1. Hensinger, Barbara BSN
  2. Parry, Juanita MSc, BSN, RN
  3. Calarco, Margaret M. PhD, RN
  4. Fuhrmann, Sarah BSN, RN


It is time to examine nurses week investments. With expenses increasingly scrutinized, healthcare leaders require data-driven decisions. Managing by instinct and intuition is both inadequate and reckless. This survey of 727 registered nurses identifies celebratory options for nurses week that nurses find meaningful. Knowing what registered nurses value will guide approaches to an effective nurses week activity planning.


Article Content

Nurses week marks the professional contribution of the nation's registered nurse (RN) workforce. Healthcare leaders recognize and celebrate this occasion in a variety of ways. Some provide their nurses with free ice cream or other foodstuffs, whereas others fund educational events replete with continuing educational units. Reports of small gifts or billboard "thank you" ad placement are common. Whatever the choice, each celebratory plan represents a financial investment that is intended to show appreciation for nurses as primary contributors to patient care.


This investment in the human assets of an organization can pay great dividends if nurses "value" the chosen tribute. Such activities have potential to improve nurse satisfaction with the workplace and affect nurse retention rates. Alternatively, the action can be perceived as demeaning or money foolishly spent. Yet, administrators often make this financial decision without first identifying just what it is that nurses do value.


At the University of Michigan Health System (UMHS), the content and scope of nurses week activities are largely determined by the nurse retention team. This team is acutely aware of the need to frequently check the pulse of the nursing community. Discussions are informed by feedback, and the team strives to base decisions on evidence. This survey of UMHS nurses was targeted to identify their viewpoints and attitudes about nurses week actions. The aim was to specifically identify valued celebratory choices.


Past Is Passe

The RN's perceived value of nurses week tributes has not been the object of a previous investigation. A literature review finds predominately anecdotal information on nurses week celebrations and mentions of one 1997 survey done at a 337-bed hospital. The survey, assessing nurses week program acceptance, found that nurses are less than satisfied with nurses week events that include beauty makeovers, speakers, transcultural displays, and massage therapists. Moreover, only 50% of the respondents participated in the offered programs.1


Several editorials in nursing journals such as American Journal of Nursing, Nursing Economics, and Nursing express concern about celebrations that distribute food or token gifts during nurses week and fail to reflect on the importance of the work done by nurses.2-4 In response to an editor's question asking nurses what they would like employers to do during nurses week, 6 of the 8 nurse respondents indicated that public recognition of nurses and nursing is paramount.5 A review of a nursing Web site with posted comments about nurses week found that during the past 3 years, most reported food events or distribution of "goodies" but no comments described planned activities based on nurse preference data. Web site contributors indicate that an action taken to honor nurses through media statements occurs frequently, and those who posted their comments appreciated that acknowledgement. Several individuals reported that their hospital used nurses week as an opportunity to present awards to nurses selected as outstanding representatives of the profession. Others noted that nurses derived satisfaction from participating in community volunteerism during this time. However, many individual Web entries expressed disappointment with celebratory choices or complained about token gifts.6


No matter what organizations choose to do for nurses week, budgeting details were not found in published or electronic accounts. Vonfrolio7 captures much of the sentiment about nurses week celebrations in the following statement: "Despite the fact that our educational levels have risen, our responsibilities have increased, and our contributions to American healthcare have grown over the past several decades, many hospitals still don't 'get it.' They're still relying on trinkets to say, 'Thanks!'" Clearly, all see nurses week as an opportunity to focus on nurses and the nursing profession. It is most often perceived as a time for celebrating the accomplishments of the professional nurse and for saying "thank you." However, the lack of literature supporting data-driven choices for nurses week activities highlights a need for further investigation.


Exploring Current Values

One thousand one hundred eighty-two UMHS nurses attended one of five 8-hour educational days designed to honor nurses and recognize the pivotal role that RNs have in the delivery of patient care. Surveys were distributed with the conference packet and collected at the end of each day. Seven hundred thirty-four surveys were returned (62% of those distributed). Seven were not included in this analysis as sex and/or age are unknown. Responses represent the opinion of approximately 25% of the nurses employed by UMHS in the spring of 2005. There were not enough men in the sample to compute test of homogeneity between the sexes; however, there is no meaningful discrepancy in the responses between men and women.


The overall sample analyzed included 727 participants, 28 were men. Forty-seven (6.5%) of respondents were less than 26 years old; 243 (33.4%) were 26 to 39 years old, with 12 of them being men. The greatest percentage of participants fell into the 40- to 58-year-old range, with 402 (55.3%) nurses. Sixteen of the nurses in this group were men. Thirty-five (4.8%) of the respondents were 59 years old or older.


This sample is quite similar to demographic characteristics of the UMHS nursing community in terms of sex and age. In 2005, at the time of the survey, the UMHS workforce was 91% women, with an average age of 42 years.


The Survey Questions

Queries addressed overriding beliefs about the objectives of nurses week commemoration as well as celebratory choices most valued by nurses. In addition, participants were also asked to rate modes of communication in order of preference. Not all nurses answered every question.


