Logan and Lauren welcome Bonnie and Mark Barnes, founders of The DAISY Foundation, a non-profit organization that expresses gratitude to nurses with programs that recognize them for the extraordinary compassionate, skillful care they provide patients and families.

Learn more about the DAISY Foundation at www.daisyfoundation.org/

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Logan Schmidt:

Hello everyone, and welcome back to From the Front Row. A while back we did an episode about burnout among nurses, and today we are here to talk about the importance of nurse recognition. We are excited to welcome Mark and Bonnie Barnes, co-founders of the DAISY Foundation, to the show. The DAISY Foundation is a nonprofit organization that works every day to make sure nurses are recognized both nationally and internationally. I’m Logan Schmidt, co-hosting today with Lauren Levin, and if it’s your first time with us, we welcome you. We’re a student-run podcast that talks about major issues in public health and how they are relevant to anyone, both in and outside the field of public health. Welcome to the show, Bonnie and Mark.

Bonnie Barnes:

It’s great to be with you.

Mark Barnes:

Thank you.

Bonnie Barnes:

Thank you.

Logan Schmidt:

To start it off, what is the DAISY Foundation and how did it start?

Bonnie Barnes:

Oh, thank you for asking because we do love to tell our story. DAISY, who started 23 years ago at the end of 1999 when Mark’s son, my stepson Patrick, died of complications of the autoimmune disease ITP. And Patrick was 33 years old. He and his wife had just given us our first grandchild six weeks before he woke up one morning with some strange symptoms and went to the doctor and he found out he had a dangerously low platelet count, so he was admitted to the hospital. Well, I will spare you what became the worst weeks of our lives when Mark and I got to spend pretty much day and night in the hospital with Patrick, but suffice it to say at the end of that time, he passed away. Well, I know all of you in public health and especially any nurses who are listening, you’ve been around families like ours who go through this emotional rollercoaster and suddenly it was over.

Now what do we do? Well, we felt very strongly that we needed to fill that gaping hole in our hearts that Patrick’s death had left with something positive. And the only positive thing we could think about about that eight week experience in the hospital was how incredible his nurses were. We’d been really impressed with how good they were from a clinical perspective, but what really, really touched us was the way they delivered their care with compassion and sensitivity, not only to Patrick, but to all of us in our family. So DAISY, that we created right after he died, stands for “diseases attacking the immune system” to keep us rooted in our experience with Patrick and his nurses. And we created the DAISY Award so that patients, and family members, and coworkers, for that matter, could share their experiences, tell their stories of extraordinary compassionate nursing care, and then a nurse would be chosen by a council of their peers within each organization that had the program to be honored all year long, throughout the year. So this was ongoing recognition of extraordinary compassionate care. So that’s our story.

Lauren Lavin:

It’s lovely to hear that it started from such a personal experience. So how did you decide on it being a nursing organization and recognition specifically for nurses?

Bonnie Barnes:

Oh, that’s a great question, Lauren, because we are so often asked to expand beyond the profession of nursing. But honestly, our hearts are with nurses. It was nurses who saved Patrick’s life twice. It was nurses who educated us, who wrapped their arms around us when we needed hugs so badly. It was nurses who got us through those eight weeks. It was nurses. And this is a profession that to us is so unsung and has been for so long. We really needed to find a way to celebrate them and now we get to celebrate them and over 5,700 healthcare facilities and schools of nursing in 37 countries around the world. So that’s why we just have an incredible affection for this profession.

Lauren Lavin:

It’s amazing how many nurses you guys have been able to recognize and all across the world. As a result, what are some of the evidence that you’ve found of DAISY’s impact and of nursing recognition in general?

Bonnie Barnes:

Well, you mentioned burnout before and there’s now a growing body of evidence of how important meaningful recognition, which is what DAISY is described as, the impact it’s having on burnout. In fact, in 24 of our partner organizations, we looked at this concept of compassion fatigue, which is a combination of burnout and secondary traumatic stress. And we saw that our nominees, those people who’d been nominated, they may not have even received the DAISY award, but they’d received the nomination from a patient or a family member. Those nurses had lower compassion fatigue and higher compassion satisfaction. That sense of doing a job well going home at the end of the day, knowing they’ve made a difference. So that feedback that they’re getting through their DAISY nominations is giving them reinforcement of why they became nurses, and that’s what the evidence is showing, that it’s this tie to purpose that makes meaningful recognition meaningful and makes DAISY special.

