct,buttheywererelated,andeachcontributeduniquelytoturnoverintention.

RusbultandFarrell(1983)reportedresultsofasurveyofnursesthatshowedthatrewards(which

includedfeedbackandcoworkerrelations)weresignificantlyrelatedtobothjobsatisfactionandcommitment.

Whatwasinterestinginthisstudyisthatitwasconductedasalongitudinalstudyanditcomparedtheresults

ofemployeeswhostayedintheorganizationwiththosewholeft.Theresultsshowedthattherelationship

betweenrewardsandjobsatisfactionforthoseemployeeswhostayedrangedbetweenr=.76and.85


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betweentime1andtime4.Furthermore,theresultsshowedthatcorrelationsbetweenrewardsandjob

commitmentforthoseemployeeswhostayedrangedbetweenr=.53and.62betweentime1andtime4.Job

rewardsexertedinfluenceonsatisfactionandcommitmentfromthebeginningandcontinuedtobeimportant

goingforward.Thoseemployeeswholeftthejobreportedperceivingrewardsasbeinglower.Forthose

employeeswholeftthejob,thecorrelationswerereportedaslower,anddecreasingovertime.Thissupportsa

processwheredecliningrewardsdistinguishbetweenthosewhostayandthosewholeave.Perceptionsof

decliningrewardsseemedtoleadtodecliningcommitmentanddecliningjobsatisfaction.

Anotherpositiveoutcomefromnursesbeingsatisfiedwiththeirjobisworkgroupcohesionand

collaboration.TourangeauandCranley(2006)reportedthatthelevelofteamwork,whichtheyusedasan

indicatorforcollaborationandworkgroupcohesion,wasasignificantpredictorofintentiontoremain

employed.Ingersoll,Olsan,DrewCates,DeVinney,andDavies(2002)reportedthatinasurveyof1853nurses

therelationshipbetweenjobsatisfactionandsatisfactionwiththeirinteractionwithpeerswasr=.81.

Furthermore,thenurseswhointendedtostayattheirorganizationreportedsignificantlyhigherlevelsof

satisfactionwiththeirgroupinteractionthanthosewhoindicatedtheyweregoingtoleave.

Larrabeeetal.(2003)reportedthatjobsatisfactionwassignificantlyrelatedtogroupcohesionr=.35.

Finally,Sourdif(2004)reportedinasurveyof108nursesfromMontrealthatorganizationalcommitmentwas

relatedtosatisfactionwithadministration(r=.60)andsatisfactionwiththeirjob(r=.43).Workgroup

cohesionwasrelatedtosatisfactionwithadministration(r=.51),satisfactionwiththeirjob(r=.39),and

organizationalcommitment(r=.49).Eachofthesecorrelationswassignificantatthe.01level(twotailed).

Pastresearchhasalsomadethelinkbetweenperceivedorganizationalsupportandsatisfaction.

ODriscollandRandall(1999)reportedthatperceivedorganizationalsupportandsatisfactionwithrewards

appearedtobestrongpredictorsofjobinvolvementandemployeesaffectiveattachmenttotheorganization.

Employeeswhofelttheirorganizationsupportedthemweremorelikelytoscorehighonaffective

commitment.Perceivedorganizationalsupportwasdefinedasthebeliefthattheirorganizationvaluestheir


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contribution,considerstheirgoalsandinterests,makeshelpavailabletosolveproblems,andcaresabouttheir

worksatisfaction.

Itisinterestingtoseethattheresearchisveryclearthatorganizationsthatsupporttheiremployees

cangarnermanyimportantoutcomessuchasjobsatisfaction,commitment,andaworkforcethatis

collaborativeandcohesive.Onewaytodemonstratesupportistogivepraiseandrecognition.Organizations

thatmaketheefforttoprovidemeaningfulrecognitionshouldenjoythesepositiveoutcomes;however

organizationsthatdonotprovidepraiseandrecognitionmayalsoreapmanynegativeoutcomesthatcanbe

detrimentaltoachievingtheirgoalsandmission.

