1. Eddy, Jaime R. BSN, RN
  2. Kovick, Laura MA
  3. Caboral-Stevens, Meriam PhD, RN, NP-C

Article Content

Organizations that recognize and appreciate employees for their hard work send a powerful message to the recipient and other staff members that they're valued-a key component of a healthy and productive work environment. Evidence shows that employee recognition is the most important driver of great work and the strongest driver of employee engagement.1 However, recognition or appreciation should be given in a timely manner for it to be meaningful to the person. In this article, we seek to understand the concept of meaningful recognition from both the nursing and organizational perspective using Walker and Avant's eight-step method of concept analysis: select a concept, determine the aims of analysis, identify uses of the concept, determine defining attributes, develop a model case, construct additional cases, identify antecedents and consequences, and identify empirical referents.2

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Uses of the concept

Meaningful recognition originated in the field of human resources, derived from employee recognition. (See Table 1.) The Society for Human Resource Management (SHRM) defines employee recognition as a way to thank workers for their outstanding efforts focused on the unique actions that make an employee exceptional, which may include innovation, retention, morale-building, personal development, and actions that embody the organization's core values.3,4 Recognition programs are most successful when in alliance with organizational mission and values. The SHRM further recommends frequent real-time manager and peer feedback to create an environment where employees feel heard. This helps strengthen the link between the employee's behavior and the effect that behavior has on the organization.3

Table 1: Related con... - Click to enlarge in new windowTable 1: Related concepts and definitions

In the field of psychology, recognition is explained through Maslow's Hierarchy of Needs, in which two of the three higher-level needs, social (belonging) and ego (esteem), are related to recognition.5,6 Humans have a social need to belong to a group or organization, whereas ego represents the need to be competent through mastery of tasks and recognized once competency is achieved.5,6 Recognition of competency and mastery of tasks is often used to understand worker motivation and its influence on productivity.7 Meaningful recognition is viewed as an organization's way of providing feedback about an employee's behaviors and the impact of these actions on others and the organization as a whole. Meaningful recognition can be differentiated from positive feedback in that meaningful recognition is a more powerful form of acknowledgment with a lasting effect on a person's life.7 From a behavioral psychology perspective, an organization that recognizes desirable employee behavior reinforces the repetition of that behavior.8


In nursing, meaningful recognition is a process that builds over time to become a norm in the work culture, propagating reflective nursing practice.9 Recognizing the meaning of nursing duties in congruence with achieving organizational goals is essential for nurses to advance personally and professionally. This self-reflective practice assists in continuous growth and the ever-changing purpose found in nurses' work. Reflective practice is the intrinsic essence of meaningful recognition, promoting self-assessment, eagerness in learning, and empowerment in the workplace.


On an individual level, what's considered meaningful varies from person to person. Recognition is meaningful to an individual when it's relevant to his or her goals and values and delivered by a person or organization that's perceived as professionally important.10 Some nurses may find greater meaning in being acknowledged through incentives and tangible awards, whereas others may find more fulfillment in being recognized with words of affirmation, simple gestures, and gratitude expressed from those they assist; for example, heartfelt gestures such as handwritten notes and on-the-spot delivery of appreciation.10 Nurses perceive recognition from patients, families, and other nurses as extrinsically meaningful. One study found that patients recognized courtesy and respect, including behaviors such as empathy/compassion, helpfulness, kindness, attentiveness, and emotional comfort, as the most appreciated traits of excellent care.11


At an organizational level, meaningful recognition is used to acknowledge individuals for their successes and serves as an intrinsic motivator to others. The American Association of Critical-Care Nurses (AACN) defines meaningful recognition as acknowledging individuals for the unique values and assets they bring to a team.12 In fact, meaningful recognition is the fifth standard in the AACN Standardsfor Establishing andSustaining Healthy WorkEnvironments.13 This standard states that all nurses must be recognized for the value they bring to the organization. It highlights the formal process that ensures all team members are recognized for their unique contributions to the collective team and entire organization. The AACN recommends that recognition proceed in a systematic fashion, with the ongoing process being evaluated regularly to ensure its efficacy in moving toward a culture that sustains and promotes excellence in both patient care and professional development.13 It also recommends ensuring that feedback is relevant to the recognized situation and equal to the nurse's contribution.13