Mark Barnes:

I’d just like to add, there’s an awful lot of research that shows this, but DAISY is an emotional award more than anything else. And I’d like to expand a little bit about the nominations. We weren’t the only ones, obviously, that wanted to say thank you to our nurses. Over the years, there’s a little over two and a half million nurses have been nominated by patients or their peers, and we know that because that’s how many nomination pins we’ve sent out to them. But the thing that I also remember very distinctly early on, a nurse came up to us at a conference and showed us the nomination pin and she said, “I just wanted you to know I got nominated for the DAISY Award. The committee did not select me, but that didn’t make any difference. My patients selected me. So I received the DAISY award from my patient and I’m very proud of that.” So it has an effect, it’s had a terrific effect, not just for the recipients of the award, but for everybody that’s been nominated.

Bonnie Barnes:

Yeah, we could talk about dividends all day long, Lauren, I got to tell you, but we’ll just leave it at that.

Lauren Lavin:

I think that was a pretty good start.

Logan Schmidt:

Going at a slightly different angle, DAISY Foundation has been around for 23 years. Can you talk a little bit more about how has the foundation evolved and has grown throughout those 23 years? How has the healthcare industry responded to providing recognition during those years?

Mark Barnes:

Could I start that, Bonnie, then you finish it, because I have to tell you, the first year, at the end of the first year, we had four hospitals that had the DAISY Award and one of them was the hospital where Patrick passed away, and I think they just felt sorry for us. And the second year we got three more. So we had seven hospitals at the end of two years. At the end of the third year we had six, because one of the hospitals that had the award dropped it. So that’s the start we had. We had to sell the concept of recognition to the nursing profession. They did not understand recognition. And we came from an industry that recognized everything. Whether you got to work on time, you got a pin, or whether you did whatever you were supposed to do, you got recognized. It’s like little league, our industry gave a participation award for everybody who showed up. Nursing wasn’t like that.

Bonnie Barnes:

Well, when nurses, nurse leaders did get ahold of the program and saw what the impact was on their teams and on their people who were being honored, and even nurses who were experiencing a DAISY award, whether they were nominated or awarded, didn’t matter, they were around standing up for the presentation. So they started seeing the impact, and nurses, nurse leaders are an incredible network, and they got ahold of it. They started talking to us about what it meant, its strategic value, and they started talking to each other. By the end of 2007, it was just Mark and me running this thing. We had 182 committed organizations we were partnering with, and we were drowning in interest in the program. And we approached, what was then called, the American Organization for Nurse Executives is now AONL, American Organization for Nursing Leadership, and asked them if they would be interested in helping us.

And with their support, and their guidance, and their brilliant CEO working with us on our business model, the world opened up. And so we were able to get incredible exposure. We were able to hire the staff that we needed to really run day-to-day, to put in an operations plan that made sense, to get Salesforce, the database, to be able to help us manage all of these, what we think of as clients, now 5,700 of them. And so that was the operational side of how it grew. But we also learned that there were other opportunities for nurse recognition that DAISY needed to incorporate. For example, lots of times a patient or family member would write a nomination and they couldn’t name just one nurse. They would name three or four who had done something incredible, had put on a wedding for them in the hospital, had helped out with a homeless person, had done something to bring in the family dog.

There were so many great stories of what teams had done for a patient that we had to create a team award, and we made that recognition multidisciplinary. So while we refer to it as nurse led, we have physicians, pharmacists, physical therapists, housekeepers, anybody can be on that team that’s participated in doing something for a patient or family. We also started looking at what was happening for nurse leaders and who it was that’s creating the environment where all this compassion is going on. Well, it takes great leadership to create that environment. So we created a DAISY Nurse Leader Award.

One day we were sitting at a DAISY board meeting and we had a dean of nursing on our board at the time who looked at Mark and me and said, “You know someone had to teach those nurses who took care of Patrick.” That was a great epiphany for us to understand and learn about the role of nursing faculty. So on and on we have added now, including a lifetime achievement award for nurses who dedicated decades of their lives to taking care of the rest of us. We’ve now got a whole array of nurse attributes, if you will, that we are able to honor with various programs. And I think that’s been another key to our evolution and growth.

Mark Barnes:

Well, I’d like to add, I’m not known for my modesty, but I would like to point out that these ideas that Bonnie mentioned, they were all brought to us by nurses, by people, not us. And every time, as I said, we came from marketing and advertising and we’re supposed to be very creative people, but nurses are some of the most creative people around, and they kept bringing us ideas. Our first DAISY award was a pin that we designed ourselves, a certificate that we put in a frame that we got at Costco and a box of cinnamon rolls. That was it. And we said it was a turnkey operation. Well it was, but it’s not a turnkey operation anymore. It requires, to make it successful, the hospital or medical facility, has to work it and has to involve people in it in order to make it successful. Because as you can see, there’s all kinds of awards and that it’s a lot of work, but boy, is it worth it to do that. Anyway, I want to give credit where credit is due.

