Meaningful recognition: An imperative for nurse manager well-being : Nursing Management

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Department: Pathway To Excellence®

Meaningful recognition

An imperative for nurse manager well-being

Barnes, Bonnie FAAN; Barnes, Mark FAAN; Pabico, Christine PhD, RN, NE-BC, FAAN

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Nursing Management (Springhouse): October 2021 - Volume 52 - Issue 10 - p 6-9
doi: 10.1097/01.NUMA.0000792044.13706.b2
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The DAISY® Award for Extraordinary Nurses was created in 1999 out of grief for the loss of Patrick Barnes to recognize nurses for their compassionate care. The program now honors exceptional nurses from around the world. This is something we never imagined when we stood at Patrick's bedside while a nurse whose name we don't recall, but whose touch we'll never forget, turned off his ventilator and he died of complications of the autoimmune disease idiopathic thrombocytopenic purpura on November 6, 1999. His passing concluded the worst 8 weeks of our lives spent with him in two hospitals whose physicians and nurses fought to help him stop producing antibodies that were destroying his platelets and making him bleed internally.

All of you have been around families like ours; we had been on an emotional roller coaster and suddenly it was over. How could we keep Patrick's spirit alive? How could we fill the gaping hole in our hearts left by his death? How could we turn our lives to something positive, given the depth of loss we felt?

Right after Patrick died, we searched for that something positive over what we often refer to as a “liquid dinner” in Amarillo, Tex., where Patrick and his wife Tena lived with their brand-new baby girl Riley. As the tears and the wine flowed, the only positive thing we could think of was the care provided by Patrick's nurses. Their clinical excellence was impressive, as we expected it would be. But it was the way they delivered their care that took our hearts. Their compassion, sensitivity, and kindness to Patrick and all of us in his family made a tremendous difference in our hospital experience, and we felt compelled to say thank you.

When we started The DAISY Award for Extraordinary Nurses in Seattle where Patrick was cared for at the end of his life, we hoped we would get to say thank you to nurses in 10 hospitals around the US. You can imagine how surprised we are that just about 22 years later, we're partnering with more than 4,900 healthcare facilities and schools of nursing in all 50 states and in 28 other countries. Over 167,000 nurses have been honored so far with nominations that share the stories of their compassion and excellence. And, even more important to us, over 2 million times, a patient, family member, or coworker has taken the time to share the story of their nurse's impact. Over 2 million times, the story of a nurse's care for a patient or a family has been written in gratitude to that nurse.

We also couldn't have imagined that today The DAISY Award would be celebrating not only individual clinical nurses, but also nurse-led teams, nurse leaders for creating the environment where extraordinary compassionate care thrives, nurses advancing health equity, nursing faculty who role-model and inspire compassionate care in their students, and nursing students who provide compassionate care in their work with patients and families. In addition, The DAISY Lifetime Achievement Award honors nurses who've dedicated decades of their lives to patient care in all the roles they've served. We're truly gratified that DAISY was in place in so many healthcare organizations when the COVID-19 pandemic took hold of our country in early 2020. Never have nurses been more deserving of meaningful recognition, or in need of it.

What makes recognition meaningful?

We think of meaningful recognition as recognition on steroids. As noted by Dr. Cindy Lefton, a trauma nurse whose PhD is in organizational psychology and who's studied recognition extensively, meaningful recognition involves “acknowledging one's behaviors and the impact these actions had on others, ensuring the feedback is relevant to the recognized situation, and is equal to the person's contribution.”1

Meaningful recognition is highly personal, acknowledging how specific behaviors impacted the recipient of a nurse's care. What also makes recognition truly meaningful is the longevity of its effect. Meaningful recognition can resonate throughout a person's life, which is why DAISY nominees hold on to their nominations throughout their careers, referring to them on their toughest days.

Meaningful recognition for nurse managers

Throughout the pandemic, nurse managers, often described as having “the toughest job in the building,” have paid a tremendous price. The February 2021 American Organization for Nursing Leadership's (AONL) Longitudinal Study on the Impact of COVID-19 on Nursing Leadership revealed that two-thirds of nurse managers don't feel emotionally healthy.2 When asked about the biggest challenge nurse managers face today that they didn't face 6 months ago, nearly 45% reported low staff morale and burnout. Furthermore, they attributed burnout and fatigue as the primary cause of the staffing shortage on their units. Looking to solutions, one-third of respondents said that the recent advancement most important to maintain beyond the COVID-19 crisis is wider recognition of nurses' contributions, only slightly fewer than the number remarking on the increased use of telehealth. These findings drove the AONL and The DAISY Foundation to issue a national call to action for meaningful recognition of nurse managers using The DAISY Nurse Leader Award.

