Open Journal of Nursing, 2013, 3, 485-492 OJN
http://dx.doi.org/10.4236/ojn.2013.37066 Published Online November 2013 (http://www.scirp.org/journal/ojn/)
Perception gaps for recognition behavior betw e e n s taff
nurses and their managers
Chiharu Miyata1, Hidenori Arai1, Sawako Suga2
1Department of Hu m an Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
2Department of N u rsing, Kansai University of Nursing and Health Sciences, Hyogo, Japan
Received 16 July 2013; revised 10 September 2013; accepted 2 October 2013
Copyright © 2013 Chiharu Miyata et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Nurse managers play a critical role in improving the
work environment. Important leadership characteris-
tics for nurse managers include visibility, accessibility,
communication, recognition, and support. The nurse
manager’s recognition behaviors strongly influence
the job satisfaction of staff nurses. In our previous
study, we investigated how staff nurses perceived the
nurse manager’s recognition behaviors and revealed
that there was a divergence in practical approaches to
these behaviors between the nurse manager and the
staff. We assume that one factor causing this diver-
gence could be perception gaps between the nurse
manager and the staff. The aim of this study, there-
fore, was to uncover what types of perception gaps
exist between the nurse manager and staff nurses and
whether the background of staff nurses, such as years
of experience or academic background, could affect
the staff nurses’ perceptions. This quantitative, cross-
sectional study invo lved 10 hospitals in Ja pan. A total
of 1425 nurses completed the questionnaire. The re-
sults showed that staff nurses considered “Respect
job schedule preferences” to be the most important of
the recognition behaviors. In contrast, nurse manag-
ers gave “Nurse manager meets with the staff nurses
to discuss patient care and unit management” the
highest score for importance. Four factors (marriage
status, age, years of clinical experience, and training
background) affected the professional awareness of
recognition behaviors. Our results suggest that nurse
managers need to consider these factors when they
conduct recognition behaviors.
Keywords: Recognition Behavior; Nurse Manager; Staff
Nurses
1. INTRODUCTION
In the face of the current shortage of nurses, it is urgent to
procure sufficient human resources by training nurses and
preventing them from leaving the profession. The im-
portance of improving staff motivation and work envir-
onments and thereby enhancing job satisfaction as a mean s
of preventing turnover and career change has recently been
highlighted. One of the factors influencing work environ-
ment and job satisfaction is the nurse manager’s manage-
ment ability; in particular, the importance of recognition
behavior, which is defined as assessing nurses’ perfor-
mances and accomplishments in a concrete manner, has
been reported [1]. Studies on nurse managers’ recognition
behaviors identified work-related stress, commitment, au-
tonomy, communication with superiors and colleagues, and
recognition behavior as factors related to improved job
satisfaction among nurses. Moreover, the recognition beha-
vior of nurse managers was defined as their explanations of
nurses’ performance and ability evaluations, which were
presented in a 38-item scale for recognition behavior by
nurse managers [2]. Goode & Blegen [3] conducted a
survey on the perceptions of staff nurses, focusing on nurse
managers’ recognition behavior. The researchers reported
that performance recognition behaviors, consisting of 27
items, and achievement recognition behaviors, consisting
of eight items, improved job satisfaction and prevented
nurses from leaving their profession.
In response to the study by Blegen [2], Ozaki [4] trans-
lated the scale into Japanese and modified it to correspond
to nursing staff scenarios in Japan. A factor analysis show-
ed that five factors (reporting/announcing results, super-
vising and supporting staff nurses, assigning jobs with
responsibility, reporting evaluations from patients, and res-
pect for desired working hours) correlated with job sa-
tisfaction.
In our previous study, we investigated how nursing staff
perceived the nurse manager’s recognition behaviors and
revealed that there was a distinction between the nurse
managers’ and the staff ’s practical approaches to these be-
haviors. We assume that one factor causing this distinction

C. Miyata et al. / Open Journal of Nursing 3 (2013) 485-492 486
could be possible perception gaps between the nurse ma-
nager and the staff. We describe the development of a
research-based management intervention to provide recog-
nition and the implementation of the intervention by nurse
managers. The aim of this study was to uncover what types
of perception gaps exist and which factors, such as years of
experience and academic background, could affect these
perception gaps.
