Joy in Work: A Fellowship Focused on the Value and Impact of Authentic Appreciation, Professional Recognition, and Meaningful Rewards on Nursing Engagement
Summary
This advanced care practice fellowship (ACPF) is dedicated to supporting and celebrating the profession of nursing at Southlake Regional Health Centre (SRHC). The intention was set to provide nursing leaders with the necessary knowledge and skills to improve joy in work and nursing engagement through authentic appreciation, professional recognition, and meaningful rewards. "Nurses recognized for their work demonstrate an increase in confidence, motivation, and performance in delivering quality care to patients” (Cronin, 1999, p.6). Inspiration for this fellowship grew from a moment of simple appreciation and recognition at a time when it was needed most and for that reason, the scope of my fellowship was narrowed to exploring joy in work and nursing engagement through appreciation and recognition.
The National Research Council of Canada (NRC) identified three overarching areas for growth from staff engagement survey (SES) results in 2019 at SRHC: trust, value, and opportunities to improve their work. A review of the literature was conducted on these themes concerning nursing engagement. Following this preliminary research, The Institute for Health Improvements (IHI): Joy in Work Framework was used as a guide to achieving the fellowship objectives.
The IHI Joy in Work Framework outlines nine major concepts, each of which is accompanied by evidence-based strategies that contribute to a happy, healthy, work environment. The framework allocates the roles and responsibilities of each staff member, direct manager, and executive leader. Five of the nine concepts were relevant to the overall fellowship learning objectives including: choice and autonomy, participatory management, meaning and purpose, camaraderie and teamwork, and recognition and rewards. The framework also provides a tool titled the ‘4 Steps for Leaders’ which is designed to gather information directly from the staff experience on enablers and barriers to joy, to creatively brainstorm improvement strategies, as well as, how to carefully and deliberately trial various initiatives brought forward (Perlo, 2017). The five concepts from the joy in work framework were used to organize and apply evidence to nursing strategies identified from the focus discussions.
Choosing the leadership stream ACPF allowed me to develop and gain confidence in my frontline leadership skills. I had the chance to read and learn from leadership literature and become a member of an International Toastmasters club. These activities helped me to enhance my professional communication skills. I learned how to simplify complex ideas in a straightforward manner. I was able to apply these skills with key fellowship stakeholders including frontline nursing professionals, direct managers, and executive leaders. This included on a one-on-one basis and as a speaker to larger groups such as SRHC’s distinguished Nursing Council.
Having the protected time to practice these skills allowed me to facilitate meaningful, high-quality discussions using the Joy in Work Framework. Engaging nurses on the front line was of absolute importance to the integrity of the fellowship. I was able to use the Joy in Work Framework in combination with my new and improved communication skills to appropriately navigate ‘tough’ conservations in a positive and well-received way. This allowed me to gain qualitative data representative of the nursing voices at SRHC and to identify staff who were actively interested in participating in current and future joy initiatives. These staff members are now considered to be ‘Champions of Joy’.
Outcomes
Learning about the real-life nursing experience at SRHC (the good and the bad) and hearing creative engagement strategies from direct care providers was key in the success of this fellowship’s objectives. The information provided by participating nurses, evidence-based research, organized by the Joy in Work Framework, all contributed to shaping a bold appreciation/recognition program to be trialed in the Emergency Room (ER). It is a 3-tiered initiative displayed in Figure 1.
Figure 1
The “For-Us-By-Us" Appreciation and Recognition Program
Each of the tiers represents a unique approach to giving appreciation and recognition. The following is a brief description of how the program functions.
