Meaningful Recognition of Pediatric Nurses via a Closed Facebook Group

Hospitals that implement the American Association of Critical Care Nurses (AACN) Healthy Work Environment (HWE) standards outperform other institutions in the overall health of the work environment (AACN, 2016; Ulrich et al., 2019). Specifically, in hospitals where nurses report higher levels of meaningful recognition, greater job satisfaction, decreased intent to leave, and increased quality of care have been reported (Ulrich et al., 2019). Meaningful recognition, one of the five AACN HWE standards, can be described as understanding one’s value and worth to an organization as well as organizational recognition of these contributions (Leger et al., 2021). Nurses “consistently rate recognition from patients, families, and other nurses as the most meaningful. It reaffirms nurses’ positive contributions, emphasizing the impact of nursing care and increasing awareness of nurses’ unique contributions to health care” (AACN, 2016, p. 29).

(AUTHOR: Please review the insertions for redacted sections carefully and give any corrections needed with your final edits. We will also need written permission from the appropriate person at the institution to publish this article as written in the journal with this identifying information. This can be in the form of an email to me signed by the appropriate person or persons. Jackie)

One form of meaningful recognition at Boston Children’s Hospital is through formally established programs, such as the Daisy and AACN Beacon Awards. Beyond these programs, leaders seek solutions to provide informal recognition to their nurses. Nurse leaders must be creative in their efforts to deliver meaningful recognition. Generational diversity and divergent personal perceptions of meaningful recognition may make it challenging for leaders to accomplish this goal (Eddy et al., 2021; Lefton, 2012).

Problem

Boston Children’s Hospital is a 404-bed free-standing pediatric hospital in Massachusetts. It is an American Nurses Credentialing Center, Magnet^ã recognized institution that has a robust nursing clinical inquiry program which promotes nursing research, evidence-based practice, and quality improvement initiatives. Support of nursing clinical inquiry is accomplished through committees and research structures. The Nurse Executive Committee for Research and Inquiry (NECRI) was established in 2012 to provide clinical inquiry oversight. Two signature structures that NECRI oversees include the Nursing Science Fellowship and the Evidence-Based Practice Mentorship Program. These mentored programs have collectively graduated 139 nurses to date, with each nurse graduate having completed a clinical inquiry project geared towards advancing nursing science (DeGrazia et al., 2019). Graduates of these programs together with nurses from across the institution submit quality improvement, evidence-based practice, or research posters for presentation during the annual Nurse's Week celebration. Despite this hospital-wide effort, few nurses have received recognition external to their units.

At Boston Children’s Hospital, the main mode to disseminate nursing clinical inquiry and achievements had been via a biannual NECRI newsletter distributed to all nurses through the hospital's internal email system. The newsletter was authored by dissemination council members and consisted of recent nursing publications and research events within the hospital system. Nurse executives and members of NECRI found this means of meaningful recognition inefficient. It was believed that the newsletter was getting lost among the large volume of emails the nurses received.

In 2016, the dissemination council was charged by NECRI to create a platform for sharing these achievements and increase meaningful recognition of nurses' accomplishments. In response, the dissemination council emailed a seven-item survey to 2369 nurses to solicit their thoughts about the NECRI dissemination newsletter.

A total of 329 nurses (14%) responded. Almost 80% (n =254) indicated that they were not receiving the biannual nursing research council newsletter. When asked what type of content the respondents would like to see in a dissemination newsletter, the most popular responses were notification of journal articles authored by the hospital's nurses; inclusion of nurse-authored posters of the month on the hospital's internal homepage; a list of upcoming nursing conferences; and a who's who of the hospital's nursing research community. Most respondents also wanted a newsletter that was published more frequently, preferably in an electronic format. The dissemination council concluded that although the response rate was low, those who did respond believed it was important for nurses to have a forum to share clinical inquiry and achievement.

Available Knowledge and Rationale

Based on the results of the survey, the dissemination council explored the use of social media for this purpose. The committee learned that healthcare institutions traditionally used social media to communicate information to patients and employees within their own community (Kordzadeh & Young, 2018). Additionally, social media use among healthcare professionals was common and had been used to build virtual communities (Lefebvre et al., 2020; Rolls et al., 2016; Ross & Cross, 2019). However, a literature review revealed no published papers that described the use of social media to provide meaningful recognition of nurses. Thus, the use of social media for this purpose would require a thoughtful stepwise approach.

Methods

Objective
The objective of this quality improvement project was to create an active social media community within this large, free-standing, pediatric, academic hospital. This community would provide an avenue for meaningful recognition of its nursing staff by highlighting nursing clinical inquiry and achievement.