Over the years, we've seen nurse managers encourage and facilitate The DAISY Award as a way to meaningfully recognize their clinical nurses, knowing the impact of positive feedback to elevate and motivate their nurses in the delivery of compassionate care. However, in most DAISY organizations, managers aren't eligible to receive The DAISY Award themselves because they don't provide direct patient care full time. When the AONL study exposed the current state of nurse managers' well-being, especially as it relates to recognition, it became evident that it's imperative for nurse managers to receive positive feedback from nurses and others working on their units.

DAISY Nurse Leader Award and Pathway to Excellence

The American Nurses Credentialing Center's (ANCC) Pathway to Excellence® Program recognizes organizations that create positive practice environments for nurses at all levels, including nurse managers. Pathway organizations also acknowledge the critical role of nurse managers in driving organizational culture at the unit level, supporting their onboarding, strengthening their leadership competency, recognizing their contributions, and implementing other strategies to retain them.3 Numerous Pathway organizations participate in The DAISY recognition program to foster a workplace culture that's caring and supportive, and one that safeguards the well-being of all staff and nurse managers.

Midland Memorial Hospital, a three-time Pathway-designated hospital in Texas, has been successfully and regularly honoring nurse managers and other leaders with The DAISY Nurse Leader Award since 2017. Kit Bredimus, DNP, RN, CEN, CNML, CPEN, NE-BC, QMHP-CS, vice president of nursing/CNO, reminds us, “The DAISY Nurse Leader Award provides invaluable feedback to nurse managers, highlighting the essential relationship between the nurse manager and their team. Managers cherish knowing how much their advocacy and support mean to the staff. Hearing the team's feedback lets them know they're making a difference. DAISY-honored nurse managers are clearly role models, setting the bar high for the unit's delivery of care and creating the environment where staff can do their best work.” Evidence of Dr. Bredimus' point is clear when one reads DAISY nominations for nurse managers. Nominations illustrate what great managers mean to their staff as they describe how managers advocate for them, fight for them, stand by them in patient care, make tough decisions, and so much more. (See Table 1.)

Table 1: - Excerpts from DAISY Nurse Leader Award nominations
Kristin Johnson, BSN, RN, CCRN-K, CNRN
Electroconvulsive therapy and float pools
Swedish Medical Center—Ballard
Seattle, Wash.
Over my 35 years of being an RN, Kristin stands out to me as an ideal leader and helps me excel in my own personal best. Kristin is an extremely hard worker. She's an example of hard work, not just because or when someone is watching but because that's who she is. She started in our unit working by our side, not trying to get out of work but to make work something to be proud of. She knows what we do because she has done it, and she has done it well.
Kristin is someone who's honest, fair, and empathetic and someone who can appreciate the hard work going on around here at Ballard. She's approachable and isn't afraid to learn new things to make our program the best that it can be. She inspires me to reach higher, work a little harder, and truly be the best that I can be for our patients, for our teammates, for Ballard Swedish, and for the nursing profession. Kristin stands out as someone special and inspiring. Finally, I wanted to say she's trustworthy. I want to make it known. She has earned my trust. These are the qualities of an ideal manager for me, and there are more in her that haven't been said in this short letter.
Emergency Department
Sky Ridge Medical Center
Lone Tree, Colo.
When you ask Pam's team what they would want someone to know about her, these are some of the things that are said: “Pam always fights for her team.” “Pam is the most intelligent person I've ever met.” “Pam is trustworthy, you could tell her anything and know that it's in good hands.” “Pam literally knows the answer to any question that I have.”
Pam demonstrates extraordinary role-modeling behavior in her everyday interactions. She doesn't bat an eye at things with which most people would be completely overwhelmed. She's supportive of every ED staff member and is responsive to the individual needs of her team. Pam is the epitome of a leader who creates an environment of trust and professional excellence. We, as the ED staff, believe that Pam motivates us to pursue and continue professional development in our individual areas of interest. She infuses humor into the day to help ease stress among the charge nurses and the ED staff. The staff know that she'll listen, understand, and support their real-time decision-making.
Pam puts the patient experience at the forefront of every person's visit who walks through the ED doors. In our department, she has established a working environment built on teamwork, camaraderie, and trust. I don't think any of us imagined or expected the challenges that the year 2020 and the COVID-19 pandemic would bring into our lives. Throughout it all, Pam has confidently led us and walked through this time with us. Early on in the pandemic, it seemed our daily practice and standards of care were changing more frequently than any of us could keep up with. Pam remained steadfast, sending multiple emails daily to ensure that our staff was well communicated with. She made it her priority that we all felt safe and informed as we cared for these patients. She also welcomed new staff as the surgery center nurses were deployed to our unit in preparation for a potential surge of patients. Pam worked quickly to have the nurses trained to perform basic ED skills and provide support to our care staff should we have a surge.
Pam is dedicated and selfless. She's our biggest advocate and our greatest teacher. She's a nurse in every sense of the word and to the deepest parts of her core, and she's a leader above all else. We appreciate all she does in our department and behind the scenes to keep the gears of the ED running.