NegativeOutcomesWhenRecognitionisAbsent

Thenumberonenegativeoutcomewhenrecognitionforjobperformanceisnotgivenisdysfunctional

jobturnover(Cartledge,2001;Contino,2002;Hayes,OBrienPallas,Duffield,Shamian,Buchan,Hughes,

Laschinger,North,&Stone,2006;Hausknecht,Rodda,&Howard,2009;Ingersolletal.2002;Janney,

Horstman,&Bane,2001;Larrabeeetal.2003;Luetal.2005;Rusbult&Farrell,1983;Takase,Maude,&

Manias,2005;Tourangeau&Cranley,2006;Sourdif,2004).Contino(2002)reportedthatsomeorganizations

reportnursingturnoverratesashighas40%.Shereportedthatwhilenoquickfixesexisted,targetedeffortsat

creatingcultureswithtwowaycommunicationandinstillingaclearunderstandingofexpectationscouldmake

adifference.Contino(2002)wrotetocreateinnovativeprogramstoretainstaff,leadersmustbeableto

identifytheiremployeesbestqualitiesandexaltthem(p.13).Shealsoreportedthatorganizationshaveto

measurethecostsinvolvedinturnoverincluding:separationandvacancycosts,recruitmentcosts,and

educationcosts.Onceprogramsareimplementedtoreduceturnover(suchasimprovedfeedbackand

recognitionprograms)theefficacyoftheprogramscanbeclearlycomputedbycomparingthecostof

implementingtheprogramversusthesavingsrealizedinreducedturnover,thusprovidingchieffinancial

officerswithquantifiableproofoftheprogramsefficacy.

Someturnovercanbefunctionalandrevitalizeanorganization(Larrabeeetal.,2003).Forinstance,

nurseswhoretiremayhavealongtenureandthereforehighersalariesthantheirnewlygraduated


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replacements.Furthermore,someturnovermayincludenurseswhowerenotsatisfiedwiththeorganization

ortheircommute,andfreshfacescanbringfreshideasandnewenergy.Highvoluntaryturnovercanquickly

havenegativeconsequencesandbecomedysfunctionalincluding:recruitmentandneworientationcosts,loss

ofexperiencednurses,periodsofovertimeduetoshortageofstaff,useoftemporaryagencynurseswhomay

beunfamiliarwiththeorganization,andthepotentialforadversepatientoutcomes(Larrabee,2003).Hayeset

al.(2006)reviewed130articlesonnursingturnoverandindicatedthatoverandoverthebiggestpredictorof

turnoverwasjobdissatisfaction.Hayesetal.(2006)reportedthatturnoverislargelyaresultoflowjob

satisfactionandcommitment,andthatpraiseandrecognitionwasonesatisfactionfactor,aswasjob

embeddedness.TheJobembeddednessconstructfocusesontheaccumulatedreasonswhyapersonstaysina

job.Oneofthelargestcontributorstodissatisfactionwasnursesreportedfeelingsofbeingundervalued

(Hayesetal.,2006).

TourangeauandCranley(2006)reportedthatjobsatisfactionwasadirectpredictorofnurseturnover,

andnursemanagersupportwasanindirectpredictor,inthatsupportmediatedtherelationshipbetweenjob

satisfactionandintenttoremain.TourangeauandCranley(2006)wrotenurseswhoweremoresatisfiedwith

thepraiseandrecognitiontheyreceivedatworkweremorelikelytoremainemployedattheircurrent

hospitals(p.504).Sourdif(2004)reportedthatsatisfactionatworkwasthevariablethatexplainedthemost

intenttostayanditaccountedforover22%ofthevariance.

Takaseetal.(2005)usedpersonenvironmentfittheoriestoinvestigatenursebehaviorsandturnover

intention.Theauthorsusedpolynomialregressiontoanalyzetheresultsof346questionnaires.Theauthors

wereabletoshowthatduetohighlevelsofprofessionalism,nursesworkhardtoprovidequalitycareevenin

environmentswheretheyreceivelittlesupport;yetthesenegativeenvironmentsdirectlyimpactedtheir

intentiontoquit.Takaseetal.(2005)wrotewhilenursesjobperformancewasexplainedbyacurvilinear

relationshipwiththeirperceptionoftheenvironmentalcharacteristics,theresultsshowedthatnurses

intentiontoquittheirjobswaslinearlyrelatedtotheirperceivedenvironmentalcharacteristics(p.895).This

articleundertookaqualitativestudyaswellasaquantitativestudybyconductingfocusgroups.Oneofthe


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themesthatemergedfromthequalitativeanalysissupportedthequantitativeresults.Morespecifically,dueto

professionalismthenursestriedtocontinuetoprovidequalitycare,butlackofsupportandrecognitionledto

anintentiontoleave.

