Paul White

Difficult work environments are the norm in long-term care and assisted living settings. Working with individuals who have physical and cognitive limitations, the emotional wear and tear of serving sometimes unappreciative patients (and families), hard physical labor, and meeting the demands of insurance companies and regulatory bodies — all combine to create a stressful workplace. 

And chronic stress over time can lead to discouragement and low staff morale.

Additionally, economic pressures persist. Many managers want to pay their staff more, but often the money just isn’t there. Leaders know their team members are stressed, but they don’t know what to do to encourage them. 

As a result, there is a growing chasm between employees and managers. Research consistently shows that the vast majority of employees don’t feel appreciated at work. In one study, 55% of the workers reported they had received NO recognition for doing good work in the past 12 months.  And 79% of employees who voluntarily leave cite a lack of appreciation as one of the primary reasons for their resignation.

Bad things happen when people don‘t feel appreciated

For managers and supervisors, a key point to understand is that this isn’t just about making people “feel good. A core issue is that when employees don’t feel appreciated, bad things happen within the organization:

• higher rates of tardiness and absenteeism

• increased incidence of not following policies and procedures

• more internal conflict and stress among team members

• decrease in productivity and quality of work

• higher turnover rate — people don’t continue with the company as long

• lower patient satisfaction ratings.

All of these results contribute to higher costs for organizations. In fact, finding and training new employees is one of the most expensive non-productive costs to long-term care facilities.

The tarnished knight in shining armor

Over the past 10 years, many leaders have looked to one “savior” to improve staff morale: employee recognition programs. In fact, employee recognition programs have proliferated (90% of businesses in the U.S. have them in place).

The problem is: Most employee recognition programs don’t work. Statistics (and personal stories) show that employee engagement and job satisfaction are actually declining, while cynicism, lack of trust and resentment are growing.

This is highly frustrating to managers and supervisors. When speaking with leaders, I often hear: “I don’t know what they want. I tell them they are doing a good job. We give out awards and some gifts — but nothing seems to help.”  

Recognition isn’t the same as appreciation

It is important to understand that recognition isn’t the same as appreciation.  Recognition, as it is practiced in most organizations, focuses primarily on external behavior, and specifically, employee performance. So team members receive a verbal compliment, or possibly some tangible reward, when they are observed to be doing well in the behaviors (or results) desired by the company.

Employee recognition programs typically are not viewed well by employees. I hear the same complaints repeatedly: “It is so contrived.” “They just want to get more out of us.”  “They don’t care about me personally — they just want me to perform better.”  “The ‘rewards’ they give us are lame anyway. Who cares about parking closer to the building?”

Over time, resentment, anger and a lack of trust build.

Foundational fact: Not everyone feels appreciated in the same way

Employees have different languages of appreciation (and unique actions within each language.) Believe it or not, not everyone likes verbal praise. Some people don’t trust words while others believe “actions speak louder than words. “For some, time is the most important message you can send.

It can be difficult to determine which of the five languages of appreciation an employee prefers. As a result, we created an online instrument that identifies team members’ primary and secondary languages of appreciation, and allows them to specify the unique actions important to them.

Keys for employees to truly feel valued

Fortunately, we have been able to identify four key components for team members to actually feel valued by their supervisors and colleagues.  For your staff to truly feel valued, appreciation must be:

1. Communicated regularly. Once or twice a year at the employee’s performance review, or a “team member of the month” ceremony doesn’t get it done. People need frequent feedback that they are valued (the frequency will differ according to the individual and the setting.)

2. Individualized and personal. A blast email to the team saying, “Good job, team. Way to get our ratings up,” doesn’t say anything to the nurse who stayed late to supervise a family visit.

3. In the language and specific actions meaningful to the recipient.  Do you realize that 30% to 35% of people don’t want to go up front to receive a reward?  Or that going to an unstructured, social gathering (like a holiday gathering) with a group of people they don’t know well is more like torture for many introverts?

4. Perceived as authentic. The biggest complaint about employee recognition activities is that they feel contrived. If the messages sent aren’t believed to be genuine, the organization is wasting their time and resources.

Good things happen when employees feel appreciated

The morale of frontline staff can be improved by helping them feel truly valued. The key is to communicate authentic appreciation in the ways that are meaningful to each team member and perceived as being genuine. 

Paul White, Ph.D., is co-author of “The 5 Languages of Appreciation in the Workplace” and the “Motivating by Appreciation Inventory. For more information, go to