Bonnie Barnes:

To the nurses, absolutely. And the committees who run the program and have been incredibly creative, we’ve learned everything from them, and we take their ideas. Mark would tell you, we steal their ideas, but I don’t [inaudible 00:13:12] talk about stealing. We share their ideas as leading practices.

Lauren Lavin:

It sounds like you guys have spent most of your career at DAISY listening to nurses. So when you guys are traveling and meeting nurses both nationally and internationally, how do you find that nurses respond to both you guys and the foundation as a whole?

Bonnie Barnes:

Well, you take this one, Mark.

Mark Barnes:

Well, it is amazing that once they have a program, it spreads like wildfire in whatever country it is in. And they respond to us giving us all the credit for it. And as I just said, the DAISY has been developed by other nurses, but the thing that we have found, and I mean this very sincerely, is wherever we have gone, nurses are nurses. All they want to do is take care of people. They don’t want personal glory. They just want to help people and they respect what DAISY has done, is that it has have given them, not personal glory, but has elevated the role of nursing in that community.

And there are some countries that we’ve been to, that the word for nursing used to be servant, same translation. But now nursing has been elevated primarily, because of what DAISY has done in terms of recognition. And the people given an opportunity to say thank you, they respond. I think Bonnie said earlier that we weren’t the only ones that wanted to say thank you to their nurses with two and a half million nominations. That’s a lot of nominations for people who wanted to take time to say thank you to their nurses. And that’s all over the world, not just in the United States.

Bonnie Barnes:

And coming back to your question, Lauren, when we travel, which we now are able to do again, and it’s such a joy for us. It is so fun to see DAISY brought to life in all kinds of languages and cultures, and it’s just such joy. And of course, there’s so been so much sadness in the world that to see this kind of joy and work happening again and seeing the nurses respond to what DAISY really means for them, it’s a little overwhelming sometimes for us.

Logan Schmidt:

It’s clear that the DAISY Foundation has grown immensely from the four hospitals you mentioned in the first year to what it’s become now internationally, and it’s growing even moreso. And going into the next question is, can you tell us about the DAISY Foundation’s new Health Equity Grant program? What is that and how did it get started?

Bonnie Barnes:

Well, it got started, actually, it’s not quite that new. It got started a few years ago when George Floyd was murdered. And I was sitting in my office where I had a television at the time and was watching the funeral as I was working, and I was having a real hard time concentrating on working. I was so deeply affected by what had happened and the outpouring of love and feeling that was happening in our country at the time. And my reaction was, well, what can we do? What can DAISY do to contribute to overcome this incredible sense of divisiveness and pain? And Mark and I got together and started talking about, one of the things we do that we haven’t talked about is we have a grant program for nurses who are doing research and evidence-based practice projects. And that program is dedicated to the treatment of patients with cancer and autoimmune disease since Patrick had both of those during his life.

But what if we created a grant program for nurses who were actually working to mitigate the social determinants of health and help elevate health equity in this country? And while we don’t have a lot of money to give away, we have enough to really help nurses who are working in the field in health equity. And so we created this, well, I talked to a dozen leaders in the area of health equity who are researchers to say what’s the best way for us to set this up? And one of our board members was just a fantastic guide for us on this, introduced us to all kinds of people who really helped us shape a program that was quite broad. At first, I thought, “Well, maybe we should choose one social determinant of health.” And they all said, “No, no, no, don’t do that. Open it up and see what you get.”

And boy, some amazing applications. We’ve been able to fund some really special work. So that’s how it got started, and we also have a health equity award that I didn’t mention earlier. That is for, not only for our healthcare partners to provide to their nurses who are working in the community, but we also partner with a number of nursing associations like Black Nurses Rock, the National Black Nurses Association, soon, the American Association for Men in Nursing, the Philippine Nurses Association, because they all have chapters that are out working in the community to mitigate social determinants of health. And that’s another way that we honor that work.

Lauren Lavin:

That’s great. As you continue to innovate, especially like you said, current events drive the direction of where you guys are going, where are your hopes? Where do you see the future for nurse recognition and DAISY?

Bonnie Barnes:

Well, we just introduced another award in January, or another application of the DAISY Award that’s around nursing ethics. And this came out of the pandemic, frankly, as we were reading nomination stories that talked about the ethical decisions that nurses were being called on to make really tough calls, especially nursing leaders. And we got together with our colleagues at the American Nursing Association, ANA, because they have a council on human rights, and ethics, and nursing, and they wrote the code of ethics for nursing, and we built an award program with them to honor nursing ethics.

