Gratitude and Compassion

Beyond thank you: The powerful reach of meaningful recognition

“I recognize that voice, that voice belongs to someone who is such a dream to me. [My nurse] was a shining light and made an unbearable hospital stay a little bit better.”

The above quote from a patient desiring to acknowledge the extraordinary work of a nurse is an example of meaningful recognition. Identified by the American Association of Critical-Care Nurses as one of the six elements of a healthy work environment, meaningful recognition goes beyond a person saying “thanks” or telling someone they did a “great job.” While “thanks” and other kinds of positive feedback are valuable, the outcomes associated from receiving meaningful recognition last longer and have a deeper interpersonal impact on the recipient. The power of meaningful recognition comes from both the content and delivery of this type of feedback, which encompasses authentically describing how one’s actions impacted another in a way that is relevant to the recipient and situation. In other words, meaningful recognition involves genuinely acknowledging what a person did and how their actions made a difference in the lives of others.

Value of meaningful recognition

Why is meaningful recognition important? Research has demonstrated that meaningful recognition can positively impact individuals and organizational cultures. From an individual perspective, the evidence indicates that meaningful positive feedback is associated with the growth of one’s psychological capital, which is our positive mindset that encompasses an optimistic outlook, and confidence in our capacity to accomplish challenging tasks, solve problems, navigate future barriers, and bounce back from difficult situations. Psychological capital (self-efficacy, hope, and resilience) has been linked to a person’s well-being, job satisfaction, job performance, and positive emotions. The outcomes associated with recognizing one’s contributions in a meaningful way can lead to increasing one’s self-awareness of the impact one made, reconnecting nurses with why they chose nursing as their profession, and building and elevating one’s sense of pride regarding their work.

From an organizational vantage point, the research has demonstrated that meaningful recognition allows us to focus on all the “right” occurring in our organizations. This does not imply that we should avoid performance improvement! Efforts aimed at error prevention, eradicating near-miss circumstances, and creating processes that do not promote work-arounds are critical interventions and are a part of our commitment to the profession of nursing. However, increasing efforts aimed at preventing mistakes and reducing errors is only half of the solution required to keep our patients safe and create healthy work environments for staff. The other half of the solution involves devoting the same commitment, effort, and rigor to recognizing and acknowledging all the “right going on” in healthcare organizations across the country. Nowhere in the Institute of Medicine’s report To Err is Human is a recommendation that healthcare organizations focus exclusively on what we are doing wrong and forgo the acknowledgement of what is going right. On the contrary; for years, the field of organizational psychology has provided research supporting the value of leveraging one’s strengths to address developmental opportunities. In addition to developmental value, the evidence has demonstrated that recognizing nurses in a meaningful way can provide leaders with opportunities and data to “showcase” the impact of nursing occurring in their facilities, reinforce the actions associated with patient satisfaction, nurture team spirit, and create an organizational culture that acknowledges and promotes “all the right going on.”

Meaningful recognition: Nursing’s field of dreams

“It’s not just what the nurses did, it was how they treated Patrick and also cared for our family that helped us get through the most difficult time of our lives.” — Bonnie Barnes, Co-Founder of The DAISY Foundation

Following the unexpected loss of Patrick, their 33-year-old son and husband, the Barnes Family created The DAISY Award (an acronym for Diseases Attacking the Immune System) to thank nurses for their extraordinary work. Powered by gratitude, nearly 1,700 healthcare organizations across the globe are currently using The DAISY Award to recognize their extraordinary nurses. Patients, family members, and colleagues nominate nurses for the award. A committee of staff nurses at each facility reviews the nominations and chooses the DAISY Honoree. A surprise, public celebration recognizing the Honoree’s extraordinary nursing occurs on the recipient’s unit with the entire team cheering for their colleague. Patients who are able to attend can join in the celebration, and several of the facilities also invite the Honoree’s family members to attend the event.


Research involving the analyses of over 2,000 DAISY Award nominations from 20 hospitals across the country, along with Honoree and nurse leader interviews, revealed that when a recognition process is “built” into an organization’s culture, patients, family members, and peers will share their stories of extraordinary nurse encounters. To date, about 400,000 nurses have been nominated for DAISY Awards and more than 40,000 nurse Honorees have been recognized for their extraordinary nursing. Clearly, our patients, their family members, and nurse colleagues want to share their stories of how a nurse impacted their lives and why this experience was meaningful to them.