Query 1: Objectives of Nurses Week Celebrations

Annually, National Nurses Week is proclaimed as a set time and opportunity to celebrate and recognize the contribution that nurses and nursing make to the community. The American Nurses Association states the purpose is to "raise awareness of the value of nursing and help to educate the public about the role nurses play in meeting the health care needs of the American people."8 This survey question lists 4 components of nurses week. Participants were asked to check all choices they viewed as important aspects of National Nurses Week. Registered nurses selected (in order of importance) recognition of the vital role the nurse plays in healthcare delivery at UMHS (94%), noting and celebrating nurse accomplishments (84.9%), educating the public about the nursing profession (80%), and volunteering in one's community (62.3%).


Query 2: Ranking Potential Nurse Week Activities

Nurses week celebrations cover a wide array of possible actions. To determine which options are valued by nurses, we asked participants to choose preferences from a limited list. Healthcare organizations commonly invest in small gifts or food-related options during National Nurses Week. Reports of raffle-like lotteries and educational events-prompted their inclusion in this question. Nurses were asked to rank 4 options in order of preference-food, gifts, educational opportunities, and a chance to win an item or opportunity. Figure 1 gives percentages of nurses rating each option as "most preferred" (1 of 4 on the Likert scale of preference).

Figure 1 - Click to enlarge in new windowFigure 1. Four highest ranking recognition items preferred by nurses.

Sixty-five percent of respondents preferred most educational opportunities, whereas 6% expressed a preference for raffle-like lotteries. Older nurses show lower preferences for food and gift items than younger nurses do. These findings align with other reports that identify educational opportunities and professional development as important to nurses.9-11


Query 3: Weighing the Value of Options

A 6-option question, structured to further define preferred choices, was used to detect the "value" that RNs place on reported healthcare organization commemorative nurses week action. Three of the choices more specifically define the type of continuing education opportunity. Other survey choices explore the need to continue more traditional celebratory methods such as ice cream socials and/or gift distribution. Gathering in small groups for opportunity to meet with the director of nursing aimed to explore value placed on communication with upper level administrators. Opportunity for additional feedback was provided through write-in option.


Nurses were asked to select a number from a 1 to 5 in the Likert scale that best reflects value of each of 6 listed items: (1) a day-long off-site educational event, (2) 2-hour educational opportunities held within the hospital setting, (3) a specialty-based unit-sponsored educational event, (4) a gift for each nurse, (5) a luncheon with the chief nurse executive for select nurse groups, and (6) snack food delivered to units.


Table 1 gives the percentages of men and women who highly value (marking a 4 or 5 on a 5-point Likert scale of value) the various choices. First review of data looks at overall value placed on each choice. There is little discrepancy between the percentages of males and females; therefore, men and women were pooled for all further analyses. This survey identified day-long off-site educational events as the most valued of the offered choices. This activity was rated as 4 or 5 on the 5-point Likert scale of value by 92.5% of all nurses. Specialty-based unit-sponsored educational events are valued next, with 77.1% of all nurses rating this activity as 4 or 5. Two-hour on-site educational activities, gifts, luncheons, and snack food were appreciated but not significantly highly valued.

Table 1 - Click to enlarge in new windowTable 1. Highly Valued Nurses Week Celebration Options (Percent of Respondents Who Selected a 4 or 5 on a 5-point Likert Scale of Value)

Secondary analysis found significant differences with respect to age (see Figure 2). [chi]2 Tests of homogeneity were significant (P < .05). The differences that were meaningful are preference for day-long off-site educational events increase with age and gifts and snack food delivered to units become less important with age.

Figure 2 - Click to enlarge in new windowFigure 2. Bar graph showing percentages of age groups that highly value (4 or 5 on Likert scale) different activities.

Query 4: Identifying Messaging Preferences

Successful nurses week planning requires effective communication if the chosen celebratory modes are to be effective. This fourth query asked participants to select from a list of 9 options the best way to deliver event information. Nurses overwhelmingly (75.1% of respondents) prefer e-mail as the mode of communication, with US mail sent to the home a distant second choice. These are followed by local hospital mail delivery systems and staff meetings. Other modalities are not significant. Table 2 lists the preferences of nurses for routes of communication (note: many respondents marked more than one preference; there were a total of 727 participants).

Table 2 - Click to enlarge in new windowTable 2. Preferred Communication Modes

Discussing Results-Give Me Substance

The survey results reveal that nurses identify recognition and acknowledgement as fundamental components of nurses week. Positive links between recognition, satisfaction, and retention are reported in the literature and would lead administrators to take every opportunity to acknowledge nurses and nursing.10,12-14 Moreover, " One of the biggest threats to nursing staff satisfaction is the lack of recognition for work performance."15 Our results reinforce the essential component of acknowledging the value of the profession and the individual nurse.


