Dear Crucial Skills,

We are looking for meaningful ways to recognize our nursing staff in our busy, stressful ICU. In our last employee satisfaction survey, we scored low in “recognition.”

We know from Crucial Influence that external rewards aren’t always the best way to motivate people. We would like to find ways that would encourage staff to grow and have internal satisfaction for doing a great job with their patients, families, and other staff.

Other than external rewards, how can we meet our staff’s need for meaningful recognition?

Managing Motivation

Dear Managing,

Your question is relevant to every leader. It’s common for hardworking, productive, and dedicated staff to say they don’t get the recognition they deserve. If not corrected, this feeling can undermine their commitment, engagement, and performance. Leaders need a variety of ways to recognize performance and show appreciation.

1. Don’t resort to using money as a motivator. Personally, I like money. I endorse the view that, “Money may not buy happiness, but it sure makes misery more comfortable.” The challenge is that money often plays the role of de-motivator. If you don’t think your pay is fair, then it’s hard to stay motivated. But, if you do think your pay is fair, then you stop thinking about it and its power to motivate fades. Leaders need to establish fair pay, but they shouldn’t rely on fair pay to motivate.

2. Use rewards in moderation and in combination. This is the guideline we introduce in our book, Crucial Influence. Rewards work best when they a) aren’t so large that they become the only reason for acting; and b) are combined with personal and social motivators.

The merit badges scouts earn are a nice example. The badges themselves are just bits of cloth or tin. They are very moderate in value. But they work in combination with both personal and social motivation. They recognize hard work and a worthy accomplishment, something to be proud of—personal motivation. And they create an occasion for family and friends to cheer the scout’s success—social motivation.

When rewards are too large and not used in combination with personal and social motivators, then all eyes are on the rewards and the rules for winning them. You see people cheat and game the system. They may even lose track of the personal and social reasons for their actions.

Here is a scary example. A hospital had made rewards and punishments a big part of their hand-hygiene program. A nurse manager saw a nurse put her hand under a hand-sanitizer dispenser, but nothing came out. The dispenser was empty. The nurse continued into the patient’s room and began to work with the patient. When the manager pulled her aside the nurse said, “I did my part. It’s not my fault the dispenser isn’t working.” This nurse was so focused on the rules, she failed to remember patient safety and the intrinsic reasons for having clean hands. That is the danger of rewards that aren’t used in moderation and in combination.

3. Make the invisible visible. This is a skill we teach in Crucial Confrontations and Crucial Accountability Training. Have you ever looked back at a tough day—a day spent coping with emergencies, interruptions, and switches in priorities—only to wonder what you’ve actually accomplished? This is the rat race, right? You know you’ve been running all day, but you aren’t sure you’ve gotten anywhere. Many of us experience this frustration, and I bet nurses who work in Intensive Care Units (ICUs) experience it more than most. Here’s why.

Patients who are in ICUs are among the sickest in the hospital. In fact, they are usually so sick that, even when they are healthy enough to be discharged, they don’t get sent home. Instead, they are sent to another unit in the hospital, one that deals with less critically ill patients. Often ICU nurses don’t get to see or experience the positive end to the patient’s story—the patient’s leaving the hospital and their happy families welcoming them home.

Work to fix this situation by creating ways for your ICU nurses to see and experience their accomplishments. I’ll suggest a couple of ideas, but I bet you and your staff can generate far more.

• Involve your ICU nurses in post-discharge calls to patients. Most hospitals are now implementing some kind of post-discharge call to patients. Research shows these calls improve patient satisfaction, reduce medication-related problems, and result in fewer return visits to emergency rooms. These calls can also be a powerfully motivating source of feedback for nurses.I’m not suggesting that your nurses have time to make these calls, though that would be great. Most hospitals already have specially trained staff who make these calls. Have the people making these calls meet with your nurses to share outcomes, or meet with the phone team yourself and then share outcomes with your ICU nurses. Create regular opportunities for your nurses to see the human impacts of their hard work.
• Solicit feedback from patients’ family members. Often, ICU patients are so sick and sedated that they hardly remember their ICU experiences. But their family members sure do! Most are overwhelmingly grateful for the wonderful work ICU nurses perform and would be happy to share. Find ways to get family members’ feedback—solicit notes, ask family members to record a message that can be shared, or have family members attend a routine meeting.
• Tighten links to the units that accept the patients you discharge. Involve staff from your internal customers—the step-down and medical-surgical units that take your patients when they no longer need to be in your ICU. Ask them to attend regular meetings, so they can share how they, their patients, and their patients’ families have been impacted by the work your ICU nurses perform.

4. Use crucial conversations to reduce de-motivators. Ask yourself whether there are leaders, physicians, or staff members whose actions undermine morale on your unit. Sometimes you can identify a handful of individuals who are rude, dismissive, or disruptive in ways that counter the recognition others provide. I’m not suggesting that these people should ever sugarcoat bad news or provide less than honest feedback. But you may ask them to be more constructive by focusing on facts, allowing room for dialogue, and showing respect.

I hope these ideas give you a few additional ways to recognize your staff. However, none of these can substitute for your own genuine appreciation for their work. Make sure you spend time rounding every day, noticing all the right things they are doing on the job, and removing barriers so they can do even more.

Please let me know what you try and how it works.

David