“A lot of times when people find out I am HIV positive, they treat me different. The nurse was always there for me. It didn’t make one little difference that I was HIV positive.” — quote from a nomination for The DAISY Award

The DAISY study showed that stories of extraordinary nursing don’t always involve the “big stuff” like saving a life. Instead, patient, family, and peer perceptions of extraordinary nursing often encompassed what we nurses perceive as the “little things” such as teaching a family how to use a G-tube, holding a patient’s hand during a procedure, explaining one’s medical condition in the way the family understands what is happening, and helping a coworker with a difficult assignment or cope with the loss of a patient. Providing patients, family members, and colleagues with a process to share their stories of how a nurse made a difference allows nurses to acknowledge all the “right going on” in their facilities. Public celebrations like The DAISY Award ceremony reinforce these actions.

Capturing the nature of our work through meaningful recognition

“He not only cares for his patient, but heals the whole family.” — quote from a nomination for The DAISY Award

So, how do we catch all the “right going on” 24/7 in our healthcare organizations? The DAISY study found that the meaningful recognition process like The DAISY Award provided nurse leaders with real-time feedback from patients, families, and colleagues describing how the science and art of nursing come together to create a perception of extraordinary care. The study found that extraordinary nursing is not something that can be scripted or occurs when one uses a template or checklist. Instead, each patient, each family, and each nurse colleague defines extraordinary nursing. These definitions of extraordinary are based upon the nurse’s ability to identify needs and meet those needs in a manner that is meaningful to that patient, family member, or colleague. Based on the patient, family member, and peer nominations analyzed, perceptions of “extraordinary” include a nurse’s clinical knowledge and expertise, and how they combine the science of nursing with the art of nursing (that is, compassion, caring, teamwork, a contagious positive attitude, and connecting with families) to deliver care.

Recognizing what nurses do and how they deliver care provides healthcare organizations with details about how nurses impact the patient experience. The richness contained in the patient stories are often difficult to capture via rating scales associated with patient satisfaction tools. Although these tools provide valuable data, creating a process that allows patients, family members, and peers to recognize extraordinary actions, it’s necessary to augment these types of surveys with explanations of why people are satisfied. Through meaningful recognition, we are able to describe the impact of nursing by learning from our patients, their family members, and our colleagues how nurses inspire, comfort, erase fear, and elevate joy.

“I didn’t think I had done anything that was a big deal. But they thought it was a big deal and that I had gone above and beyond.” — DAISY Award Honoree

Why meaningful recognition is important for nurses

Even though patients, family members, and peers want to express their gratitude, a common response to meaningful recognition from nurses is “I was just doing my job.” Describing the “shock and awe” they experienced upon receiving this type of meaningful recognition, the DAISY Honorees interviewed often replied they were “surprised, flabbergasted, and stunned.” Recognizing the impact nurses have on patients, their families, and our colleagues is beyond “just doing our jobs.” This type of acknowledgement not only validates the importance of our work, but also serves to elevate the mastery and skill associated with the art and science of nursing.

The evidence supports that through meaningful recognition, we can elevate one’s perceptions of self-confidence and esteem, optimism, hope, and resilience. Strengthening one’s psychological capital benefits the individual, our organizations, and those we serve. Through the words of our patients, family members, and colleagues, we can more effectively articulate the work we do, further understand how we touch the lives of others, gain insight into why we make a difference, promote the value of nursing, and recognize that we are indeed a profession of extraordinary.

Cindy Lefton is vice president of organizational consulting for Psychological Associates and a clinical education specialist for trauma and acute care surgery for Barnes-Jewish Hospital in St. Louis, Missouri.

Selected references

American Association of Critical-Care Nurses. AACN Standards for establishing and sustaining healthy work environments: A journey to excellence. Am J Crit Care. 2005;14(3):187-97.

Avey JB, Reichard RJ, Luthans F, et al. Meta-analysis of the impact of positive psychological capital on employee attitudes, behaviors, and performance. Human Resour Dev Q. 2011;22(2):127-52.

Avey JB, Wernsing TS, Mhatre KH. A longitudinal analysis of positive psychological constructs and emotions on stress, anxiety, and well-being. J Leadersh Organ Stud. 2011;18(2):216-28.

Froman L. Positive Psychology in the workplace. J Adult Dev. 2010;17(2):59-69.

Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. 1st ed. Washington, DC: The National Academies Press. Institute of Medicine, Committee on Quality of Health Care in America;2000:1-287.

Lefton C. Strengthening the workforce through meaningful recognition. Nurs Econ. 2012;30(6):331-38, 355

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One thought on “Beyond thank you: The powerful reach of meaningful recognition”

  1. TheNursesNurse says:

    The telling of the extrordinary work that nurses do on a daily basis is something that needs to be said over and over. Not many people understand the depth of a nurse’s duties until they need one.
    TheNursesNurse.com

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