burnout, job satisfaction, languages of appreciation, motivation, nursing, retention



  1. White, Paul E.


Abstract: Communicating appreciation to staff is critical in healthcare settings today. Five specific Languages of Appreciation have been identified that can be communicated in individualized ways in the workplace to affirm, encourage, mediate stress, and improve employee morale. In tight budget environments, such an employee recognition program doesn't require financial resources or a line item in the budget.


Article Content

Susan spoke fondly of Dr. Jones, her employer of the past 12 years, who recently retired. She reflected on how Dr. Jones communicated his care for her and other staff members as he regularly took them out for "team" lunches, asked about their families, and thanked staff after assisting him with procedures. Susan knew she was an important part of the office team. "No one ever wanted to quit," Susan reminisced. "He was great to work for."

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Susan's experience, a true story, demonstrates the impact of valuing people in the work setting. Without a sense of being valued by supervisors and colleagues, workers start to feel like a machine or commodity. Steven Covey, author of the bestselling and still popular Seven Habits of Highly Effective People (2004) feels so strongly about people's need for appreciation he states: "Next to physical survival, the greatest need of a human being is psychological survival, to be understood, to be affirmed, to be validated, to be appreciated" (p. 241).


In the current healthcare environment, nurses and other team members are doing more with less, feeling stressed, and in some cases approaching burnout if not already compassion fatigued. Clinical supervisors and managers across the nation feel frustrated, not knowing how to support and reward employees for the hard work they are doing. Although there are a few exceptions, virtually every industry sector is struggling financially and as a result, has made staff reductions, reduced expenditures, and slowed down raises and bonuses-typical ways used to value employees. Supervisors feel they don't have many options when trying to reward employees.


In these difficult economic times a common issue raised when talking about communicating appreciation is: "Shouldn't people just be thankful they have a job? Why should we focus all of this time and energy on making employees feel appreciated? They get paid, don't they? Isn't that enough?"


Most agree that people should be thankful for the opportunity to work. However, this does not mean we shouldn't be kind and encouraging, communicating our appreciation to colleagues and managers. Scripture specifically instructs Christians to appreciate and build others up (i.e., 1 Corinthians 13; Ephesians 4:29; Colossians 3:12-13; 1 Thessalonians 5:11). Furthermore, Christ-followers are called to be an example to those with whom we work, working in a way that honors God and others (Matthew 5:13-16; Ephesians 6:7; 1 Peter 2:12).



Unfortunately, there is a huge chasm between management and employees' perceptions of appreciation in the workplace. In Gallup Poll and other surveys, 65% of workers have reported receiving no recognition or appreciation at work in the past 12 months (Rath & Clifton, 2004). For employees who quit their jobs, 79% report a lack of appreciation as one of the major reasons for leaving (Branham, 2005). In contrast, 78% of human resource executives indicate the key to keeping employees engaged and motivated is by showing them the company cares about their well-being (Harvard Business Review Analytic Services, 2011).


Interestingly, although 80% of large companies, including hospitals, have employee recognition programs in place, only 31% of employees in these companies report feeling recognized for doing good quality work (Globoforce, 2011). This baffles managers who often ask, "How can staff not feel appreciated? I tell them I appreciate them all the time. What do they want?"


Organizational researchers have found that nonfinancial factors are significant for improving employee morale, motivation, and engagement with work. In fact, being treated with respect is the most important factor desired by employees (Mercer, 2011). Unfortunately, researchers also are finding that the level of employee engagement-commitment and sense of being valued-is actually declining, with 70% of employees nationally reporting either total disengagement or marginal engagement in their work, in spite of the large amount of resources being spent in this area (Blessing/White, 2011).


Nurses and other healthcare professionals are familiar with appreciation and recognition problems. Job dissatisfaction and high turnover are well-documented in nursing (Hayes et al., in press). Job satisfaction is a strong predictor of nurses' intent to stay with a current employer (Coomber & Barribal, 2007; Fraser, 2011). Burnout, which impacts job satisfaction and turnover, continues to be of high concern in nursing (Fraser; Poncet et al., 2007).


