Improving Employee Relationships
One way is to understand who caregivers are and how they prefer to be appreciated by their employers
by Paul White, PhD and Monique S. Gras, RN BSN

Modern Healthcare recently reported that many homecare agencies are cutting staff hours, eliminating services and increasing rates, and as a result they are losing clients. It is an all too familiar scenario for those who have worked in this industry for a long time. High turnover in nursing staff (including nurses, nursing assistants and home health assistants) is like a plague on home health agencies. The turnover rate of home health care workers was 63 percent in 2015, according to the Private Duty Benchmarking Study conducted by Home Care Pulse.

One way to improve this dire picture is to understand who caregivers are and how they prefer to be appreciated by their employers. Research has demonstrated that staff are more likely to quit their jobs when they do not feel valued by their supervisors and colleagues. A recent article in HomeCare (How Technology Will Impact Home Health Care) reported that the shortage in home health workers is increasing reliability on robots and apps—highlighting the importance and urgency of retaining the home health workers currently in the field.

While some home health organizations strive to improve employee appreciation, there are challenges in doing so. Home health workers are spread out between patient homes and can be difficult to contact. Low wages, infrequent raises and long travel distances breed dissatisfaction for nurses and their assistants. Also, lack of time and resources for training can leave home health staff poorly equipped for their tasks. Some characteristics reported by Susan Tullai-McGuinness as important to RNs in the home health field include autonomy, supportive supervisors, educational support, adequate staffing, good nurse/physician collaboration and an environment that demonstrates high concern for patients.

Core Conditions for Staff to Feel Appreciated

Practical steps to showing appreciation to home health employees can be found in The 5 Languages of Appreciation in the Workplace by Dr. Gary Chapman and Dr. Paul White. Four core conditions have been identified as needing to be present in order for employees to truly feel appreciated (which differs from recognition just being communicated). Team members will feel valued when appreciation is communicated:

1. Regularly. What is regularly? It varies depending on the work setting, the frequency of interaction between co-workers and the nature of the relationship between coworkers. However, “regularly” implies more than once a year at an employee’s performance review. Home health nurses want to know that their hard work is being noticed, so communication and encouragement is essential.

2. Through the language and actions important to the recipient. The key word here is “recipient.” Most of us tend to communicate appreciation to others through the actions that we value. But not everyone feels appreciated in the same ways. Some people appreciate words of affirmation (in a remote setting this could be as simple as an uplifting text message), while others are encouraged when a coworker helps them with a difficult task. Spending time is another way to demonstrate support, like stopping by a colleague’s office to see how they are doing. Bringing a colleague a special cup of coffee when you know they have had a long day can be a needed pick me up. Even a high five or a fist bump can be a form of celebration when a difficult project has been completed.

3. In a way that is personal and individualized. While group-based recognition is a good start (“Way to go, team. Our patient satisfaction ratings improved significantly last quarter.”), if the appreciation does not relate to what the individual team member did to help achieve the goal, the communication will fall flat. Team members want to know what they have done is valued—for example, that you appreciate that they documented a case with precision.

4. In a manner that is perceived as genuine and authentic. If the communication of appreciation is not perceived as being genuine, nothing else really matters. Actions of recognition can appear inauthentic when: a) the actions suddenly appear after implementation of a program on appreciation; b) a person’s tone of voice, posture or facial expressions do not seem to match what they are saying; c) the person’s private interactions differ from their public interactions; d) the individual has a history of “saying one thing and doing another;” or e) there is an overall question of the motivation of the deliverer. Do they have an ulterior motive? There are other potential factors that undermine perceived authenticity, but these are some of the most common mentioned.

Practical Steps for Communicating

Helping individuals change their actions and habits is difficult. No one is looking for more work to do. As a result, the focus needs to be on making encouragement actions more efficient—to spend time with those who value time, to send notes to those who are impacted by them, to help someone out who will be grateful for the assistance and to give a gift to someone who will appreciate the thought.

Two important points should be emphasized: 1. appreciation can be communicated by anyone to anyone, and 2. any team member, regardless of position, can positively impact their workplace culture. Employees report they do not just want to be recognized by their supervisor, but they also want to know how to encourage one another.

How do people find out what their colleagues value? The topic of how to make others feel appreciated is not a common workplace conversation, and this type of question can make individuals feel somewhat uncomfortable. But people do tend to think in terms of “encouragement” and “discouragement.” So, the question is: “When you are discouraged, what is something that someone can do or say that would encourage you?”

Additionally, an online assessment tool is available that identifies the primary language of appreciation of individuals (, along with the specific actions that are most important to them. The results can be compiled to create a group profile and list of valued actions for a team who works together.

Nurses in the field have indicated that a supportive environment helps encourage them and boosts their performance as they navigate the challenges of client care. By learning how to communicate authentic appreciation to one another, staff morale can improve significantly, and a more positive workplace can result.