Platform Research
Focusing on the meaningful recognition domain within AACN's HWE structure, the dissemination council partnered with the hospital's social media experts and nursing executives to explore social media sites that would best fulfill their needs. The dissemination council envisioned a social media platform that would both encourage a dialogue between the author of a scholarly product featured and the social media community related to the posted material and provide meaningful recognition of published manuscripts and clinical inquiry presented at scientific meetings. Important qualities for this platform included easy accessibility by the nursing staff; user-friendly navigation; and easy maintenance by dissemination council members.

Collectively, the dissemination council and social media team agreed the site should be one with which most nurses were familiar and that they were already using. After discussing the advantages and disadvantages of several social media sites and consultation with nurse executives, a private Facebook Group (FB) was chosen. According to Pew Internet Research's annual social media use surveys in 2018 and 2019, Facebook is the most widely used social media site among all age groups. About 75% of members engage with the site daily, and about 50% do so multiple times each day (Smith & Anderson, 2018; 2019).

Implementation Processes
Guided by the hospital social media team, the dissemination council leadership developed structures and processes for launching the site. One of the early steps was brainstorming a FB group name. After much deliberation, the dissemination council members agreed upon Nursing Broadcast. Next, members identified moderators for the Nursing Broadcast group. The role of a moderator was to generate a consistent stream of content to be posted throughout a given month and facilitate online discussions. Moderators would also contact authors, alerting them of an upcoming post of their clinical inquiry or achievement. Through these alerts, new FB members would be recruited (see Table 1).

AUTHORS: Please re-create this table 1 as a separate word document and send as an individual file. Please do not use any formatting – just put the table in a Word document and then we can format it for APA accordingly. It should look similar to table 2.

Table 1.

Adapted from the Boston Children’s Hospital Use of Social Media Policy^©, 2019,
Boston Children’s Hospital Social Media Best Practices: Affiliated Accounts, n.d., and Facebook Community Standards, n.d.

The hospital social media team recommended creating a three-month timeline of posts to ensure an adequate, diverse, and consistent amount of content on the page. When creating posts, moderators followed best practices according to the hospital's established social media policy and FB guidelines. Membership guidelines and requirements, and general do's and don'ts of social media postings, were developed. The dissemination council sought guidance from the hospital social media team colleagues about basic FB use and etiquette as well as constructing visually appealing and engaging posts (see Table 2.). These colleagues also oriented moderators, noted on the platform as FB administrators or admins, on use of use the platform. They offered insight about administrator functions to follow the metrics for the Nursing Broadcast group to evaluate usage.

(AUTHORS: a couple of questions. First, were the social media colleagues the same colleagues on the hospital social media team previously discussed? This concept needs a bit of clarification. It might be as simple as just consistently referring to them as the hospital social media team so that readers can tell the various groups you are describing in each of these steps.

Are the Facebook administrators the same as the moderators? I am assuming that the answer to this is yes - that the persons who were chosen as moderators are called admins on Facebook. But we need to make this clear to readers.

I have adjusted that language above, but please read this carefully to be sure that it accurately reflects your process with these revisions for clarification. We can modify as needed. Thanks, Jackie)

Table 2 Broadcast Posting Do’s and Don’ts

Adapted from the Boston Children’s Hospital Use of Social Media Policy^©, 2019, Boston Children’s Hospital Social Media Best Practices: Affiliated Accounts, and Facebook Community Standards.

Benchmarks to measure success throughout the first twelve months were identified as consistent growth of members in the FB community and page engagement. The measurement plan included monthly monitoring of new Nursing Broadcast members and how often members were engaging in the following ways: viewing, reacting, posting, or commenting on posts. The dissemination council members publicized the Nursing Broadcast Facebook group through a multitude of outlets to the hospital nurses, including word of mouth, staff meetings, posters in breakrooms, and internal email.

Results

From February 1, 2019, to January 31, 2020, the Nursing Broadcast Facebook community grew to 435 members, of which 310 (71%) were active members. There were 392 posts consisting of 260 (66.3%) nursing event announcements and calls for clinical inquiry; 60 (15.3%) publications; 52 (13.2%) posters; 10 (2.5%) webinars; 6 (1.5%) abstracts; and 4 (1%) awards/promotions. There were 318 comments and 4027 reactions (e.g., likes). Content that highlighted nursing promotions, awards, and annual nurse's week events generated the most reactions.

Discussion

At Boston Children’s Hospital, there are a number of formal initiatives which recognize exemplary nursing practice and provide meaningful recognition, including the annual Clinical Excellence in Nursing Award and Clinical Excellence in Nursing Leadership Award, "Way to Shine" shoutouts, and the Daisy Award. In addition to posting these forms of recognition, the Nursing Broadcast FB community recognizes timely, in the moment nursing achievements. Whether a newly published manuscript or nursing clinical ladder promotion, these achievements are often recognized within peer groups or nursing units; however, colleagues throughout the hospital enterprise were often unaware. Broadcasting these achievements to our community facilitates meaningful recognition by acknowledging members through their likes/reactions or comments on the posts. The most popular posts on Nursing Broadcast are those recognizing nurses for awards, achievements, and staff milestones. These posts have garnered attention from close peers as well as senior nurse executives and staff who work in other clinical programs.