Takaseetal.(2005)reportedthisexchangefromoneofthefocusgroups:

[firstfocusgroupmember]Ithinkthereismoreeffectonjobsatisfactionifyoureinanenvironment

whereyourenotgettingsupportandyourejustnotbeingpraisedoryourenotbeingrecognized,

overallthejobsatisfactionisdecreasedbutnotperformance[secondfocusgroupmember]yes,if

youdohaveanawfulworkplace,youmayeventuallyleave.(p.896)

Janneyetal.(2001)reportedononeorganizationseffortstoincreasenursesatisfactionandretention.Oneof

themainfactorsthatwasreportedduringfocusgroupswastherespectandrecognitionthatnursingmanagers

provided.Aseriesofretreatswereconductedtogetfeedbackfromthestaffnurses.Basedonthefeedback

received,aprogramwasimplementedthatincludedlisteningtostaffnurses,gettingfeedbackondecisions,

andimplementingformalandinformalrecognitionprograms.Theauthorsreportedthattheorganization

realizedaturnoverdropfrom12%to6.2%,aswellasa75%decreaseinovertime.Cartledge(2001)reported

onresultsofaqualitativestudytoinvestigatereasonsforturnoverofintensivecarenursesintheUK.She

reportedthatfourthemesemergedfrominterviewsregardingreasonsforturnoverincluding:stress,

professionaldevelopment,recognitionandtherespectofothers,andtheimplicationsofshiftwork.Thelackof

recognitionledtothenursesfeelingundervaluedandnotrecognizedforthecontributionstheyweremaking.

Finally,BradySchwartz(2005)reportedthattheMagnetRecognitionProgram,whichrecognizes

excellenceinlongtermoracutecarenursingfacilities,contributestojobsatisfactionandthisisrelatedtoa

decreaseinturnover.Inasurveyof470RNscomparingnonMagnetdesignatedhospitals(n=297)toMagnet

designatedhospitals(n=173),nursesfromMagnetfacilitiesreportedsignificantlyhigheroveralljob

satisfactionscoresandwerealsomorelikelytostayintheircurrentposition.Lacey,Cox,Lorfing,Teasley,

Carroll,andSexton(2007)alsoreportedthatinasurveyof3,337registerednurses,thosefromsitesthathad

achievedMagnetstatus(aswellthosenursesfromMagnetaspiringsites)weremoresatisfiedwiththeirjobs


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andtheyweremorecommittedtotheirorganizationthannursesfromnonMagnetsites.Intheprocessof

achievingMagnetstatus,nursingsupportfeaturesareputinplaceandthesefeaturesappeareffectivein

influencingsatisfactionandcommitment,whichinturnaffectstheirintenttostay.InordertogainMagnet

status,afacilitymustdemonstratetheirabilitytocreateahealthyworkenvironment.Nurseswanttocontinue

theiremploymentinthesehealthyworkenvironments.

Decreasingturnoverisimportantbecauselargeratesofturnoverareespeciallyproblematicgiventhe

concurrentnursingshortage.Whatisbecomingapparentisthatsomeoftherecentturnoverincludesthe

nurseswhohavethemostexperience.Ingersolletal.(2002)reportedresultsfrom1,853nurseswho

completedquestionnaires.Overallsatisfactionwiththeirjobwassignificantlyhigherfornurseswhointended

tostayatthesameemployerinthesamejobcomparedtonurseswhointendedtostayatthesameemployer

butchangejobs,andnurseswhointendedtochangeemployerscompletelyF(5,1851)=16.4,p


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hourlyworkersincludedadvancementopportunitiesandorganizationalprestige,whereasthereasonsgivenby

lowperformersandhourlyemployeesmostoftenincludedextrinsicrewards.Thisshowsthatifthegoalisto

retainhighperformingemployees,humanresourcemanagementpracticesshouldattempttotargetwhatis

valuedmostbythishighperforminggroup.Turnoverisonlyonenegativeoutcomeseeninorganizationsthat

dontrecognizeemployees;anotherisabsenteeism.Luetal.(2005)reportedthatjobsatisfactionwasrelated

toabsenteeism.