Ignoring morale and job satisfaction can be costly, especially when it means recruiting and orienting new employees. Retaining quality, experienced nurses is critical in today's healthcare climate. Some hospitals have had to reduce the number of nurses and other employees and postpone raises and financial compensation, even though demands on employees are greater than ever. These factors can lead to discouragement and burnout-which occurs more rapidly when employees do not feel appreciated or emotionally supported. Julia Balzer Riley, editor of Communication in Nursing (2011) emphasizes, "In a climate of professional and personal change coming at an unprecedented rate, rewarding colleagues with praise or by other methods becomes important" (p. 157).



Each of us wants to know that what we are doing matters, that we matter. Without a sense of being valued by others, employees start to feel they are being used like a commodity, not viewed as a person. If no one notices a team member's commitment to doing the job well, motivation diminishes.


When employees do not feel valued, the results are predictable. They will:


* experience a lack of connectedness with the mission of the organization; performance declines.


* become discouraged; willingness to persevere through difficulties will diminish.


* complain about their work, colleagues, and supervisor.


* dislike coming to work; attendance may become inconsistent.


* consider leaving the organization and start to search for other employment opportunities.



Many people assume the way to help employees feel appreciated is primarily verbal. The truth is some of us don't value being told we are appreciated. Some people don't trust verbal praise thinking, "Words are cheap." They may come from backgrounds where whenever they were praised, they were being "set up" for being used or manipulated. As a result, their defenses are on high alert when a colleague or supervisor gives them a compliment. Therefore, it is important to understand that communicating appreciation is not the same as giving a compliment or writing someone a thank-you note.


Fortunately, there are effective methods to communicate appreciation and encouragement to coworkers and subordinates. Such methods incorporate the different ways individuals receive the messages sent. A great thing about communicating appreciation is that it doesn't require financial resources or a budget!



There are five key components for employees to think and feel they are appreciated. Appreciation must be communicated:


* Individually and personally (rather than globally and to the group).


* In the "language of appreciation" that communicates best to the recipient.


* Using the specific actions that are impactful and valued by the recipient.


* Regularly (versus once a year at a performance review).


* In a way that is perceived as genuine and authentic.



How do these factors play out in a work setting?


1. Effective recognition and appreciation must be individualized and delivered personally. Researchers have found that attempts to communicate appreciation globally across an organization are not very effective. No one wants to be part of a program that requires others to show "canned" appreciation. People want appreciation to be personal and genuine, not contrived. Trying a general "just say thanks" campaign across the company will not have much impact. In fact, this type of approach can backfire and create a negative reaction from employees.


Buckingham and Clifton (2001) state in their bestseller, Now, Discover Your Strengths: "To excel as a manager, to turn your people's talents into productive, powerful strengths, requires an additional all-important ingredient. Lacking this... you will never reach excellence. The all-important ingredient is individualization" (p. 171). This was demonstrated in the opening example. Susan appreciated her employer talking with her about her family; she felt respected when thanked individually. Another nurse reported that when staff went out for lunch together she felt valued as a team member.


2. Appreciation needs to be communicated using the recipient's preferred appreciation language. One challenge is to know what most effectively communicates appreciation to each member of a work team. Five basic languages of appreciation have been identified which can be communicated in the workplace (Chapman & White, 2011): Words of Affirmation, Quality Time, Acts of Service, Tangible Gifts, and Appropriate Physical Touch (Table 1).

Table 1: Five Basic ... - Click to enlarge in new windowTable 1: Five Basic Languages of Appreciation in the Workplace (

For example, some people value being told specifically what they are doing well and how they are helping patients and the team (Words of Affirmation). Others feel appreciated when coworkers and supervisors spend time with them individually, actively listening to them (Quality Time). To receive help in getting a task done can be especially encouraging to some (Acts of Service). There are team members who feel appreciated when you bring them a little something special, like their favorite cup of Starbucks coffee (Tangible Gifts). A "high five" or pat on the back for a job well done motivates other team members (Appropriate Physical Touch).