Tier 1
Quarterly Department Goal Setting
Staff are to work together to decide on a goal (i.e. putting equipment away)
Visually displayed on the program board in the break room
Unit Council and the ER leadership team are to be Champions of the Goal
Success is to be evaluated using quarterly visual pulse surveys
The goal is achieved, we will celebrate and form our next goal together
The goal had not yet been achieved, we will re-strategize and re-assess in 3 months
Tier 2
Employee of the Month
Staff participates by writing a colleague’s name on an anonymous piece of paper and an explanation of why they feel they should be recognized; this collects an assortment of kindness and promotes teamwork. Some examples of common themes include ‘always lending a hand’, and, ‘bringing a good attitude to work’.
The employee whose name is mentioned the most will have their name displayed on the program board along with all others who were nominated
Staff will also receive a magnetic polaroid while holding a dated "Employee of the Month” sign upon being chosen/elected
Tier 3
Real-time Peer-to-Peer Feedback
4x6 inch paper ‘Peer-to-Peer Feedback’ cards are located on the program board
Cards can be used to write down positive feedback to recognize a specific staff member to which can be given to the staff member in real-time
Cards received can be kept in professional portfolios and used as evidence of the quality of work they do
The ‘For-Us-By-Us’ program was designed not only to provide appreciation and recognition but also to facilitate nursing engagement. “Lower levels of staff engagement are linked with lower-quality patient care, including safety, and burnout limits providers’ empathy- a crucial component of effective person-centered care” (Perlo, 2013, p. 5.). Happy healthy work environments are associated with improved positive patient outcomes, decreased adverse events, lower costs, and improved quality care (RNAO, 2013). By implementing strategies to support nursing engagement patients will, in turn, receive high-quality care.
The final deliverable of this fellowship was a presentation to share the knowledge and outcomes obtained to key stakeholders: the Emergency Room leadership team, the Director of Patient Experience (primary mentor), and the Chief Nursing Officer (CNO). This presentation outlined the overall fellowship learning goals, knowledge, and outcomes, as well as possibilities for the future. At the request of the CNO and Director of Patient Experience, the presentation will be delivered to all direct managers and executive leaders across the organization. The hope is that sharing the valuable knowledge and momentum gained with this fellowship will encourage other leaders to build and actively participate in positive social change movements. I envision our organization to be an example of what is possible when we work collaboratively on a path to joy.
Overall experience
Overall, I found this fellowship to be an exceptionally valuable experience. In the initial stages, the process seemed daunting, but as the fellowship progressed, I became excited and proud of everything I was able to accomplish in the allotted time. Having my idea recognized and supported by the RNAO, my organization, and my colleagues was an honour.
I am grateful to have had this time to pursue my passion for positivity in work, and the opportunity to help build healthy working relationships at all levels in SRHC. It has been a pleasure to begin bridging the lines of communication from the frontline to executive leaders to make real change in this organization. Though SRHC has struggled with workplace civility and culture in the past, this fellowship was an opportune conduit for building relationships and establishing common goals through organized and meaningful conversation.
I am humbled by the enthusiasm my colleagues brought to the Fellowship mission. My favourite moments on this journey include mentioning ‘joy in work’ to my nursing colleagues and seeing their eyes light up wanting to participate, as well as, engaging in conversation with staff at all levels of the organization and finding common ground on important fellowship topics. The momentum built through this fellowship has grown my anticipation for positive change at SRHC. We have begun to grow a strong social network of interdisciplinary nursing allies who want to take action and make SRHC a more joyful place to work. This fellowship has been tremendously rewarding to me professionally and personally, and I am endlessly thankful to SRHC and the RNAO for trusting me with this opportunity.
References
Cronin, S. N., & Becherer, D. (1999). Recognition of staff nurses' job performance and achievements: Staff and manager perceptions. The Journal of Nursing Administration. (p. 6).
Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D (with D. Berwick). IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts:
Institute for Health Improvement; 2017. (p. 5., p.17, et. al.)
Registered Nurses Association of Ontario (2013). Developing and Sustaining Interprofessional Health Care: Optimizing patients/clients, organizational, and system outcomes. Toronto, Canada: Registered Nurses’ Association of Ontario.