2. METHODS
2.1. Participants
The study was conducted in 10 hospitals with 100 beds
or more in the Kanto, Kansai, and Kyushu regions of
Japan. Following the agreement of the involved organi-
zations, a meeting was held so that the researchers
could explain the project and procedures to all of the
unit nurse managers. Individuals were informed that
their answers would be treated anonymously and con-
fidentially.
2.2. Data Collection
We used a descriptive, cross-sectional design. The in-
strument used for data collection was questionnaire
about recognition behavior developed by Blegan [2].
This scale was translated by Ozaki [4] and converted to
a revised 35-item Japanese scale. The questionnaires
were divided into two parts. Part One consisted of the
background information of responders, and Part Two
contained 35-items for determining recognition beha-
vior. The following demographic data were collected:
age, gender, marital status, overall work experience,
position (nurse manager or staff), academic background
(associates degree, diploma in nursing, junior college
graduate, or university/graduate university), mental health,
and physical health. The participants were asked to
describe a variety of nurse manager recognition beha-
viors using a four-point Likert-scale ranging from
“fully agree” to “fully disagree”.
2.3. Ethical Consideration
The study was approved by the Ethics Committee of
Kyoto University Graduate School and the Faculty of
Medicine. Additionally, research permission was given
by the chief nursing directors of all 10 hospitals. The
questionnaires included the researchers’ contact details,
and the collected information was provided voluntarily
and kept anonymous.
2.4. Statistical Analysis
All statistical analyses were performed using SPSS
(Statistical Package for the Social Sciences) 20.0J
(SPSS Japan Inc., Tokyo, Japan) for Windows. The
categorical data were described using frequencies and
percentages. Recognition behavior was analyzed using
principal factor analysis. The median values and inter-
quartile range (IQR) were used to describe continuous
data. The evaluations of the implementation of the three
extracted factors were compared using the Mann-
Whitney U-test. Demographic comparisons based on
recognition behavior were analyzed using the Kruskal-
Wallis test, and a multiple comparison was performed
using a multiple analysis of variance (ANOVA) fol-
lowed by the Bonferroni test.
3. RESULTS
A total of 1425 nurses participated in this study. The
participants were nurse managers (n = 117) and staff
nurses (n = 1248). Ninety-four percent of the nurse
managers were women, and 63% of them were married.
The mean age was 47.7 years (range : 42.2 - 53.2 years).
Regarding professional work experience, 14% had 10 -
19 years of nursing experience, and 86% had 4 - 19
years of experience. The nurse managers’ academic
backgrounds included an associate’s degree (25%), a
diploma in nursing (57%), junior college graduation
(13%), and university or graduate school education
(5%). Among the staff nurses, 94% were women, and
66% were single. The mean age was 33.8 years (range:
24.7 - 42.9 years). Regarding professional work ex-
perience, 30% had 10 - 19 years of nursing experience,
and 28% had 4 - 9 years (range: less than one year-42
years). Their academic backgrounds included an as-
sociate’s degree (15%), a diploma in nursing (56%),
junior college graduation (8%), and university or gra-
duate school education (21%; Table 1).
We compared the three items with the highest aver-
ages among the 35 questions to determine the differences
between nurse managers’ and staff nurses’ views of
recognition behavior (Table 2). The staff nurses gave
“Respect job schedule preferences” the highest score,
indicating that they considered it the most important
recognit i o n behavior.
This was followed by “Nurse manager meets with the
staff nurses to discuss patient care and unit management”
and “Patient evaluations that compliment individual
nurses on the unit are posted on the bulletin board.” For
nurse managers, “Nurse manager meets with the staff
nurses to discuss patient care and unit management”
had the highest score, followed by “Patient evaluations
that compliment individual nurses on the unit are
posted on the bulletin board” and “The nurse manager
evaluates the staff by their work”; therefore, the top
two items were the same as those indicated by the staff
nurses.
The three items with the lowest average score were
“Release time is given to spend a day with the supervisor

C. Miyata et al. / Open Journal of Nursing 3 (2013) 485-492 487
Table 1. Demographic characteristics of nurses (n = 1425).
