Accentuate the Positive in School Nursing: The Power of Affirmation

Why Is Affirmation Important?

Maslow (1968) outlined basic human needs including love and belonging, esteem, self-esteem, and self-actualization. How are these needs met? Primarily by the positive assertion of human dignity by self and others. That is affirmation! It is fostered by the unconditional positive regard and empathy of others, which Carl Rogers stated paved the path toward self-esteem and actualization. Dunn (1970) defined “appreciation in depth” as being specific, not vague or general (p. 67). This definition reinforces and enlarges our understanding of affirmation. A comment from a supervisor such as, “Your principal called me to commend your quick thinking today when one of the students had an asthma attack,” is indicative of both the supervisor’s affirmation, because the comment was quickly relayed to the nurse, and the principal’s appreciation of the intervention. It is a powerful example of “in-depth appreciation” or affirmation. What nurse would not respond positively to such a comment?

However, do nurses or others often take the time to pass along such commendation? School nurses have to cultivate the skill of affirmation and make time to pass along positive responses. Recipients of these usually rare comments need to remember, The secret of accepting affirmation is not to hold it tightly to yourself, but to accept it graciously with a “thank you”—then, pass it on (Dunn, 1970). These skills can be learned, but they must be practiced to become sincere and spontaneous. Affirmation is important because gratitude is an attitude.

Sparks of appreciation, leaving a friendly trail of little sparks of appreciation is largely a matter of cultivating the habit of reflecting your happiness by expressing it to the people around you. It will prove a heart-warming habit for them and for you. (Dunn, 1970, p. 62)

In his unique book, Dunn (1970) suggests ways one may learn to appreciate and affirm others. Both the one who learns to affirm and to practice such a radical idea and the recipient are winners when they “give themselves away,” for both receiving and giving affirmation presents a challenge that fosters growth. One of the precepts of this idea is that the person who gives should most often not let his or her gift be known to others. The idea is that there be no trumpet sounding before the gift is given. Because accepting a gift is also difficult, Dunn suggests, “To receive a present handsomely and in the right spirit, even when you have none to return is to give one in return” (p. 117). Affirmation is both giving and receiving, with no consideration of debt or return but as a matter of lifestyle.

Who Needs to Be Affirmed?

This is one of the shortest segments to be discussed, because everyone can benefit from affirmation. The supervised and the supervisor, the nursing team, the principal, teachers, students, and parents all need to know they are appreciated and valued. Why does the supervisory staff need affirmation? After all, is their position not enough affirmation? Stop and consider for a moment that no matter how small a cog you may perceive yourself to be or how far from the administration building your practice environment may be, you, too, need and deserve affirmation. On different levels, each school nurse is a supervisor of others. Think of how terrific you feel when you are shown appreciation. Does it not follow that your director or others to whom you answer would be just as pleased at your words of affirmation for their achievements? Yes, everyone thrives on affirmation.

When Should Affirmation Be Given?

There is no specified time when affirmation should be given. However, the following would be ideal times. Some of these times are rarely considered as times for expressing appreciation or accentuating the positive.

1. Times of Progress/Evaluation. Too often, times of evaluation may be very sterile, cut and dried. These times may be used for the previously discussed “constructive criticism.” True, not every evaluation is going to be positive. However, Mayer and Mayer (1999) list a few reminders: “Evaluations must be based on objective performance criteria. During such an evaluation, it is important to have employees express their own goals and desires for their future within the organization” (p. 145). They also suggest that during the evaluation process, employees should be given a chance to express job satisfaction and request further training opportunities that might advance their skill level or improve their position. If they express a desire to advance, the supervisor should be able to recommend educational or skills training programs that would be of value.

Make certain the evaluation process is clearly understood, and allow for a self-evaluation to precede the evaluation. Give adequate time for the conference, which will preferably be face to face, so that questions and comments can be made. Always try to make some positive comments. Surely someone has said something positive about this person, even if it is as little as, “She is never late to work,” which you can report in the absence of any other positive statements.

Fortunately, you will have many evaluations that begin or end with news such as, “You’ve been promoted to. . . ” or “You’ve moved up the ladder another step now.” Such statements impart a powerful and positive message. That spontaneous smile, touch on the shoulder, or hug, when appropriate, is like the frosting on the cake. Your comment, “I look forward to your return to work in the fall,” genuinely spoken, can be as significant as a promotion.

2. Special Instances of Unexpected Achievement. When events occur that should be recognized immediately, don’t wait. Set up an opportunity to meet with or call the person as quickly as possible. If that is not possible, write a note of congratulations at once. Polish up the person’s “shine,” and you have not only affirmed the person but probably have made a friend for life. If thanking a coworker for help during a special time of need, Timberlake (1988) recommends, “Be thankful, be clear, specific and sincere. Look in their eyes and call them by name. When possible, thank people when they least expect it. Make their day!” (p. 147).

Consider the following examples of affirming those persons who have made unexpected achievements of a special type: “Your cool head in that situation was noticed by. . . ,” “You certainly have my admiration for completing your master’s degree,” or “I sincerely appreciate your participation in the think tank. How creative you are!” Take time to think of ways to surprise deserving persons by showing off their special achievements.