Comments from authors whose clinical inquiry work were posted have included:

• "The recognition means a lot, and I appreciate you sharing with our colleagues"
• "Thanks for including us in this!"
• "This is wonderful. We really appreciate the shout out!”
• "Thank you!”
• “I appreciate the post and the heads up!”
• “Thanks so much for sharing!”

The Nursing Broadcast Facebook community connects the nursing staff and celebrates accomplishments and career milestones. This informal avenue of nursing staff recognition complements existing hospital-based formal recognition programs. Implementation of the Nursing Broadcast FB group has also helped sustain our community when many have felt social isolation due to COVID-19.

Nursing Broadcast continues to exceed the initial projections of sustained growth and engagement of its members. In February 2020, the dissemination council, reflecting on its broader commitment to interprofessional collaboration, voted to expand Nursing Broadcast to include members from all disciplines across patient services. Nursing Broadcast was then renamed the Boston Children’s Hospital Broadcast. From February 2020 through December 2020, membership grew from 439 to 679 members (54.3% increase) and 518 active members. There were 338 posts, 1181 comments, and 9111 reactions/likes.

Conclusion

Nursing Broadcast was deemed a success by the dissemination council, the hospital social media team colleagues, and nurse executives as it met expectations of consistent membership growth and engagement throughout the first year. AACN’s HWE standard of meaningful recognition was achieved by successfully creating an online platform highlighting nursing clinical inquiry and achievement.

Authors

(AUTHORS: We are now including author ORCID IDs, if available. This is not mandatory. If you have one, please provide it to us and we will be included. If you do not, we will remove that heading from under your bio. For articles with multiple authors, please provide this information to the corresponding author who can submit it with the galley proof edits.)

Christine LaGrasta, DNP, RN, CPNP-PC/AC
Email: christine.lagrasta@childrens.harvard.edu
ORCID ID:

Dr. Christine LaGrasta is a pediatric nurse practitioner on the inpatient cardiology unit at Boston Children’s Hospital. She led the working group, as they conceptualized and formed the Facebook Groups page, developed the content and promoted the social media sight to the nursing community.

Shannon Olbrot, BS, BSN, RN, CCRN
Email: shannon.olbrot@childrens.harvard.edu
ORCID ID:

Shannon Olbrot is a Level II Staff Nurse and Clinical Nurse Educator in the Cardiac Intensive Care Unit at Boston Children’s Hospital. She participated in the development of the Facebook Groups page and served as a moderator for the page.

Kerri Ann Fournier, BSN, RN, CPN
Email: kerri.fournier@childrens.harvard.edu
ORCID ID:

Kerri Ann Fournier is a Level II Staff Nurse working in the Clinical Research Operations Center at Boston Children’s Hospital. She participated in development of the Facebook Groups page and served as a moderator for the page.

Colleen O’Shaughnessy, MSN, RN, CCRN
Email: colleen.o’shaughnessy@childrens.harvard.edu
ORCID ID:

Colleen O’Shaughnessy is a Level II Staff Nurse in the Cardiac Intensive Care Unit at Boston Children’s Hospital. She participated in the development of the Facebook Groups page and served as a moderator for the page.

Paula Conrad, MSN, RN, CNL, CCRN
Email: paula.conrad@childrens.harvard.edu
ORCID ID:

Paula Conrad is a Level III Staff Nurse, working in the Department of Infection Prevention and Control at Boston Children’s Hospital. She participated in the development of the Facebook Groups page and served as a moderator for the page.

Patricia A. Hickey, PhD, RN, FAAN
Email: patricia.hickey@childrens.harvard.edu
ORCID ID:

Dr. Patricia A. Hickey is Senior Vice President, Associate Chief Nurse and Chair of the Nurse Executive Committee for Research and Inquiry at Boston Children's Hospital Her academic appointment is Assistant Professor of Pediatrics at Harvard Medical School.

Michele DeGrazia, PhD, RN, NNP-BC, FAAN
Email: michele.degrazia@childrens.harvard.edu
ORCID ID:

Dr. Michele DeGrazia is the Director of Nursing Research for the Neonatal Intensive Care Unit, Chair of the Nursing Research Council, and Co-Chair of the Nurse Executive Committee for Research and Inquiry at Boston Children's Hospital. Her academic appointment is Assistant Professor of Pediatrics at Harvard Medical School. Dr. DeGrazia provided oversight and mentorship in the formation of the Facebook Groups page.