Decreasing Turnover Through Meaningful Recognition

Project Topic:

Give a Cup of Kudos: Improving Meaningful Recognition

Hospital, City and State:

The University of Alabama-Birmingham Health System, Birmingham, Alabama

Unit:

• Hospitalist 3

CSI Participants:

• Chrystian Ambrose, BSN, RN
• Elizabeth Baker, BSN, RN
• Angela Teel, MSN, RN

Project Goals/Objectives:

1. Improve Oldenburg burnout scores by 10%
2. Decrease turnover by 20%
3. Increase Healthy Work Environment Assessment Tool (HWEAT) Meaningful Recognition score from 3.1 to 3.5

Project Outcomes:

1. Improved Oldenburg burnout scores 16.11%
2. Decreased turnover 14.3%, from seven to six
3. Increase Healthy Work Environment Assessment Tool (HWEAT) Meaningful Recognition score to 4.01
4. Potential annual savings of $104,760 and return on investment of 741%

Project Overview:

The Cardio-Hospitalist 3 (HSP3) team at the University of Alabama at Birmingham (UAB) Hospital implemented a nursing workforce project focused on improving meaningful recognition as a strategy to enhance staff morale, reduce burnout, and improve nurse retention. The initiative was developed in response to significant staff turnover on the 31-bed cardiac unit, which experienced 13 staff departures between September 2024 and 2025. Team members identified inadequate meaningful recognition as a contributing factor affecting staff engagement and retention.

To address this challenge, the team launched a multifaceted recognition program centered around a “Cup of Kudos” campaign. Interventions included a unit-wide kickoff event, peer-to-peer recognition through a Kudos Board, monthly prize drawings, a coffee cart, a “We Care” cart stocked with staff appreciation items, ongoing promotional efforts, and leadership engagement in recognizing staff contributions. Surveys were also conducted to better understand what types of recognition were most meaningful to employees and to measure project outcomes over time.

Project outcomes demonstrated notable improvements in workplace culture and recognition. Meaningful Recognition scores on the AACN Healthy Work Environment Assessment Tool (HWEAT) increased from 3.12 to 4.01, moving the unit from a “somewhat healthy” to a “moderately healthy” rating. Aggregate HWEAT scores also improved from 3.40 to 4.09. While burnout remained a concern, Oldenburg Burnout Inventory scores showed modest improvement, and staff reported stronger recognition from both peers and leadership.

The project also produced measurable retention benefits. Nurse turnover decreased by 14.3%, representing one fewer nurse leaving the unit during the measurement period. Using an estimated replacement cost of $61,110 per nurse, the team calculated a projected annual savings of approximately $104,760. Additional positive outcomes included stronger relationships among staff members and the creation of sustainable recognition resources such as the unit’s “We Care” cart.

The team plans to sustain the initiative by maintaining the coffee cart, Kudos Board, leadership recognition efforts, and staff appreciation resources. Key lessons learned included the importance of teamwork, the highly individualized nature of meaningful recognition, and the challenges of maintaining participation and engagement across a busy clinical environment. Overall, the project demonstrated that structured recognition initiatives can positively influence workplace culture, employee satisfaction and nurse retention.