A Culture of Nurture: Transforming Nursing Through Meaningful Recognition

Project Topic:

Meaningful Recognition

Hospital, City and State:

Cedars-Sinai Medical Center, Los Angeles, California

Unit:

6-North (east and west)

Surgical Progressive Care

CSI Participants:

• Cherie Kakinami, MSN, RN, PhD, PCCN
• Kirsten Lapid, BSN, RN, PCCN
• Krystabel Mordeno, BSN, RN, CMSRN
• Jane Reid, BSN, RN, PCCN
• Coach: Omar Tinio, MSN, RN, CMSRN

Project Goals/Objectives:

1. Improve AACN Healthy Work Environment Assessment Tool (HWEAT) Meaningful Recognition Score by 0.5 and decrease the poor and fair responses to less than 10%
2. Improve meaningful recognition between nurse managers and staff
3. Create a leadership spotlight board where four employees are recognized each month
4. Improve relationship between new leadership team and staff
5. Boost unit morale
6. Increase employee engagement survey scores with more than 80% favorable responses
7. Decrease employee turnover on RNs to less than 5% and Care Partners to less than 2%

Project Outcomes:

1. Increased HWEAT scores aggregate score from 4.33 to 4.58
2. Increase all six HWEAT standard scores and average of 0.25 with all standards >4.20
3. Greatest increase HWEAT Meaningful Recognition standard from 4.24 to 4.54
4. Decreased poor and fair responses for the question “in my work unit, the recognition taking place between RNs and nurse manager is...” 7% and increased the excellent and outstanding responses 12%
5. Increased employee engagement survey from 84 to 87 and increased favorable responses for six out of eight questions with a >80% favorable response to seven out of eight questions
6. Decreased employee turnover
   • Decreased registered nurse (RN) turnover rate in the postclinical period (January-September 2024)- 3.10% versus 1.50%
   • Decreased clinical partner (CP) turnover rate in the postclinical period (January-September 2024)- 11.9% versus 2.38%
7. These outcomes resulted in a positive estimated annual fiscal impact of $253,422

Project Overview:

In 2023, our unit underwent several leadership changes, including the appointment of a new associate director, assistant nurse manager, nursing professional development practitioner, and clinical nurse IV. This transition created uncertainty among staff, and the unit morale was low. Based on our preclinical HWEAT survey data, the CSI team decided to focus our project on the the Meaningful Recognition standard, specifically focusing on the prompt, “in my work unit, the recognition taking place between RNs and nurse managers is…”. Although this wasn’t our lowest-scoring standard, we chose it because it had a relatively high number of “fair” and “poor” responses.

To address this, the CSI team launched our project in January 2024 with a nacho party. We invited staff to share their thoughts on what meaningful recognition meant to them and how they preferred to be recognized. The team also introduced a Leadership Spotlight Board, which featured four randomly selected employees each month. This board displayed employees’ pictures, light-hearted fun facts that they had shared, and personalized acknowledgements from the leadership team.

The Leadership Spotlight Board proved to be more than just a recognition tool. The fun facts staff shared became unconventional conversation starters, fostering a sense of connection and helped staff members get to know one another better.

The CSI team members were also a part of the Staff Experience Committee, where we helped plan other team-building events such as the holiday party and summer picnic.

Several other existing meaningful recognition initiatives already existed on the unit. Standing Ovations is a hospital-wide recognition system which allows both patients and staff to show appreciation for someone. Staff typically receive their Standing Ovation by email. We also have a peer-to-peer recognition initiative, called “Shout-outs”, where staff can submit a short message to recognize their colleagues. Shout-outs are sent out monthly by email and also posted visibly on the unit. To complement the Leadership Spotlight Boards, management began reading aloud Standing Ovations and Shout-outs during staff meetings and shift huddles.

Beyond the priceless team-building benefits, our project also yielded significant financial savings. By decreasing employee turnover, we estimated an annual cost savings of $225,264.