Examples of meaningful recognition at the organizational level include the DAISY Award and the Beacon Award for Excellence.14,15 The DAISY Foundation was formed in 1999 by a family deeply affected by the nursing care their family member received. In response, the foundation created the DAISY Award for Extraordinary Nurses to recognize "extraordinary compassionate care being provided by a nurse."14 Patients who shared their stories and thankfulness in nominating a nurse for a DAISY Award reflected high satisfaction with their patient experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.16 The DAISY Award highlights the significance of nurses receiving positive feedback. The Beacon Award for Excellence is given to an entire unit for exceptional contributions to the organization's "overall mission and vision."15 These units represent a positive and supportive work environment that exemplifies collaboration across all organizational levels. Recognition is the result of individuals working together to put organizational values and goals into action.


Defining attributes

The three identified defining attributes of meaningful recognition are that it's linked to a specific accomplishment(s) related to organizational goals, delivered by a professionally important person or organization, and done in a timely and ongoing manner.


The link

Meaningful recognition is a dynamic process linked to three participating components: the individual or organization giving the recognition, the individual receiving the recognition, and the specific behavior being recognized. This behavior is considered the accomplishment, which is viewed as a unique contribution from the nurse to the organization. The contribution must be linked to a perceived action, such as a job or task completed by the nurse. In essence, a nurse who shares the same values as the organization and strives to fulfill its mission illustrates the synergy of meaningful recognition between an individual and the organization. This synergy is an affective commitment or the degree to which a nurse identifies and participates within the organization. Meaningful recognition and commitment aren't the same construct, but they're largely interrelated.6


The delivery

Meaningful recognition can come from patients, families, coworkers, other members of a collaborative healthcare team, management, and organizations as a whole. For recognition to be considered meaningful, the individual or organization acknowledging the accomplishment must be considered professionally important to the nurse.


Timely and ongoing acknowledgment

Meaningful recognition isn't a one-time event, but rather an ongoing process in which nurses strive to achieve organizational goals to shape work culture.9 Meaningful recognition should be provided in a timely manner; however, recognition delivered in times of emotionally charged organizational change could be misconstrued as disrespectful tokenism.13 To achieve effective and desirable results, recognition must occur thoughtfully but promptly on an ongoing basis.


Model case

Consider the following exemplar: Shawn has worked as a full-time nurse on the cardiac rehabilitation unit for several years. One of his recently discharged patients fills out an application nominating him for a DAISY Award, which he receives. The patient also shows her profound gratitude to Shawn by writing him a letter detailing what an impact his compassionate care had on her recovery. Shawn's manager speaks about his excellent care during staff rounds, his coworkers acknowledge his achievements, and Shawn describes fulfillment in his job.


The DAISY Award nomination was related to the compassionate care that Shawn gave his patient, which represents the specific accomplishment of providing compassionate care linked to organizational goals. The DAISY Award was delivered by a professionally important person because Shawn received it based on a patient's nomination. And because his patient was recently discharged, it was a timely acknowledgment.


Additional cases

Consider the following contrary case: Dylan has been a nurse on a medical-surgical unit for 7 years. He reports being frustrated due to a lack of recognition for his contribution to the organization, a lack of opportunities for professional growth, and the absence of progress evaluations from the management team. He additionally describes compassion fatigue, low job satisfaction, and burnout. Dylan states, "I went into nursing to make a positive impact on my patients' lives, but I don't feel valued or appreciated as a nurse on my unit or within my organization."


This case demonstrates the opposite of meaningful recognition within a workplace. Dylan wasn't acknowledged for his specific accomplishments, there was no appraisal delivered by an individual professionally important to him and, due to the complete lack of recognition, Dylan is unfilled in his job.