Demerouti,Bakker,Nachreiner,andSchaufeli(2000)reportedthathavingtoofewresources(which

includedperformancefeedback,jobcontrol,taskvariety,supportfromsupervisors,rewards,andparticipation

indecisionmaking)ledtodisengagementfromwork.Theytestedtheresultsofsurveysfrom109German

nursesusingstructuralequationmodeling.Thefinalmodelthattheytestedshowednominallyacceptablefit

indicesincluding:2(80,N=109)=100.67,p=.059,andaGFI=.88,AGFI=.83,RMR=.05,NFI=.78,andCFI=

.94.Havingtoofewresourcescontributedtodisengagementbecauseofstressandburnout.Stressand

burnoutisanotherpossiblenegativeoutcomefromlackofsupportandrecognition.

Demeroutietal.(2000)reportedthathighjobdemandsalonedidnotpredictstressamongnurses,but

stressandburnoutwasfoundamongnurseswhowereexposedtoademandingworkenvironmentwithtoo

fewjobresourcestocombatthedemands.Luetal.(2005)reportedthatjobsatisfactionwasrelatedtostress

withastrong,negativecorrelationreportedintheliterature(r= .61).Gelsemaetal.(2005)reportedthat

rewardsareimportantinthestressprocess.Rewardscanactasabufferbycompensatingforhigheffort.In

particular,socialsupportofsupervisorsisimportant.

Thefinalnegativeoutcomethatoccurswhensupportandmeaningfulrecognitionareabsentcan

potentiallyaffecteveryone,especiallythosepeoplemostdependentonnursesperformance,theirpatients.

Researchhasclearlyshownthatthequalityofpatientcarecanbejeopardizedbyunhealthywork

environments(Hayesetal.,2006;Lacey,Teasley,Henion,Cox,Bonura,&Brown,2008).Hurstetal.(1994)

proposedthatifstaffmembersweresatisfiedwiththeirorganizationandtheamountofrecognitiontheywere

receiving,theyshouldbebetterabletofocustheirenergyonincreasingthequalityofpatientcare.McDaniel


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andPatrick(1992)reportedthatlevelsofnursingturnoverwashighlyrelatedtopatientsperceptionof

satisfaction(r= .98).HamptonandHampton(2004)reportedthatrewardsweremorehighlyrelatedto

professionalismthantojobsatisfactionintheirmodel,supportingtheirhypothesisthatprofessionalismcanbe

enhancedbyarewardsystemthatreinforcesprofessionalbehavior.Itisimportanttorealizethatthereare

significantandpositiverelationsbetweenrewards,professionalism,andmarketorientationofnurses.Hayes

etal.(2006)reportedintheirreviewoftheliteraturethatpatientsatisfactionwaslinkedtonursesjob

satisfactionandmostimportantly,managerandorganizationalsupportfornurseswasrelatedtonurses

assessmentsofqualitycare.Leiter,Harvie,&Frizzell(1998)wrote:

Patientsonunitswherenursesfoundtheirworkmeaningfulweremoresatisfiedwithallaspectsof

theirhospitalstay.Patientswhostayedonunitswherenursingstafffeltmoreexhaustedormore

frequentlyexpressedtheintentiontoquitwerelesssatisfiedwiththevariouscomponentsoftheir

care.(p.1611)

Thequalityofpatientcarehasadirectimpactofthewellnessofpatients.Zimmerman,GruberBaldini,Hebel,

Sloane,andMagaziner(2002)reportedthatturnoverratesofnurseswererelatedtotheinfectionand

hospitalizationratesofresidentsinnursinghomes. Theauthorsusedasampleof2,285residentsfroma

stratified,randomsampleof59nursinghomesinMarylandbetween1992and1995.Theauthorsreported

thatwitheachproportionatelossofanurse(afulltimenursingemployee/100beds)theriskofinfection

increasedalmost30%andtheriskofhospitalizationincreasedmorethan80%.Someofthereasonsgivenfor

therelationshipbetweennurseturnoverandinfectionincludedthatturnover:makesitmoredifficultto

establishandmaintaineffectivecontrolpolicies,mayreducethefamiliaritybetweenstaffandresidentmaking

achangeinresidentstatusanddetectionofhealthchangeshardertodetect,mayleadtoinconsistent

supervisionandtrainingofstaff,andmayaffecttheclimateofcollaborationandprofessionalnursingcare.The

dataalsoindicatedthathighratesofhospitalizationforinfectionwereassociatedwithlackofadministrative

emphasisonstaffsatisfaction.