Nurse manager (n = 177) Staff nurse (n = 1248)
Demographic variable n % n %
Gender
Male 11 6 81 6
Female 166 94 1167 94
Marital status
Single 66 37 826 66
Married 111 63 422 34
Age range, years, mean (±SD) 47.7 (±5.5) 33.8 (±9.1)
Under 30 0 0 516 44
30 - 39 14 8 319 27
40 - 49 94 53 260 22
Over 49 69 39 81 7
Overall work experience, years, mean (±SD） 25.1 (±5.6) 11.0 (±8.7)
Under 3 0 0 288 23
4 - 9 0 0 346 28
10 - 19 24 14 373 30
Over 19 153 86 241 19
Academic background
Associate degree 45 25 186 15
Diploma in nursing 100 57 703 56
Junior college graduate 23 13 101 8
University or graduate university 9 5 258 21
Table 2. Nurse managers’ behaviors that provide recognition for performance and achievement (the highest average).
Staff nurses (n = 1248)
Nurse managers’ behaviors Mean (SD)
I Respect job schedule pr eferences 3.15 (0.65)
II Nurse manager meets with the staff nursee to discuss patient care a nd uni t management. 3.15 (0.62)
III Patient evaluations that compliment individual nurses on th e u nit are posted on the bulluten board. 3.08 (0.62)
Nurse managers (n = 177)
Nurse managers’ behaviors Mean (SD)
I Nurs e manager meets with the staff nursee to discuss patient care and unit management. 3.34 (0.59)
II Patient evaluations that compliment individual nurses on th e u nit are posted on the bulluten board. 3.33 (0.57)
III The nurse manager evaluates the staff by their work. 3.29 (0.54)
to experience management functions,” “Achievements
are announced in the hospital newsletter,” and “Release
time is given to work on special projects for the unit,”
suggesting that they had a low lev el of importance to the
staff as recognition behaviors (Table 3). For the nurse
managers, the lowest three items were “Release time is
given to work on special projects for the unit,” “Pre-
ference for selection of hours is given to the nurse,” and
“Helps with the staffs’ job when busy.”
Using the responses to these 35 questions related to
recognition behavior, we performed a factor analysis
(main factor method: promax rotation) for nurse mana g er s

C. Miyata et al. / Open Journal of Nursing 3 (2013) 485-492 488
Table 3. Nurse manager’s behaviors that provide recognition for performance and achievement (the lowest average score).
Staff nurses (n = 1248)
Nurse managers’ behaviors Mean (SD)
I Release time is given to spend a day with the supervisor to experi en ce ma nagement functions. 2.63 (0.69)
II Achievements are announc ed in t he h osp it al n ews le tt er. 2.64 (0.71)
III Release time is given to work on special projects for the unit. 2.67 (0.75)
Nurse Managers (n = 177)
Nurse managers’ behaviors Mean (SD)
I Release time is given to work on special projects for the unit. 2.75 (0.66)
II Preference for selection of hours is given to the nurse. 2.75 (0.64)
III Helps with the staffs’ job when busy. 2.77 (0.71)
and staff nurses. We also performed a factor analysis that
excluded items that had many plural factors, taking a
load of 0.4 as a reference. As a result, five items (“The
nurse manager praises the staff individually,” “Release
time is given to spend a day with the supervisor to ex-
perience management functions,” “Senior nursing ma-
nagement receives a letter from the nurse manager
regarding the staff nurse’s performance,” “Private verbal
feedback is given by the nurse manager,” “Using time to
serve the staff”) were excluded from the 35 items due to
low factor loadings (0.4 or less) in both the staff nurses’
and nurse managers’ responses.
For the staff nurses, an additional six items (“The
nurse manager brags about the performance of the unit
staff nurse,” “The nurse manager encourages the staff
nurse to develop expertise in one aspect of care,” “Peer
review provides an opportunity for the staff nurse to
share developed projects/materials,” “Release time is gi-
ven to work on special projects for the unit,” “Nurse
manager meets with the staff nurse to provide support
and assistance towards professional and career goals,”
“The nurse manager congratulates the nurse in front of
peers”) were excluded, for a total of 11 excluded items.