So that’s another example of, yes, we’re listening hard, we’re looking at current events, and we’re thinking about where recognition can fit. I think where we may see going forward, certainly our international work is expanding daily, and just as Mark said earlier, we’re seeing, for example, in the national health system in the UK, where DAISY started in one hospital and won what they call trust system of hospitals. It’s now really spreading far because of the needs of nursing and the NHS in other private systems in the UK. So I think we stay focused on recognition and go with it where it takes us.

Logan Schmidt:

[inaudible 00:20:16] that you all are using recent events to modify and amplify certain aspects of nursing that needs meaningful recognition to highlight what nurses are doing. And that’s fantastic to hear about these innovations of the DAISY Foundation. The last question that we like to ask in every podcast episode is, what is one thing that you thought you knew but were later wrong about?

Bonnie Barnes:

There are many, many things.

Mark Barnes:

Almost everything. We didn’t know anything about nursing, so we thought we would take what we had learned in our marketing careers, for example, that recognition would just be a natural thing. We had to tell people that they had to be recognized. We never, ever, in our wildest dreams, thought that we would be in 35 different countries. I think we introduced the program at the University of Washington where Pat passed away and he said in their daily newspaper, the headline was DAISY planted at the University. And the article pointed out that Bonnie said, “We hope to get 10 hospitals to take the DAISY award.” And then we thought that would be success. So that’s what we didn’t know. We didn’t know that there was an incredible need for recognition in this industry.

Bonnie Barnes:

We knew we had the need to say thank you. We just didn’t know how that it was going to ultimately be received the way it was. The other thing I would say that we’ve learned is that nursing, it’s often referred to as a science and an art, and the need for evidence, despite the fact that, as Mark said, it’s such an emotional program and it’s built on emotion, but there are a lot of nurse leaders who really need to know what impact is, and nursing is evidence-based. And it didn’t occur to us in the early years that we would need to have research.

So the first time a health system came to us, a chief nursing officer, came to us and said, “We’re doing a survey about the DAISY award in our hospital and just want to let you know that.” I was like, “Really?” I got kind of nervous about it. Survey sounded like, “Oh my gosh, what if they don’t like it?” Of course, the findings were incredibly positive beyond, and we learned a lot through that, but I don’t think we appreciated how important research and evidence would be to the success and amplification of this program.

Mark Barnes:

Well, and you have to appreciate is that you have to have the evidence for the clinical part of nursing. There’s no question about that, but I’ve always felt that the emotional part. If you tell somebody, “Thank you for doing a great job,” they’re going to appreciate that. That’s the emotional part of it. And I would get so frustrated when some nurse leader would say, “Well, what is your evidence?” I said, “Your evidence is,” I said, “You’re doing a great job. Don’t you feel better when I say that?” “Well, yeah, I do, but that’s not the evidence.” So I and nursing have had a little bit of a conflict over the years at times, but I still feel DAISY, it has the evidence. We’ve done that, but it still is emotion. It is a feelgood moment, and I want to stress that as we go forward.

Bonnie Barnes:

But where the feelgood moment has its impact is on the ongoing care that a nurse is able to provide as a result, and I think that’s been really important for us to be able to uncover for our healthcare as it isn’t actually a moment. DAISY is really long-lasting recognition. Nurses hold onto those nominations. They read them when they’re having tough days. They think about the day that they got the DAISY award, is something they never forget. So the long-lasting nature of truly meaningful recognition is what I think is the evidence that we needed to uncover, and it’s made a big difference. We could talk about, again, all day long on what we didn’t know and we’ve learned, oh my gosh, or we were wrong about, many things.

Lauren Lavin:

That’s the process of getting to something as successful as you guys have, and I think we can all relate to the story of recognition. I don’t think that’s necessarily unique to nursing. We all feel a little better when we’re told good job, especially in a way that’s meaningful.

Bonnie Barnes:

Absolutely.

Lauren Lavin:

So to wrap up, I just want to extend a very big thank you to both Bonnie and Mark for joining us today to talk about the DAISY Foundation. We really are grateful for both the innovation and I would say the recognition that you guys have brought to the nursing profession, especially during the trying times of the last couple of years. And we hope that to our audience, that this show encourages you to learn more about the DAISY Foundation and the importance of recognition in healthcare professions. This has been Lauren and Logan, From the Front Row, thank you for tuning in.

Anya Morozov:

That’s it for our episode this week. Big thanks to Bonnie and Mark Barnes for joining us today. This episode was hosted and written by Logan Schmidt and Lauren Lavin, and edited and produced by Anya Morozov. You can learn more about the University of Iowa, College of Public Health, on Facebook, and our podcast is available on Spotify, Apple Podcast and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa, College of Public Health. Until next week, stay healthy, stay curious, and take care.