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Takaseetal.(2005)indicated,ascitedearlier,thatnurseswillstrivetomaintainprofessionalismand

patientcare,evenintoxicenvironments,butthatturnoverwasdirectlyaffected.Itcouldwellbethatthe

nurseswhoremaintryhardtocontinuetoprovidequalitycare,butwhenpoorjobsatisfactiondrivesnursesto

findabetterenvironmenttoworkin,patientcareisaffectedbyshortstaffandpossiblyburnoutamongthe

remainingnurses.Theliteratureisclearthateffortstocreatehealthyworkenvironmentswithsuchprograms

asmeaningfulrecognitionareimportantandhavevaluetobothnursesandtheirpatients.Therearemany

greatexamplesofsuchprogramsthathavebeenimplemented.

SuccessofMeaningfulRecognitionPrograms

Asreviewedabove,loweredturnoverratesandhigherjobsatisfactionfornursescanbeachievedwith

meaningfulrecognition.Beforeimplementingretentionprogramsthoughitisimportanttounderstandwhat

nurseswant.Lacey(2003)reportedthatsurveysofnursesin87hospitalsinNorthCarolinashowedthat

positivecollegialenvironmentandrecognitionprogramswerementionedby11%ofthenurseswho

responded.Thenumberonefactorinretentionmentionedbythenurseswascompetitivewages(24%),

followedbyflexibleschedules(16%),opportunityfordecisionmakinginput(15%),comprehensivebenefits

(12%),professionaldevelopmentopportunities(11%),collegialenvironment(6%),recognitionprograms(5%),

bonusprograms(5%),adequatestaffing(4%),andahostofotherreasonsmentionedwithsmallfrequency.

Blegenetal.(1992)surveyed341nursesregardingthemeaningfulnessofrecognitionbehaviorsandwrote:

Itismoreimportantforheadnursestorecognizeoutstandingperformancethancompetent

performanceorachievement.Themostmeaningfulrecognitionthatheadnursescanprovideissalary

increasescommensuratewithperformancelevels,privateverbalfeedbacktothestaffnurses,and

writtenacknowledgmentofthestaffnursescontributions.(p.63)

Hensinger,Parry,Calarco,andFuhrmann(2008)reportedonasurveyof727RNsregardingwhichNurses

Weekcelebrationsandawardsaremostmeaningful.Theresultsshowthatnursesidentifyrecognitionand

acknowledgmentasfundamentaltoNursesWeek.Providingeducationaleventsandopportunitieswere

consideredthemostmeaningfultypesofrecognition.


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CroninandBecherer(1999)proposedthatrewardprogramsshouldhavecostsavingsdueto:

improvedrecruitment,decreasedturnover,increasedjobsatisfaction,andincreasedmotivation(whichshould

leadtobetterperformance).Whiletheirstudydidnotspecificallyassessthereturnoninvestmentfor

recognitionprograms,CroninandBecherer(1999)didreportaninterestingfindingfromtheirsurveyof287

staffnursesand55nursemanagers.Inthesurvey,nursingmanagersbelievedthatstaffnurseswouldmost

highlyvaluerecognitionfrommanagersandsupervisors;howeverstaffnursesactuallyrankedrecognition

frompatientsandfamiliesasthehighestsourceofrecognition.Staffnursesalsoratedrecognitionfrom

coworkersassecondhighest.Recognitionfrommanagersandsupervisorswasonlyrankedthird.Ulrichetal.

(2009)reportedthatintheirfollowupsurvey,mostofthemeaningfulrecognitioncamefrompatientsand

families(48.9%)andfromotherRNs(27.0%),whereasnurseadministratorswereless,only(8.5%),aswere

frontlinenursemanagers(7.7%),physicians(4.6%),andotherhealthcarecolleagues(3.3%).

