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).

Meaningful recognition can be described as understanding one’s value and worth to an organization as well as organizational recognition...

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 over 200 nurses, 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. Yet, even with this hospital-wide effort, opportunities existed to provide recognition beyond their immediate workplace setting.

...opportunities existed to provide recognition of nurses beyond their immediate workplace setting.

At Boston Children’s, the main mode to disseminate nursing clinical inquiry and achievements had been a biannual nursing research council 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.

...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 biannual nursing research council 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.

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.

...the dissemination council partnered with the hospital's social media experts and nursing executives to explore social media sites...

Collectively, the dissemination council and the hospital social media team agreed the site should be one with which most nurses were familiar and that they already used. After discussing the advantages and disadvantages of several social media sites and in 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 was the most widely used social media site among all age groups. About 75% of members engaged with the site daily, and about 50% did so multiple times each day (Smith & Anderson, 2018; 2019).

One of the early steps was brainstorming a FB group name.

Implementation Processes
Guided by the hospital social media team, the dissemination council leadership developed structures and processes for launching the site. Membership guidelines, requirements, and general etiquette of social media postings were established. 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 monthly  moderators for the Nursing Broadcast. Monthly moderators were members of the dissemination council. Their role  was to generate a consistent stream of content to be posted throughout a given month and facilitate online discussions. When creating posts, monthly moderators followed best practices according to the hospital's established social media policy and FB guidelines. Monthly moderators also contacted 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).

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.

...moderators followed best practices according to the hospital's established social media policy and FB guidelines.

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.  The hospital social media team-oriented FB administrators, who also served as dissemination council members on closed FB groups administative functions. These functions included adding new FB members, moderators, constructing visually appealing and engaging posts, do's and don'ts of posting and following Nursing Broadcast metrics to evaluate usage. (see Table 2).

Table 2. Nursing 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

The measurement plan included monthly monitoring of new Nursing Broadcast members and how often members were engaging...

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 highlighting nursing promotions, awards, and annual nurse's week events generated the most reactions.

Discussion

Content highlighting nursing promotions, awards, and annual nurse's week events generated the most reactions.

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.

The most popular posts on Nursing Broadcast are those recognizing nurses for awards, achievements, and staff milestones.

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 sustained our community when many have felt social isolation due to COVID-19.

Implementation of the Nursing Broadcast FB group has also sustained 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) with 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

Christine LaGrasta, DNP, RN, CPNP-PC/AC
Email: christine.lagrasta@childrens.harvard.edu
ORCID ID: 0000-0003-4089-1891

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

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

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

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

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

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. She reviewed and edited the final manuscript and provided leadership and mentoring through the writing process.

Michele DeGrazia, PhD, RN, NNP-BC, FAAN
Email: michele.degrazia@childrens.harvard.edu
ORCID ID: 0000-0002-7362-3394

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.