Eventually, we extracted 24 items, which were classified
into three factors. Factor One consisted of eight items
related to evaluation, such as “The achievements of
nurses are posted on the bulletin board” and “Achieve-
ments are announced in the hospital newsletter” and was
classified as “Evaluation, presentation, and report.” Fac-
tor Two consisted of nine items related to job schedule
preferences, patient care, and participation in decision-
making in wards, such as “Respect job schedule pre-
ferences,” “Helps with the staffs’ job when busy,” “The
nurse is given preference for t he selection of work ho urs”
and was classified as “Individual value and transfer of
responsibility.” Factor Three consisted of seven items
related to participation in training and professional abi-
lity activities, su ch as “Staff nurses are asked to represent
the unit at hospital meetings” and “Staff nurses are
selected as presenters for new employees” and was la-
beled “Professional development.”
For the nurse managers, an additional eight items
(such as “Staff nurses are encouraged to participate in
professional activities at the local and national level”)
were excluded. We classified the 28 remaining items into
three factors. Factor One included 14 items related to
staff considerations, such as “For consistently working
extra hours, a written letter is given to the staff nurse and
a copy is placed in the personnel file” and “Respect job
schedule preferences” and these items were categorized
as “Individual consideration and development.” Factor
Two consisted of nine items related to the publication of
evaluations and reports to the nurse manager, such as
“Nurses’ achievements are posted on the bulletin board”
and “Achievements are announced in the hospital
newsletter,” and these items were called “Notification
and report of achievements.” Factor Three was composed
of three items related to the nurse manager’s behavior in
evaluating the staff, such as “The nurse manager con-
gratulates the nurse in front of peers” and “The nurse
manager brags about the performance of unit staff
nurse,” and this factor was labeled “Expression of eva-
luation.”
The internal consistency of each factor in the factor
analysis for both nurse managers and staff was 0.50,
indicating the reliab ility of the questionn a ire (Table 4).
We compared the median score of the lower item total
score for factors with staff’s attributes. In Factor Three,
married nurses obtained a significantly higher score than
did single nurses, the 40-year age group obtained higher
scores than the 20-year age group did, and those with 10 -
19 years clinical experience obtained higher scores
than those with three years’ experience or less, in-
dicating the importance of Factor Three as a recog-
nition behavior.
However, in terms of academic background, university

C. Miyata et al. / Open Journal of Nursing 3 (2013) 485-492 489
and college graduates obtained a significantly lower
score compared with those with associate degrees and diplomas in nursing, indicating that Factor Three was not considered important in those areas (Table 5).
Table 4. Resu lt of exploratory factor analysis on recognition behavior.
Staff nurses (n = 1248)
Factor Number of items Cronbach’s alpha Factor loadings
I Evaluation presentation and report 8 0.869 0.577 - 0.83
II Individual value and transfer of respo n s ibility 9 0.847 0.48 - 818
III Professional development 7 0.752 0.532 - 0.816
Nurse managers (n = 177)
Factor Number of items Cronbach’s alpha Factor loadings
I Individual consideration and development 14 0.869 0.489 - 0.858
II Evaluation presentation and repor t 9 0.847 0.418 - 0.678
III Expression of evaluation 4 0.752 0.488 - 0.639
Table 5. Demographic comparison based on recognition behavior analyzed by an exploratory factor (Staff nurses).
Factor One Factor Two Factor Three
Median IQR p Median IQR p Median IQR p
Gender
Male 23 20 - 2527 25 - 2921 19 - 22
Female 24 21 - 240.763a) 27 25 - 290.992 21 19 - 22 0.876
Marital status
Single 23 21 - 2427 25 - 2921
18 - 21
Married 23 21 - 250.293a) 27 25 - 300.152 21 19 - 23 0.001
Age range, years
Under 30 24 21 - 2427 25 - 2721 18 - 21
30 - 39 23 20 - 2427 25 - 2721 19 - 22
40 - 49 24 21 - 2427 25 - 2721 19 - 22
Over 49 23 21 - 24
0.121
27 24 - 27
0.62
21 21 - 22
0.002
Overall work experience, years
Under 4 23 21 - 2427 25 - 2921 18 - 21
4 - 9 24 20 - 2427 25 - 2921 18 - 22
10 - 19 23 21 - 2527 25 - 3021 19 - 23
Over 19 23 21 - 25
0.513
27 24 - 29
0.46
21 19 - 23
0.002
Academic background
Associate degree 24 20 - 2527 25 - 3021 19 - 22
Diploma in nursing 24 21 - 2427 25 - 2921 19 - 22
Junior college graduate 23 21 - 2527 25 - 2921 18 - 21
University or graduate university 23 21 - 24
0.993
27 24 - 28
0.06
21 18 - 21
0.001
n = 1248, *p < 0.05, **p < 0.001 a)Mann-Whitney test. Kruskal-Wallis test and the mu ltiple c omparisons test were per formed b y a mult iple ana lysis of vari-
ance.

