We all want respect and recognition. We all want to feel that others hear our voices and value our contributions.

Nurses have sought recognition for decades. But many healthcare employers don’t respond—or worse, they respond by going through the motions of recognizing their nurses.

Some employers may think that giving penlights and mugs during Nurses’ Week is meaningful recognition. Nurses think it’s mechanical recognition—an act that does nothing to make the recipient feel respected and valued.

Sharing the challenge
In a workplace without an environment of meaningful recognition, nurses may feel angry, invisible, frustrated, and ignored. And these feelings can lead to negative behaviors such as calling in sick, and to an overall negative attitude toward the workplace, colleagues, and the nursing profession.

On the other hand, in a workplace with meaningful recognition, nurses feel confident, validated, and rejuvenated. These feelings empower nurses in their roles and motivate them to do more to serve patients and families and to support and collaborate with their colleagues.
The American Association of Critical-Care Nurses has developed “Standards for establishing and sustaining healthy work environments” to challenge healthcare organizations to adopt ways to create environments where people can be successful. The fifth standard, Meaningful Recognition, is aimed at creating an environment of excellence and respect and charges both healthcare institutions and nurses to develop partnerships and create resources that will result in more meaningful recognition of nurses.

Creating our reality
Meaningful recognition can’t be demanded or imposed on others. It arises from an environment of mutual respect. And administrators alone can’t create this environment. We all have a duty to work together to create it.

But how? The philosopher Ken Wilber suggests that creating the reality we desire requires attention to four dimensions:

• the individual interior dimension of personal and inner self-awareness (beliefs, feelings, fears, and cognitive, emotional, moral, and spiritual development)
• the individual exterior dimension of self-knowing (competencies, behaviors, and skills development)
• the collective interior dimension of shared synergy among colleagues and team members (dialogues that explore cultural values, ideas, goals, and outcomes)
• the collective exterior dimension and alignment with the broader systems and structures (hospital departments, social and economic policy, and legal and regulatory environment)

To achieve your goal, you must focus on the four dimensions simultaneously.

If you change your inner awareness, you’ll also change the outer environment because we all express what’s inside through our behavior and skills. Thus, if you feel respect for yourself and gratitude for your contributions, you can create a change in the outer environment to reflect these feelings.Looking inside

Take an honest look inside and ask the right questions to become self-aware: What are my deepest desires and needs? What part of me needs healing? How can I transform my inner self to create a change of heart or viewpoint? Who is responsible for getting what I need? Next, ask questions about how you express yourself. Do I have healthy coping mechanisms when my needs aren’t met? Am I a joyful person or an angry person in the workplace? Do I show gratitude to others? Am I trustworthy? Do I forgive? Do I practice self-care with exercise and healthy diet?

Find your own voice as an individual and as a nurse. This means articulating what you need and expecting that you will receive it.

Looking outward
Work collaboratively to cultivate the external environment you want. Look for shared values that bring your work community together. Ask these questions to create a better environment: How does my workplace recognize and reward nurses? Is the recognition meaningful to nurses? Is a code of ethics or code of conduct in place? Do we have a method for monitoring the reward system? What are the obstacles to recognition in the workplace? Is time for self-care sanctioned and honored? Have the healthy work environment standards been implemented?

Bolus of self-care
Cultivating gratitude and meaningful recognition in the workplace usually begins with a healthy bolus of self-care. Nurture yourself by spending time alone, spending quality time with family and friends, and following your passions.

Here are other actions you can take:

• Do the work of forgiveness.
• Practice wonderment (as children do).
• Transform your expectations: What do you need to let go of? Do you really need to “go to the mat” over this situation? Can you see what’s really important?
• Practice acceptance of what is.
• Look for the hidden benefits in difficult situations.
• Write a note of gratitude to yourself. Take the time to appreciate your talents and contributions.
• Write a note of gratitude to a colleague. Take the time to notice when others do ordinary tasks in extraordinary ways.

Speak up, speak out
Be bold about expressing what you see as your contributions and how the institution can offer meaningful recognition. Let the employer know that those penlights and mugs don’t cut it, and offer meaningful suggestions. Maybe chair massages once a month, certificates to a one-day spa, or educational or networking opportunities would make you feel nurtured and valued. It’s up to you to determine what that recognition should be.

If you offer suggestions and are told there’s no money in the budget, be resourceful. Ask for money from community organizations. Lots of community organizations are looking for well-deserving places to put their money. So speak up!

Healthcare institutions need to do a better job of showing respect for nurses. And nurses need to do a better job of respecting themselves and their nursing colleagues. Rather than waiting for the external environment to change, change your inner environment. If we do that, we can expect a shift in perception and a transformation of the workplace around us.

Selected references
American Association of Critical-Care Nurses. AACN’s Healthy Work Environment Initiative. Available at: http://www.aacn.org/aacn/pubpolcy.nsf/vwdoc/workenv?opendocument. Accessed December 1, 2006.

Borgatti J. Frazzled, Fried…Finished? A Guide to Help Nurses Find Balance. Borgatti Communications; 2004. Available at: www.joanborgatti.com and www.booklocker.com.

Ryan, MJ. Attitudes of Gratitude: How to Give and Receive Joy Every Day of Your Life. Boston, Mass: Conari Press; 1999.

Wilber K. The Integral Operating System. Louisville, Colo: Sounds True; 2005.

Wilbur K. A Theory of Everything: An Integral Vision for Business, Politics, Science, and Spirituality. Boston, Mass: Shambhala Publications, Inc; 2000.

Cynda Hylton Rushton, PhD, RN, FAAN, is Associate Professor of Nursing Faculty of the Berman Bioethics Institute, and Program Director at Harriet Lane Compassionate Care Program at the Johns Hopkins University and Children’s Center. She is also a Robert Wood Johnson Nurse Executive Fellow 2006-2009.