From a biblical perspective, Christ-followers can readily appreciate the languages of appreciation. Christians are to affirm others (Proverbs 10:21, 12:18), give encouragement (Hebrews 10:25), actively serve others (Matthew 20:26-28; Galatians 6:10), generously share our belongings (Acts 2:44-45; 1 Timothy 6:18), and share culturally appropriate acts of affection (Romans 16:16). A more extensive Bible study for the 5 Languages of Appreciation at Work can be found online as supplement digital content at


3. A challenge to effective appreciation is we tend to communicate to others in ways that are most meaningful to us. It is a natural tendency to speak in our preferred language. However, our colleagues often value different types of appreciation. This can lead to a message of appreciation "missing the mark." Missing the mark is why many employees are not encouraged when they receive an award as part of the company's recognition plan-the experience doesn't speak in their preferred language of appreciation. In fact, one worker who did not like being in the limelight said, "You can give me an award, but before I go up and get it you'll have to shoot me." It is critical to show appreciation to coworkers in the appreciation language they value.


It is difficult to infer another person's preferred appreciation language simply through observation. For most of us there are too many relationships to keep track of everyone's preferences and there usually isn't enough information to make an accurate assessment of all coworkers. This is especially true in settings with rotating shifts and numerous staff members reporting to different immediate supervisors such as charge nurses, or working in different areas.


Since each individual receives and values appreciation differently, supervisors and colleagues need to understand the appreciation language of the recipient to communicate appreciation effectively. To simplify this process, we developed the Motivating by Appreciation Inventory (White & Chapman, 2011) to assess individual employees' language of appreciation. Managers can assess their employees' languages of appreciation by giving them this simple online inventory of 30 questions that takes less than 15 minutes to complete. Responses indicate which language the employee prefers primarily and secondarily to receive appreciative communication. With permission from staff, managers can post the results for all staff to share with the entire team. A free group profile template (Figure 1) is available from Appreciation at Work (see Web Resources).

Figure 1:. Group pro... - Click to enlarge in new windowFigure 1:. Group profile template.

4. Acts of appreciation need to be viewed as valuable by the recipient. Even if appreciation is communicated in the right language, if the action is not valued by the recipient, it has little impact. For example, Quality Time means different things to different people. It can mean spending individual time talking, going to lunch, or getting together after work. The challenge is knowing what actions effectively communicate appreciation. The Motivating by Appreciation Inventory assists in determining which language and actions are most meaningful for employees or coworkers (White & Chapman, 2011).


5. For appreciation to be effective and believable, it must be communicated regularly. Receiving positive feedback solely at performance reviews does not lead employees to believe they are truly valued. Whatever praise they may receive is discounted by the fact that they only hear it once or twice a year when it is prescribed by the structure of the meeting.


How often should appreciation be given? Daily? Weekly? Monthly? The answer is it depends on various factors such as the workplace environment, the personality of the individual, the relationship between the supervisor and supervisee, and the professional experience of the team member. A seasoned confident nurse who has a good relationship with the manager probably needs appreciation communicated less frequently than a new graduate who is "learning the ropes." In highly stressful environments, small acts of encouragement may be needed daily while communication every couple of weeks may be sufficient in other settings. Regardless of the actual rate of communication, more is generally better than less. If in doubt, it won't hurt to do something to ensure a colleague knows you value her or him and the contributions he or she makes.


6. Appreciation needs to be communicated in a way that is perceived as authentic by the recipient. Workers are skeptical of programs implemented from the top down where supervisors are given standardized instruction to "communicate appreciation for each team member at least once a week." We all want to know we are valued but we want appreciation to be authentic, not contrived. Ultimately, it is each individual's responsibility to ensure honest, heartfelt communication. We also know that if an organization-wide implementation of "showing appreciation" is mandated, the results can be terrible. Why? Because the mandate immediately undermines the perceived authenticity of any appreciation communicated, even if it is genuine and heartfelt.