3. When Spirits Lag. “You seem to be having a tough time,” may be a good way to begin a conversation. For many, those times when spirits lag can be times of affirmation and may be some of the most appreciated interactions you will have with your employee. Your support and comments often speak to your sensitivity, your interpersonal focus on those with whom you work, and your willingness to share their vulnerability.

Fish! A Remarkable Way to Boost Morale and Improve Results (Lunden, Paul, & Christensen, 2000) is a delightful book that proposes a philosophy for the various “marketplaces of life.” It challenges readers to choose their attitude, to play, to make their day, and to be present. Being “fully present,” not daydreaming or working on the computer, as you offer yourself is the most affirming thing you can do when expressing true appreciation. Your presence says, “You are all-important to me at this very moment!”

4. When You Have a “Nudge” to Do So. The feeling of the “rightness of the moment” is something that may prompt you to tell someone they are appreciated. Although you may not have planned your comments of encouragement, affirmation, or admiration for a particular person at a certain time, you may look back and realize that you made your comments at a crucial moment and made a difference. Once again, Mayer and Mayer (1999) make a salient point:

Staffs need to feel that if they perform well and contribute to the organization they will not be “rewarded” with a pink slip as soon as times get tough. . . some simple attention to the needs of staff and a willingness to treat them like the valuable assets they are, can go a long way toward solving (and preventing) a variety of organizational problems. (p. 229)

Your positive response to staff or other team personnel before any negative situation develops may save the day, and it shows your vigilance to all that is around you.

You, as a school nurse, also have the opportunity to go with that “nudge” with principals, teachers, other staff, students, and parents. Can you affirm the caring and concerned parent who comes across as obstinate and overbearing but whom you suspect may be frightened or depressed? How about the parent who seems to be uncaring or unconcerned? You may be the one who can say the crucial words or simply reach out with a warm touch in a difficult moment. Which students do you speak to with affirmation and approval as they attempt to grasp things you are trying to teach them regarding their own health needs? Secretaries, cafeteria workers, and maintenance staff can also provide you with opportunities for learning and practicing skills of affirmation and encouragement. If you are not already seeing the need for affirmation in those around you, it may be that you have never thought about such needs, or perhaps you are not fully present for those with whom you work.

Where Can You Give Affirmation?

1. Privately. Affirmation and praise are frequently given privately in the one-on-one exchange. In the office or closed-door setting, the most complete and full presence of the persons involved is experienced. Similarly, in the process of evaluation, a quiet, calm, unhurried atmosphere and an aura of caring allow the person to enjoy the positive attention.

2. Small-Group Meetings. A small-group setting, such as a team or planning meeting, is appropriate for group commendation and for recognition of members who have made special contributions or excelled in leadership. The team as a whole can also be commended. The group may present a token of appreciation to the leader or others. From such a meeting, a report may be further generated in some manner that will praise and validate the team or individuals to other employees. Sometimes, this is also a way of giving further information about ongoing projects and planning that affect the entire organization and for which there will be needs for other individuals to volunteer and serve. A little public commendation within the organization may go a long way in guaranteeing personal satisfaction of those who serve and in the enlistment of other members in the future.

3. Grand, Planned Awards Meetings. There are many awards that are given to nurses and other professionals annually. The “School Nurse of the Year” award by local, state, or national organizations is an honor of excellence. Although every outstanding school nurse may not achieve this distinction, if there is a feeling of acceptance and appreciation in the practice setting, there can be a great deal of joy when one of your colleagues is recognized. The person honored brings a breath of the fresh air of approval into the setting where colleagues have learned to work together and value one other.

A healthy organization is dependent on a successful work force. “This in turn depends on a staff being recognized, appreciated, and appropriately valued by management” (Mayer & Mayer, 1999, p. 228).

How Do You Accentuate the Positive?

To be able to accentuate the positive, you must know your environment well. Melton (1979) states, “Many people do not realize that they are responsible for their environment; they see their surroundings as totally external and are unaware that it has anything to do with them” (p. 12). How healthy is your particular school nursing practice environment? Very probably more healthy than you know. Compared to other nursing practice environments, school nursing has an exceptional recruitment and retention record. The current and predicted nursing shortages may not affect school nursing to the extent that they have in other practice arenas. Nevertheless, economic, demographic, and legislative issues affect every nurse in the country in some way. Each nurse can benefit by focusing positively on those aspects of the personal working environment that will enhance job satisfaction.

Imagine that you have found an ideal nurse as a new employee. Would you ever consider ridiculing him or her in any way? Ideally you would nurture that new nurse; be caring and understanding; and assign an excellent mentor to take whatever time is necessary to explain the job description, policies, procedures, evaluation methods, and continuing education programs or other opportunities for learning that are part of the job. Just as there is an expectation for an ideal nurse, that nurse also has an expectation for the ideal clinical practice environment. Fortunate is the school nurse who can report, “I have found the ideal job!” Below are some hints on how to accentuate the positive and achieve the match of nurse with job that results in excellent job performance and above-average job satisfaction.