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Each spring, nurse executives face the dilemma of deciding how to recognize staff for National Nurses Week in meaningful ways. Many a keychain, mug, carnation, pin, lunch bag, or pizza have been given in good faith only to be cast aside and even ridiculed: "All I'm worth to this place is a coffee cup?" Too often nurses feel the recognition they receive doesn't adequately reflect their contributions. Other attempts at recognition during Nurses Week, such as an elegant dinner event with a nationally renowned guest speaker, can also be disappointing because only a small percentage of the overall nursing workforce is able to participate. Nurse executives unfortunately often encounter a no-win situation when it comes to nurse recognition.
Nurse executives are aware of the importance of recognition in the retention of nursing staff, but often nurse retention takes second place to nurse recruitment. A great deal of attention, energy, study, and money is spent on recruitment. Resources for retention initiatives are often hard to come by. Organizations choosing to invest in nurse retention initiatives may realize substantial costs savings when they aren't spending money recruiting and training new staff.1 Job satisfaction is predicted by several factors, including working for organizations that emphasize providing quality care, as well as partnering with managers who recognize the importance of personal lives and family. Additional factors identified among nurses are opportunities to influence decision making in the workplace and recognition of their accomplishments.2
The role of recognition in retention has been noted in recent literature. One researcher contends that implementing or significantly expanding an effective employee recognition program will earn an organization on average a 200% to 300% return on investment. During hard economic times, businesses expand their recognition programs rather than shrink them. Recognition is essential to success.3
Despite the importance of recognition, most nurses are dissatisfied with the acknowledgment they receive. This dissatisfaction can result in not only increased nurse turnover, but also reduced nurse productivity and suboptimal patient-care outcomes.4 The National Association for Employee Recognition White Paper highlights the premise that when employees believe they "serve a purpose" and others are noticing that they're doing a good job, they'll be more productive.5
One relational job design theory suggests that motivation evolves from making a positive difference for the beneficiaries (in this case, patients) of a person's work and having the chance to observe the impact.6,7 When nursing staff members feel they're making an important contribution to the well-being of others, they're happier. When planning recognition events, it's vital that an organization understands what matters most to employees and to avoid recognition that isn't appreciated or valued by the staff.
In order to determine appropriate recognition of staff, hospitals need to continuously ask their nurses how they'd prefer to be recognized for any contributions. A survey of the nursing workforce at the University of Michigan Health System (UMHS) was conducted to determine how nurses wanted to be recognized during National Nurses Week. Administrators and planners of Nurses Week activities used the results to plan events to celebrate and honor nurses. The post Nurses Week evaluations resulted in 92% of nurses rating their overall satisfaction in the events planned as superior. This type of informed approach toward recognition can pay great dividends if the nurses value the chosen tribute.8
Providing valued recognition for nursing staff may prove challenging because of how nurses see themselves. Nurses often struggle with a poor self-image, which affects how they view their contribution. One author contends that if enough nurses can improve how they think about themselves, perhaps the image and achievements of the entire profession will improve.9
Nurses often have difficulty articulating both to themselves and others what their role is and the difference nursing makes in the lives of people. The value of the nurse is often overlooked, not only by those on the outside but also by nurses themselves. According to journalist and author Suzanne Gordon, years of invisibility have taken their toll. Nurses have a history of being uncomfortable in accepting compliments and praise for their work.10 Many patients have tried to verbally thank nurses for saving their lives, advocating for them, or being skilled and compassionate simultaneously-only to hear the nurse reply, "It was nothing, I was only doing my job." Gordon points to this behavior by noting the common response of the nurse: "I'm just a nurse." Nursing's legacy of professional silencing and self-silencing harms the profession. She contends that for nurses to truly be respected, the public needs to know what nurses know.11
Having gleaned an overall understanding of the importance of recognition and the dilemma faced by organizations in the area of nurse recognition, UMHS conceptualized and implemented a new approach to recognize staff during Nurses Week. A video medium was selected as the vehicle for this new approach because it helps viewers learn and internalize values and norms effectively and it's readily accessible and easy to distribute.12 UMHS concluded that video had the potential for a widespread, immediate, and powerful impact on how a community of nurses perceives its role and value.13 The purpose of the video was to create a powerful set of images and sounds designed to evoke positive feelings and emotions about being a nurse. Additionally, UMHS considered the advice of author Christina Baldwin, who contends that the use of storytelling can help those working within an organization to reconnect with its purpose.14
The organization believed that a video showing images of nurses caring for patients would cause the staff members to pause and reflect on what they actually contribute to society. The process of developing the video involved five steps: preparing the business case, securing the funding, selecting the videographer, producing the video, and editing the video.
The first step involved in the video process was preparing the business case. The cost of producing a video was determined by consulting with experts. The initial estimated cost of producing and editing a video was $20,000. After completing a cost-benefit analysis, it was determined that the potential savings would be substantial because national estimates of the cost to replace a nurse range from $82,000 to $88,000.14 Because the organization employs 3,800 nurses, it was determined that retaining at least one nurse would more than offset the cost of the video.
Step two was to secure the necessary funding. When the plan was presented to hospital administration, there was support and interest in creating the video; however, there was only $5,000 available to cover the costs. Because the director of nurse recruitment and retention was willing to assume the roles of producer and editor and UMHS decided to use real nurses without scripts (instead of actors and professional writers), $5,000 was plenty.
Step three was selecting a videographer. A trained videographer knows the techniques of effective photography and is able to capture compelling images. When choosing a videographer, it's important to determine if he or she is able to see the vision and intent of the film-and can work under strict conditions. There are particular challenges when videotaping in a healthcare institution. For example, the videographer should be knowledgeable about protecting the privacy of those not involved in the video and not interfering with the work of the staff. An individual with videography training must also be skilled in dealing effectively with the subjects of the video to successfully complete the project.