Nurses at any level within an organization can communicate appreciation to colleagues. Each person has the ability to positively influence those with whom she or he works; it is not a responsibility relegated only to supervisors or managers. In fact, in many settings front-line staffs have started the process of consistently communicating appreciation to peers. As a result of the changes observed, their supervisors have implemented appreciation concepts organization-wide.


Of significance, just one person can positively impact the work climate. Anne, a nurse at an area hospital, reports she can always tell which charge nurse is working on a particular unit by the body language of the nurses she sees when she gets off the elevator. Are they warm and friendly, or stiff and cold? Anne notices she finds herself hurrying to get her work finished when she feels the "cold" environment around her. She hopes the "warm, friendly" charge nurse is leading when she works on that unit. The environment reflects the friendly charge nurse's positive attitude and encouraging words, which helps unit staff want to perform with excellence. Attitudes are infectious. This charge nurse communicates to coworkers they are appreciated and necessary. Review the Case Study in Appreciation for additional insights on how languages of appreciation can be implemented at work.



The stress level in most healthcare settings is high, creating demanding work environments. Long exposure to stress eventually leads to burnout, where people either become ineffective in their work (just "going through the motions") or quit their jobs. But the stress of the workplace can be mediated when team members feel genuinely valued and appreciated for their contributions. When employees enjoy their work more, communication in the workplace becomes more positive.


Although attempts to encourage and support staff through employee recognition programs have been ineffective, core factors have been identified that help staff feel valued and appreciated. To be communicated effectively, appreciation should be expressed personally and individually, in the language and actions valued by the recipient, consistently over time, and in a manner that is perceived as authentic by the recipient. As a result, supervisors and managers don't have to "shoot in the dark," trying to guess what will be effective in encouraging individual team members. Understanding and utilizing the Languages of Appreciation can allow supervisors, employees, and coworkers to implement specific actions of appreciation in ways that will "hit the mark" and effectively encourage others.


Case Study in Appreciation:

Jennifer, a supervisor for three medical/surgical hospital floors, observed the stress level rise steadily related to tighter staffing to reduce costs. In addition, the patient care units were moving to electronic medical records. Jennifer had observed a noticeable decline in staff morale; team members were tense and irritable and there seemed to be more complaining.

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One day Jennifer overheard a staff nurse lament, "Do this. Do that. I just move through the day with no please, no thank you. You never hear anything positive." Others nodded their heads in agreement. Another nurse commented, "I feel like chucking this job and working somewhere else."


Unfortunately, Jennifer agreed. The constant demands seemed to be growing with little positive communication coming from administration, physicians, the patients, or patients' families. Signs of stress were showing up in complaining, returning late from breaks, and "bending" rules.


Determined something had to be done, Jennifer decided to work with the unit nurse managers and charge nurses toward change. After doing some research she discovered and read The5 Languages of Appreciation in the Workplace (Chapman & White, 2011). Jennifer realized the behaviors she was observing were classic examples of staff not feeling valued or appreciated. After reading the book and taking the Motivating By Appreciation Inventory (White & Chapman, 2011), Jennifer decided to approach her team. She shared her observations, which they agreed with unanimously. She asked if they would be willing to go through a process to help find ways to support and encourage one another, with the goal of eventually using the resources with all team members.


"As long as it isn't going to take a lot of extra time, I'm up for it," Chad, one of the nurse managers said.


"I'm ok with it if it isn't one of those 'write 5 thank you notes a week' projects that human resources tries to have us do every year," chimed in Maria, another manager.


Jennifer replied, "We will do this as part of our regular team meeting so it won't take any additional time, and we won't do it every week. If you want to read the book, fine. If you just want to take the inventory, that's okay, too. It's online and you can do it whenever it works for you. And we'll make sure the action steps are ones that fit what we really need."