Eighty percent of the respondents believe that educating the public about the impact of nursing on healthcare is important. Efforts to influence community perceptions about nursing can build respect for and interest in the profession. Initiatives such as the Johnson & Johnson multimedia Campaign for Nursing's Future increase awareness of the vital role of nurses in healthcare delivery and are often recognized as a means of inspiring (attracting) a new generation to seek a career in nursing.16 However, the Johnson & Johnson initiative also builds pride in those who have already chosen nursing. It depicts RNs as qualified, competent, compassionate healthcare providers with their own body of expertise. Healthcare leaders who make community education an element of their nurses week commemoration strengthen this message of respect for this essential profession.


Information gained on nurse preferences for activities or items often associated with nurses week celebrations found most RNs interested in educational programs focusing on clinical and professional development. Support for such activity has multiple benefits. Not only does it respond to RN core values, it also provides opportunity to build high-performance cultures and address institutional educational objectives. Making education a feature of nurses week sends an important message. Astute administrators recognize that no asset adds greater potential for an organization than the collective knowledge of its employees.


Also identified here is the communication mode most preferred by RNs-e-mail. More than 75% of this survey population favored electronic messaging. Unit-based options such as staff meetings and unit newsletters, often thought of as key, are less favored as primary modes of information transfer. Our newer nurses entered the profession with computer skills that include e-mail, and our more mature nurses have adapted to this technical change which incorporates electronic messaging. The speed of this modality linked with absence of additional cost to the institution is appealing.


Review of written comments and suggestions support the broader values reported here. Nurses want public acknowledgement and recognition that their work is valued. They want substance not trinkets. Gifts, food, and certificates are not necessary. And participants appreciated the opportunity to provide ideas for future nurses weeks. It has been noted that "the difference between tokenism and substance can be the degree to which nurses are involved in the planning of nurses week commemoration."7 Seeking direction provided by the nurse workforce to identify options for meaningful recognition is pivotal. In the 2005 report of the American Association of Critical Care Nurses documenting ways to improve nurse work environment, "meaningful recognition" is one of the 6 standards endorsed. The report cautions nurse leaders to avoid tokenism and instead build recognition that fits institutional culture.17



The survey distribution to participants of an off-site educational day limits the ability to generalize the results beyond the sample population. Although the sample size represented more than 25% of the UMHS nurse workforce, propensity to attend the event where distribution took place may be more likely to generate results that so strongly value such an event. However, subsequent events with educational components which occurred in 2006 and 2007 did draw large numbers of attendees who had not been present in 2005. Evaluations of those events are positive with more than 92% of attendees consistently rating the events as superior.


One objective was to compare preferences by sex. However, the small number of male nurses who answered the questionnaire precluded ability to report significant results. With males representing only 5.4% of the nation's professional nurses, measuring male preferences will require multisite investigations.18


This survey was administered at a large Midwestern teaching hospital, and results may vary with a broader survey sample. Further studies are required to determine variance in nurses week celebratory preferences. Distinction that might be associated with hospital size, region, and/or type; differences that might surface with a randomized questionnaire distribution; and benefits and efficiencies of linking features of nurses week celebrations to hospital mission should be explored.


Relevance for the 21st Century

Data-driven management decisions propel effective nursing departments to excellence. Organizational leaders who invest in their human capital create a basis for long-term competitive advantage. Those who fail jeopardize their own success. Expenditures for nurses week events can be optimized by saving most of the budget for educational opportunities. In addition to contributing to nurse satisfaction, funding of such activity addresses hospital mission and enhances patient care.


The apparent affinity for recognition of role and accomplishments strongly supports the need for organizational leaders to provide such feedback and build community norms that embrace respectful behavior that fosters acknowledgement of excellence at all levels.


Gift items are often perceived as token trinkets. Replacing the tradition of distributing such items with action that reflects options identified by nurses as meaningful will pay greater dividends. To communicate the schedule of events, cost-free e-mail with a concurrent simple local announcement is preferred and allows budgeted monies for postage and so forth to be used where it is more valued and appreciated.


University of Michigan Health System's chief nurse executive, Margaret M. Calarco, PhD, RN, adds that "The core organizational value underlying this work is the inclusion of the nursing community in all processes which impact their work environment. The only successful way to determine what nurses find valuable and meaningful is to connect with them directly and actively. The chief nurse executive plays a pivotal role in creating the forum for direct decision-making to occur and for establishing clear values around active participation, inclusiveness and 'professional voice.' In concert with UMHS values of inclusion and active participation, the survey of nurses to guide us in creating meaningful recognition processes was an important step in strengthening our organizational culture."


Although UMHS nurses' emphasis and preference for professional educational activities were not a surprise, nurse executives are encouraged to conduct their own institutional surveys to hear the voice of their community and create opportunities for active participation in this and all other decisions. Each institution is "unique" in its culture, values, and norms, and although this study provides insight into one culture and community, the results may not apply to every institution.


Calarco continues, "The process used was the most important part of our work. As long as the outcomes are generated by the professional community itself, then the culture is strengthened by the process. It is this inclusive process that strengthens nurse satisfaction and retention. In addition, the provision of educational opportunities through a variety of venues, expands intellectual capacity and productivity, as well. It is this combination of active engagement which creates a sustainable cycle of regard and recognition, thereby strengthening an engaged and productive culture and community."




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