The fourth step was to produce the video. Hiring a professional video producer would be ideal, but there weren't enough funds. The director of nurse recruitment and retention served in this capacity despite the fact that she had no production experience. She received assistance from an experienced video production mentor at a local university. After gaining approval for the concept from managers and staff on the units where the taping was happening, the video producer scheduled the shoot, accompanied the videographer as he completed the taping, and obtained the proper consent forms from staff, patients, and families featured in the film. The video was shot over 3 days in 26 venues throughout the health system. The first 5 minutes of the 7-minute video consists of nurses working with patients and one another. The last 2 minutes of the video involve short interviews with four nurses describing why they chose their profession.
The final step was to edit the video. Again, it's ideal to hire an editor to complete this step; however, it was decided that to decrease costs, the director of nurse recruitment and retention would preview all of the footage to identify key scenes, which could then be quickly pulled together by a professional editor. Several hundred dollars were saved by decreasing the amount of professional editing required. After the video was complete, it was shown at a Nursing Grand Rounds during National Nurses Week. (See Creating a video in your facility.)
To evaluate the impact of the video and to determine whether it had achieved the goal of providing meaningful nurse recognition, 42 newly hired nurses were asked to complete an evaluation during their central nurse orientation. Several questions focused on how nurses were depicted in the video. All of the respondents reported that nurses were compassionate, caring, and committed, whereas 93% indicated that the nurses were shown as knowledgeable professionals.
When asked if the video brought out an increased sense of pride in their work and the work of their colleagues, 98% indicated that it did. ("I feel very proud to be in my profession." "This video evoked pride in me." "It made me proud to be a nurse.") Emotional responses were also reported by those who viewed the video. ("It touched my heart." "I cried real tears and could not stop until the video was over." "It made me cry to see what we do and how people look to us to provide them with expert care.")
When asked about their perceptions of authenticity, 90% indicated that they felt the video was a realistic depiction of nursing at this organization. All of the nurses completing the survey reported that the video portrayed a positive image of nursing in the organization. It was especially important that some of the respondents pointed out that "The video caused me to remember what I do as a nurse and what a real difference I make."
Interviews were conducted with nurses who were featured in the video. There were 63 nurses shown in total. When these nurses were asked if participating in the project brought out an increased sense of pride in their work, all indicated that it had. When asked to share their feelings of this unique experience, one nurse stated, "I was so proud to be a part of the video. New nurses to the institution see me in the hallways and tell me that they saw me in the video!" Another nurse reflected, "What we do can become so routine to us. It is easy to forget the impact we have on patients and families. This video captures what we do and reminds us of the greatness of what we do."
In addition to being used as a method for providing recognition during National Nurses Week, the video has become an integral part of the organization. It's shown biweekly in the orientation of every new nurse, it's been placed on recruitment websites, it's been used by the CNO during her annual presentations to the nursing community, and has also been shown at retirement celebrations.
The video continues to have a powerful effect when it's viewed repeatedly. New nurses at UMHS are shown the video during their first day in orientation. The coordinator of orientation noted that "Every week the video is shown to new nurses, and each time it evokes very strong feelings of pride as well as tears. Each time I see it, I find something new. I watch all incoming nurses respond to this video as part of orientation. Participants simply love the video and are often moved to tears. It resonates! This video has been a real gift to our nurses."
Based on the response to the video, plans are being made to create other films to recognize nurses. A video featuring patients and families sharing their insights and experiences, and talking about the impact nurses have had on their lives, is being planned. Additionally, a video in which new nurses share their experiences of working with their preceptors is also being considered.
Based on the survey results and the anecdotal data, the video was a successful tool for helping nurses reconnect with their profession and showing the staff members their value. UMHS was effective in creating a means for recognition that was appreciated and cherished by nursing staff. Due to the positive experience with producing this film, the business case for creating future videos will be enhanced. Thanks to the video, during future Nurses Weeks, UMHS will be able to continue to show its appreciation for the hard working, valuable nursing staff via a respected medium.
When creating an institution-based nursing video, there are important factors to consider before beginning:
* Establish clarity around the purpose of the video. This will help provide artistic focus, but will also help develop the business case and identify potential sources of funding.
* Create a business case for producing the video. Although involvement of professional videographers is essential, equally vital to the success of the project is the involvement of a local nursing expert familiar with the nursing culture and staff. Talk to the stakeholders in nurse retention and engagement in terms of dollars and cents. It makes sense to invest money in the care and keeping of excellent nurses. Spending $5,000 on a video more than pays for itself even if just one nurse is retained.
* Engage the nursing leadership. Recording in a patient-care environment produces many challenges. Let the leadership know you've done your homework and planning; this will help them feel comfortable allowing a camera crew to enter patient-care areas.
* Work with the departments within the organization. Hospital security, patient relations, and public relations should be consulted to avoid delays in shooting.
* Engage as many staff as possible by recording in diverse practice areas. It's also important that recording occur on all shifts. Strive to create a video where everyone can see themselves.
* Tell the story truthfully. Be authentic in the filming and depiction of the nursing environment and staff-avoid scripting.
* Develop a debut for the video in an appropriate venue. Think about creative ways to make the video accessible to the intended audience.
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2. Buerhaus P, Staiger D, Auerbach D. The Future of the Nursing Workforce in the United States, Data, Trends, and Implications. Sudbury, MA: Jones and Bartlett Publishers; 2009:262. [Context Link]
3. Byam, M. The WOW! Workforce. Grand Rapids, MI: The Terrryberry Company; 2008:29-31. [Context Link]
4. Gess E, Manojlovich M, Warner S. An evidence-based protocol for nurse retention. J Nurs Adm. 2008;38(10):441-447. [Context Link]
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