Over the next 9 weeks Jennifer and her team went through an appreciation training process, which included watching 10-minute instructional videos every few weeks, discussing the material, and developing action steps after each session. Each week, they received an e-mail from Jennifer, which provided both encouragement and instruction in how to apply the concepts to work relationships. They talked about the "weirdness factor" of trying to encourage one another while everyone knew they were working on the issue together; and how to make sure whatever appreciation was shared was perceived as authentic and not contrived.


One of the key pieces of change was discovering their preferred languages of appreciation, along with specific actions that would be meaningful to each colleague. For example, Chad didn't value verbal praise. But if someone spent some time hanging out, watching a game after work with him or talked with him about college sports, he felt more connected. Conversely, Shakyra, a charge nurse, valued focused attention. She loved to talk and have others listen. If a colleague would ask her about her kids and listen to a story, she felt supported. So although both Chad and Shakyra's primary language of appreciation was Quality Time, the practical outworking looked quite different.


Jennifer began to notice the team's attitudes improve. The managers and charge nurses were more positive in their interactions together, joked more, and seemed more energized. This was corroborated by Chad, who said, "I was pretty skeptical about this appreciation thing. It seemed too touchy-feely. But I have to tell you, it's nice to hear a compliment when you have done something well."


Over the following weeks, some of the managers and charge nurses decided to implement the Appreciation at Work training with their teams. Chad observed Nancy, a nurse on the unit, stay late on a busy Friday, cheerfully answering patient calls. He had learned Nancy primarily responds to Words of Affirmation so he encouraged her by saying, "I really appreciate your cheerful responses to the patients' calls. You help us all stay positive under stress." He added a quick pat on the back knowing Nancy's secondary language of appreciation is Appropriate Physical Touch.


Shakyra discovered that Jim, a staff nurse, enjoys Acts of Service to show him he is appreciated. Giving him help with patient care or making sure he has taken his break communicate to Jim he is valued. For Susan, the unit secretary, checking in with her periodically during the shift to ask if she needs help communicates she is a valued team member. To Jim and Susan, when people are willing to help them they feel significant.


Amy, a staff nurse, appreciates Tangible Gifts. She enjoys the "theme dinner" nights in the hospital cafeteria, which aren't a big deal, but are fun and make her feel special. She eats there with her nurse manager Maria, whose primary language of appreciation also is Tangible Gifts. Maria enjoys the crafts and baked goods staff members bring for holidays and birthdays as these make her feel she is appreciated and that coworkers value each other. The group chart of the staff's appreciation languages Maria put up in her office helps her remember everyone's primary and secondary appreciation languages.


As a result of these efforts, the morale in the medical/surgical area gradually improved. There were still high-stress days but overall the atmosphere and interactions were less edgy. "Oooh, thanks; I feel so appreciated now!" became one of the standard jokes on the floor, giving staff an opportunity to laugh together.


Web Resources


* Appreciation at Work-


* Managing by Appreciation Inventory-


* Globoforce-


* How Full Is Your Bucket?-



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Chapman, G., & White, P. (2011). The 5 languages of appreciation in the workplace. Chicago, IL: Northfield. [Context Link]


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Poncet, M. C., Toullic, P., Papazian, L., Kentish-Barnes, N., Timsit, J., Pochard, F., ..., Azoulay, E. (2007). Burnout syndrome in critical care nursing staff. American Journal of Respiratory and Critical Care Medicine, 175(7), 698-704. [Context Link]


Rath, T., & Clifton, D. O. (2004). How full is your bucket? New York, NY: Gallup. [Context Link]


Riley, J. B. (2011). Communication in nursing. (7th ed.). St. Louis, MO: Mosby.


White, P., & Chapman, G. (2011). Motivating by appreciation inventory. Wichita, KS: Family Business Resources, Inc. [Context Link]