InForms - Advancing Intelligence, Feedback, and Employee Voice

Last week we published Part I of our blog series, Back to Basics: Driving Fulfillment for Frontline Caregivers. The series is based on my recent discussion with Bonnie Barnes, FAAN, Co-Founder, CEO, and Board President at The DAISY Foundation. In Part II we continue the conversation and talk about:

  • Why recognition is so important for both healthcare leaders and frontline caregivers
  • Fulfillment and who plays a role in it
  • Making recognition and authentic engagement a consistent everyday practice
  • Shifting to providing emotional fuel

We continue to hear how organizations struggle to support their frontline leaders. It’s always been a challenge, but since the onset of the pandemic, it has reached a critical tipping point. Bonnie, what are your thoughts on the role that frontline leaders need to play in creating an environment that systemically puts forth and encourages recognition?

This may sound like a strange way to respond. However, one thing that we’re seeing is that when you honor frontline leaders with our DAISY Nurse Leader Award, they get to experience what it feels like to be recognized themselves. It’s a lot more motivating for them to then create the space and time necessary to recognize their staff.

They know in their hearts that recognition is important. Don’t we all? I mean, we all want to receive some kind of recognition. But the nurse leaders who received the DAISY Award have this epiphany, “Oh, my gosh, this is what this feels like. How would I not want to provide this to my staff.”

We actually created this recognition some years ago when it became evident that our managers, directors, and Chief Nursing Officers were creating an environment where compassion took place. But, typically, they were not eligible to receive the DAISY Award. So, we wanted a way to create a special recognition for them. It’s been wonderfully successful and meaningful in helping to drive, not only recognition for those leaders, but recognition for staff as well. The leaders really get it and they see the priority.

I’d like to come back to this concept of authentic, holistic, meaningful engagement. What we are hearing is that this type of engagement feeds the soul in a very different way. It’s great that leaders remember birthdays and work anniversaries. But it’s not the same as an affirmation that provides frontline caregivers personalized encouragement or emotional support. Affirmations feed the soul and help create fulfillment.

What’s your perspective on fulfillment and who plays a role in it? 

I think it all comes down to the story about what a nurse has done. That can be described as highly emotional, or it can be something as simple as my nurse gave me the will to live. This is powerful, powerful feedback.

We’ve conducted research in this area, and others have as well. But, when nurses have come to appreciate that they’ve made a difference that they didn’t know they made, and they hear about it through feedback, replaying these stories back to them about what was really important to them, it’s completely emotionally recharging. I often wonder how nurses get up in the morning and perform the work they do, day after day, or night after night? Knowing how hard it is.

What feeds them is the sense of gratitude. This is especially true when it comes to things they didn’t know made an impact. To me, that’s what fulfillment is about. This is not a concept of passing somebody in the hall and saying, “Gosh, you did a great job.” This is a rich description of the impact someone made. Knowing what you did. How you made a difference. That’s what we all want to have in our lives.

Nurses experience joy and meaning and connecting to purpose, making a difference, which leads to the joy in the power of human connection or fulfillment. In theory, these programs sound great. However, we continually hear that it is difficult to execute consistently so we have to find new ways to operationalize these programs.

I want to comment on the concept of “difficult to do consistently.” Once we get into the ritual of recognition, it’s not difficult to do. It’s nothing but joyful to do.

Every CNO I know who has the DAISY Award in their organization has said, DAISY Days are their best days of the month. Giving this program or a program like it to staff nurses, with shared governance and shared workload, such as it is, provides the best outcome. It’s not the responsibility of leadership to run the DAISY Award.

We knew when we started this program it would require the creativity and resourcefulness and, frankly, the delight of staff nurses to really build it. Those are the people who make it easy to do. They overcome any barriers as long as the CNO and the rest of the C-suite give them the resources and the time to do it. If they have that, this thing runs itself.

We also hear from the committees that run the program about the joy they get from reading the nominations, creating the nomination boxes, and developing all kinds of wonderfully creative ways of surprising nurses who are being recognized. The staff’s creativity is what makes this easy. They love doing it.

It’s a virtuous circle, right? You give feedback and recognition, and it comes back to you. Everyone involved feels good.

As you know, Laudio is focused on healthcare and supporting frontline leaders. In fact, we are deeply embedded into the workflows of frontline leaders to operationalize best practices.