Itisimportantthatemployeesrealizethatrecognitionisgivenasaspecialrewardforexemplary

serviceandperformance.Ifemployeesseerecognitionprogramsasanormalpartoftheorganizationssystem,

orarequirementofmanagers,recognitioncanbecomeanentitlementinsteadofanextragestureof

appreciation(Graham&Unruh,1990;McConnell,1997).Furthermore,communicationregardingwhythe

recognitionwasgivenshouldbecleartoall.McConnell(1997)wrotewhenemployeesseeapeerrecognized,

theyneedtobeabletothink:ifIachievethesamekindsofresults,Icanbesimilarlyhonored(p.90).Thiscan

increaseeveryonesperformanceandcontributetotheorganizationssuccess.

Hurstetal.(1994)citedliteraturethatreportedsavingsfrompublicpostingrecognitionprograms

rangingfrom$600to$105,000peryear.Returnoninvestmentwillbeeasiertoachievewithcheaper

recognitionprograms.Programsdonothavetobeexpensivethough.GrahamandUnruh(1990)reportedina

surveyof175medicaltechnologiststhatamanagergivingverbalpraisewasthetopratedmotivation

technique,withwrittenpraiseaclosesecondandpublicrecognitionalsonearthetop.Bylone(2008)reported

onthesuccessofasimplesolutionwhereabulletinboardwashungwithnotesthatnurseshadreceivedfrom

patientsandfamiliesthankingastaffmemberforgoingtheextramile.Blanknotecardswerealsoplacednext


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tothebulletinboardsothatpatientsandfamiliescouldwriteandpostthankyounotes.Thearticlementioned

sometouchingnotesthathadbeenleft.Webb,Tour,Hurt,andvanKammen(1992)reportedonthesuccessof

arecognitionprogramwhereduringeachquarterthereisaweekdesignedasratingsweekwhereentireunits

canberecognizedfortheirexcellence.Theprogramconsistsofanengravedbrasstrophywhichispresentedto

thewinnerbythepreviouswinner.BreakfastanddinnerpartiesarealsoheldwithremarksbytheMedical

CenterDirectorandChiefofStaff.Photographsaretakenandadisplayispreparedbythepublicrelations

office.Theprogramhasbeencreditedwithimprovingproductivityanddecreasingturnover.Theauthorsmake

averyvalidpoint;recognitionshouldtakeplacemorethanjustonceperyear.

Keyes(1994)reportedthatacareerladderprogramhadbeenimplementedwithlittlesuccess.Career

ladderprogramsrewardnurseswhoachievesometypeofprofessionaldevelopmentbyincreasingtheircareer

progressionrate.Thestaffnursesindicatedthattherewereseveralprobablereasonsforthefailureofthe

careerladderprogramincluding:thosewhoparticipatedwerenotnecessarilytheoutstandingnurses,those

whoparticipatedweremostlydrivenbythepotentialforsalaryincreases,oneofthecriteriaforbeing

rewardedrequiredextracurricularworkandcommitteeworkwhichcausedthosenursestoleavethefloor,the

heavypaperworkfortheprogramtooktimeawayfromthenursesworkingwithpatients,onceawardedinthe

careerladderprogramannualrenewalwasassured,animositydevelopedandanegativeaurabeganto

surroundtheprogramsothatwinnershidordownplayedreceivingtherewardbecauseofnegativefeelings

frompeers.Withlessthan10%ofthenursesparticipating,theprogramwasscrappedandanewrecognition

programwasimplemented.Thenewprogramsdevelopmentutilizedsignificantinvolvementandinputfrom

thestaffnursesinitsdesign,itrequiredunitspecificpeerassessmentwherethenursesthemselvesparticipate

intheselectionofthewinners,andtheprogramrankorderedthenursesintheunittoensurethatthebest

nurseswerebeingrewarded.Thenewsystemhasbeensuccessful.Keyes(1994)reportedthattwoyearsinto

theprogram75%ofthestaffnursesparticipated,approximately25%ofthenursesarebeingrecognized,

nursesarenowproudoftheaward,unitsfeelempoweredtomakechangestotheprogramwhenneeded,and

thereisneveranydifficultyfindingmemberstoparticipateinthecommittee.