Lastly, consider the following related case: Mary is an 82-year-old woman who's admitted to an assisted-living facility. Her son visits every night after work and helps feed her. One night, her son can't visit because of an illness. Mary becomes very sad because she looks forward to her son's visit. John, the nursing assistant on duty, stays with Mary during dinner and helps her eat. When Mary's son finds out about what John did, he gives John a big hug and thanks John for taking the time to sit with his mother. This is an example of on-the-spot, day-to-day recognition.


Antecedents and consequences

The expectation of a task, outcome, or behavior from an individual, group, or organization of professional importance to the nurse must first precede meaningful recognition. This includes the nurse understanding and adopting organizational values and goals and implementing them in his or her practice and daily interactions. Meaningful recognition must then be initiated by those who evaluate the nurse's performance. When meaningful recognition of the nurse for his or her accomplishment occurs, the value of the individual within the organization is validated.


Meaningful recognition has positive consequences for both the individual and the organization. (See Table 2.) At the individual level, meaningful recognition has been associated with decreased burnout and increased compassion satisfaction.17 Meaningful recognition is also associated with an increase in an individual's self-esteem.7 This has a cascade of positive effects, first enhancing self-efficacy, optimism, and resiliency as a nurse, which in turn improves job performance, communication, and patient safety. Additionally, providing nurses with rewards and opportunities for clinical advancement can increase recruitment and retention.13

Table 2: Defining at... - Click to enlarge in new windowTable 2: Defining attributes, antecedents, consequences, and empirical referents

Organizationally, the impact of meaningful recognition is profound. Meaningful recognition is linked to higher levels of motivation and loyalty among employees, further boosting engagement, productivity, and profit.8 Other consequences include decreased nursing turnover, lower absenteeism rates, increased job satisfaction, job embeddedness (the feeling of being valued, satisfied, and engaged in one's work), improved retention, and better patient outcomes/satisfaction. Meaningful recognition also shapes a culture where employees harmoniously work toward an end goal, which can be described as work group cohesion.7 In addition, meaningful recognition has been linked to substantial and positive improvement in HCAHPS scores.11 All of these consequences are identifiers that meaningful recognition is causing positive effects in the healthcare workplace.


Empirical referents

On an individual level, meaningful recognition can be measured by timely receipt of appreciation through words of affirmation and heartfelt gestures (such as handwritten notes). Quantifiable examples of meaningful recognition include tangible incentives, such as pay raises, desirable schedules, generous benefits, and construction of a clear framework for professional growth.18 A more renowned empirical referent of meaningful recognition is the DAISY Award. On an organizational level, empirical referents of meaningful recognition include performance management systems with an emphasis on structured feedback and awards such as the Beacon Award for Excellence or organization-wide recognition via the Magnet(R) or Pathway to Excellence(R) programs.19,20


There are several tools found in the literature that measure recognition in the workplace. These include the Employee Recognition Questionnaire, the AACN Healthy Work Environment Assessment tool, and the Utrecht Work Engagement Scale.


In summary

This concept analysis demonstrates that meaningful recognition is an alignment of individual values and goals with organizational values and goals to create a synergy, which benefits not only nurses, but also their patients and the organization. Understanding the concept of meaningful recognition can help nurse leaders identify effective ways to implement programs that capitalize on both the individual and organizational perspectives. Nurse leaders provide their staff members with feedback and can recognize nurses for a job well done not only at the unit level, but also at the organizational level. Nurse leaders also have the capability to establish and support meaningful recognition programs within their organization, reinforcing organizational values and goals while building employee commitment, confidence, and engagement.


When a nurse is meaningfully recognized as an essential and valuable team member within the healthcare system, there's an allegiance formed, uniting the nurse and his or her organization. The closer the nurse aligns with an organization's values and mission, the stronger the synergy of meaningful recognition.


INSTRUCTIONS Meaningful recognition: A synergy between the individual and the organization



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