The call to action for recognizing nurse managers and other leaders is aligned with the Pathway framework. (See Figure 1.) The leadership standard, one of the essential components of the framework, requires organizations to implement strategies that support and retain nurse managers. Meaningful recognition contributes to compassion satisfaction and positively impacts job satisfaction and intent to stay.4 The well-being standard requires organizations to have a proactive approach in safeguarding clinician well-being. Pathway organizations include clinician well-being in their strategic planning; periodically assess staff to minimize burnout; and foster resilience through support processes, especially following adverse situations. Formal recognition programs are supported and, more important, a culture of daily recognition for both clinical nurses and nurse managers is promoted.

Figure 1::
ANCC Pathway to Excellence® Framework for Positive Practice Environments

St. Joseph's Children's Hospital in Tampa, Fla., a recently designated Pathway hospital, recognizes the critical role that nurse managers play in supporting the team. For that reason, the senior vice president/CNO and regional CNOs sponsor a Nurses Week nurse leader celebration where nurse managers are recognized with The DAISY Nurse Leader Award for their exemplary leadership.

A highly effective way to support well-being, gratitude is woven throughout the cultures of Pathway-designated organizations and those that honor their nurses with The DAISY Award. Gratitude contributes to reduced stress, positive relationships, and a sense of meaning and purpose in work.5 Although gratitude may not replace other important workplace strategies, research reveals how it emotionally recharges nurses, fueling the resiliency they need to do the difficult work they do. A culture of gratitude is fully reinforced with meaningful recognition for nurses and their leaders.

Carolyn Fox, MSc, BSc Hons, RN, OBE, is the chief nurse of the UK's University Hospitals of Leicester National Health Service Trust. In her former role as chief nurse of the Northampton General Hospital Trust, she led her team to the UK's first Pathway to Excellence designation, and her new organization is on the Pathway journey now. She commented, “As chief nurse, I have a moral obligation to create a positive practice environment where nurse managers and nurses are recognized for their valuable and unique contribution to both patient and staff experience. In fact, nurse managers at University Hospitals of Leicester provide leadership and managerial support to the majority of our nurses, making their role integral to an environment where nurses can grow, develop, and flourish. Meaningful recognition of nurse leaders plays a crucial role in their well-being, topping up their emotional bank accounts and, ultimately, the well-being of their teams. If the tone for meaningful recognition is set at the top, then our ward managers have a critical and crucial role to play in organizational culture, so let's start by recognizing and honoring them.”

Road to recovery

We all know that the pandemic isn't over; however, we hope the recovery of our nurses from the unspeakable stress they've experienced is underway. The growth in the number of Pathway organizations and those adopting The DAISY Award is a testament to healthcare's commitment to nurses' well-being, prioritizing the transformation of workplaces into positive, healthy environments that support staff resilience and retention. We hope you'll take part in the call to action for recognition of nurse managers. The nurses doing “the toughest job in the building” deserve nothing less.


1. Lefton C. Strengthening the workforce through meaningful recognition. Nurs Econ. 2012;30(6):331–338,355.
2. American Organization for Nursing Leadership. Nursing leadership COVID-19 survey. 2021.
3. Bates M, Hargreaves J, McCright M, Pabico C, Hume L. Introducing the 2020 Pathway to Excellence® manual. Nurs Manage. 2020;51(4):7–10.
4. Duffield CM, Roche MA, Blay N, Stasa H. Nursing unit managers, staff retention and the work environment. J Clin Nurs. 2011;20(1–2):23–33.
5. Suttie J. Can practicing gratitude boost nurses' resilience. Greater Good Magazine. 2021.
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