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AONEreportingthatmeaningfulrecognitionisimportanttomaintaininghealthyworkenvironments,an

improvedunderstandingoftheoutcomesofmeaningfulrecognitionisneeded.Daehlen(2008)wroteakey

areaforfurtherresearchonnursesjobretentionseemstobetherelationshipsbetweentheirreasonsfor

leavingtheworkforce,jobsatisfactionandthedeterminantsofjobsatisfaction(p.1798).Whilemeaningful

recognitionshouldimprovenursesjobsatisfaction,moreresearchisneededonthelink.Giventheprojected

shortageofnurses,andtheimportancethatnursesmaketosociety,thisresearchshouldbedeemedcritical.


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Table1CriticalElementsofMeaningfulRecognitionasOutlinedintheAACNStandards

foraHealthyWorkEnvironment

CriticalElementsThehealthcareorganizationhasacomprehensivesysteminplacethatincludesformalprocessesand

structuredforumsthatensureasustainablefocusonrecognizingallteammembersfortheircontributionsand

thevaluetheybringtotheworkoftheorganization.

Thehealthcareorganizationestablishesasystematicprocessforallteammemberstolearnaboutthe

institutionsrecognitionsystemandhowtoparticipatebyrecognizingthecontributionsofcolleaguesandthevaluetheybringtotheorganization.

Thehealthcareorganizationsrecognitionsystemreachesfromthebedsidetotheboardtable,ensuringthat

individualsreceiverecognitionconsistentwiththeirpersonaldefinitionofmeaning,fulfillment,development,

andadvancementateverystageoftheirprofessionalcareer.

Thehealthcareorganizationsrecognitionsystemincludesprocesseswhichvalidatethatrecognitionis

meaningfultothosebeingacknowledged.

Teammembersunderstandthateveryoneisresponsibleforplayinganactiveroleintheorganizations

recognitionprogramandmeaningfullyrecognizingcontributions.

Thehealthcareorganizationregularlyandcomprehensivelyevaluatesitsrecognitionsystem,ensuringeffective

programsthathelpmovetheorganizationtowardasustainablecultureofexcellencethatvaluesmeaningful

recognition.

TakenfromAmericanAssociationofCriticalCareNurses(2005)


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Table2AComparisonofNursesPerceptionsofTheirWorkEnvironmentsinanAACN2006

SurveytoaFollowupAACNSurveyin2008

Statement1:RNsarerecognizedforthevalueeachbringstotheorganization:

StronglyAgree Agree Disagree StronglyDisagree

IntheRNsorganization,2006 10.8 46.2 32.5 10.5


IntheRNsworkunit,2006 17.8 46.9 25.6 9.7


Statement2:RNsrecognizeothersforthevaluetheybringtotheworkoftheorganization:

StronglyAgree Agree Disagree StronglyDisagree





TakenfromUlrichetal.(2009)


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Figure1.AbrahamMaslowshumanneedstheory.

Takenfromhttp://www.ruralhealth.utas.edu.au/commlead/leadership/maslowdiagram.htm


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ABOUTPSYCHOLOGICALASSOCIATESPsychologicalAssociatesisafirmofbehavioralscientistswhoapplybehavioralscienceprinciplestothework

placetoimprovestaffperformance. Theirfiftyyearsofexperiencehasproventhatincreasingsynergy,

collaboration,candor,andtrusttobusinesspractices/strategiesleadstobetterbusinessoutcomes. Intheir

healthcarepractice,PAoffersavarietyofservicestocreateandsustainahealthyworkenvironment. They

helphealthcareexecutiveshonethepeopleskillsthatcontributedirectlytosuccessfuloutcomes.They

transformnursesintonurseleadersequippedtomeetchallengesinhealthcaretodayleaderswhocan

focustheenergyandenthusiasmofothersonthemissionandvisionofanorganization.Theydevelopleaders

fromthebedsidetotheboardroom. PAshealthcareteammembershaveworkedinhospitalsformany

yearsasphysicians,nursesandleaders. Aseachmemberhaswalkedintheshoesofahealthcareprovider,

theyknowwhatworksandwhatwillnot.

ThisliteraturereviewwasconductedforTheDAISYFoundationasadonationfromPAtohelpusunderstand

theimpactrecognitionhasonnursesworkplaceandcommitmenttotheirworkandcolleagues. Ourprofound

gratitudetoDr.CindyLefton,RN,PhD,andRickBreugger,M.A.fortheirfinework.

FormoreinformationaboutPA,pleasevisitwww.q4solutions.com
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