We’ve done some research across the country on the impact different types of outreach and engagement have on satisfaction and retention. Here are a couple of stats:

  • When a manager/leader engages in one personalized interaction, per team member each month there is a 35% reduction in turnover
  • Feedback or outreach coming straight from a manager or something that a manager generates results in a 57% reduction in turnover.

My point here is that in today’s environment we must support our leaders. We need to find ways to make it easier to manage and impact large spans of control that are 24 x 7. Leaders need to be able to reach all team members equitably. And that’s not easy to do in a consistent way.

But this is where Laudio is focused. Taking thousands of communications, enabling leaders to personalize them, and then take action and follow through. We need to shift back to basics in how we support our frontline caregivers and until now we haven’t had the technology to create and facilitate this type of environment at scale. What are you seeing in this area, Bonnie?

 In research that just came out from the American Organization for Nursing Leadership (AONL), we’re also seeing that clearly described at the nurse manager/leader level. There is a need for recognition there as well, CJ.  And, as I mentioned earlier we’ve been seeing this for several years. But now, it’s reached a critical point. I know you’re also engaged with this at Laudio. We need to use that as a fulcrum and make sure that our leaders are being tended to as well.

I think, and I say this with tremendous respect and affection for the nursing profession, but I believe we’ve taken them for granted over the years. Nurses have believed that they had a limitless cauldron of love and support. That they could continue giving and giving, and not need anything in return.

Our healthcare systems have been taking, and we as patients and families have been doing the same. We’ve suddenly realized that we can’t take this incredible resource of humanity for granted. We’ve got to fuel them, recharge them, and give them the recognition they need. There’s not an infinite supply of nurses.

You once told me about your work with Walter Reed National Military Hospital and the “aha moment” you had that a shift was needed in how we support nurses and nurse leaders. I’m curious how this applies in today’s environment.

Walter Reed is a story we have told for years. When we first kicked off the DAISY Award at Walter Reed National Military Hospital, you can imagine we were so proud. Oh my gosh, we get to honor these extraordinary nurses taking care of our nation’s heroes. What a big deal this was.

And, of course, nobody does celebration better than the military. So, prior to what was going to be a great big ceremony in an auditorium with hundreds of nurses in attendance, we were invited by the commander of the base at Walter Reed, Admiral Stocks to come and have coffee with him. Mark and I were beyond excited. We had a lovely conversation with him, and Mark asked him a question. We hear from nurses all the time, including every nurse who gets the DAISY Award. They all say to us, “I didn’t do anything special. I’m just doing my job.”

We asked why nurses say this? Admiral Stocks just looked at us and said, “Well, it’s really obvious. It’s because nurses are heroes. We hear this from our Medal of Honor winners. We hear it from our Purple Heart recipients. We hear it from our nurses because they are heroes.”

For years we would tell this story because that very thing happened at the celebration. We are all marching behind Admiral Stocks, with everybody standing and waving flags. There were pipes and drums. It was an amazing ceremony. A soldier in a wheelchair was brought out. He had nominated his nurse and he read a beautiful nomination with his nurse standing next to him, hand on his shoulder. I’ll never forget this. In the end, he said to her, “You’re my hero.” And what do you think she said, “I didn’t do anything special. I was just doing my job.”

Mark and I were so taken aback by this because to hear the contrast between what this real hero had said to someone who is a hero to him was so profound, and yet this nurse just kind of wrote it off. So, we’ve been thinking a lot about this. We’ve told this story a lot in a way to say to nurses, “You are heroes. Every day you do something that makes a difference for patients and families. We think of you as heroes.”

Now, along comes the pandemic and we see signs at all the hospitals saying, “heroes work here.” We see people screaming and yelling in every city around the world. Fire trucks welcome nurses in for their shifts. Celebration and free pizza and everything else for nurses. But what we’re hearing is they don’t want to be seen as heroes.

Free pizzas great. But don’t make me feel like I’ve got to be something superhuman because I’m just a person like everybody else. That was an epiphany for us. We realized we must tend to the basic needs of nurses who are human beings. And one of those basic needs is keeping them emotionally fueled and emotionally charged to do the very, very hard work they perform.

The importance of their well-being cannot be taken for granted anymore. They’re not a bottomless pit of empathy and compassion.