C. Miyata et al. / Open Journal of Nursing 3 (2013) 485-492 490
4. DISCUSSION
Compared with the average of the each lower item (35
questions) concerning recognition behavior for staff
nurses, the highest scores were obtained for “respect job
schedule preferences”. This is most likely because of the
importance of a good work-life balance. Inadequate work
scheduling and long working times have been identified
as a major threat to employees’ health and well-being.
Shift working has been found to cause fatigue, sleep
disruptions, impaired concentration, irritability, and
somatic symptoms, such as digestive problems [5,6].
However, studies have suggested that the effects of
shift work can be reduced not only by adopting ap-
propriate shift rotations [7] but also by increasing the
predictability of work schedules [8] and choices over
shift patterns [9]. Among the survey respondents, 66%
were single; those respondents placed importance on
having sufficient individual free time. Further, 71%
were younger than 30 years old, at a point in life when
they experience many life-changing events, such as
marriage and giving birth. It is also possible that
younger nurses experience more stress and fatigue be-
cause they have greater family responsibilities than
older nurses do [10].
In terms of less important items among the recognition
behaviors, “Nurse manager meets with the staff nurses to
discuss patient care and unit management” was selected
by both staff nurses and nurse managers. According to
previous research, an important predictor of a staff
nurse’s job satisfaction is the p rofession al practice model
[11-14]. Some characteristics of professional practice are
autonomy and shared governance [15]. Nurse managers
should not just listen to the thoughts and opinion s of staff
nurses in a one-sided way; instead, they should convey
the intentions of their own actions and let the staff nurses
participate in decision-making [16]. This shows that
nurse managers are also aware of the importance of this
type of communication.
Among the recognition behaviors, the item of which
the staff nurses were the least aware was “Release time is
given to spend a day with the supervisor to experience
management functions”. This may be because the daily
work demands of a nurse, such as the introduction of
sophisticated medical devices and the need for increased
care for the elderly, are becoming increasingly complex,
and either the nurses have insufficient interest or knowl-
edge of administrative matters or they believe that such
matters are the responsibility of the nurse manager. In
comparison, there was a tendency for nurse managers not
to be aware of the item “Helps with the staff’s job when
busy”. This result suggests that in Japan, staff nurses do
not regard the nurse manager as an “administrator”, but
rather as a staff member who performs nurse duties, as a
previous study indicates [4]. Furthermore, most staff
nurses recognized the nurse manager as another member
of the nursing staff who performs nursing duties rather
than someone in a “management position”, which sug-
gests that the difference between the nurse manage-
ment and staff roles may not be clear to staff nurses.
Thus, a trend toward insufficient understanding of
management was observed among this study’s res-
pondents.
A slight difference in the lower items among the fac-
tors was observed from the results of the factor ana-
lysis; however, a common awareness was noted for
two factors, including items relating to consideration
to each staff member, notification of achievements and
reports.
Two lower items (“The nurse manager congratulates
the nurse in front of peers” and “The nurse manager
brags about the performance of the unit staff nurse”)
were excluded from the factor analysis for staff nurses.
In contrast, these items were included as “Expression of
evaluation” in the factor analysis for nurse managers.
These exclusions occurred because staff nurses do not
like to be praised in public. In addition, this exclusion
may arise from the fact that Japanese people are con-
servative, believe that “envy is th e companion of honor”,
and prefer quieter, emotional approval to receiving ap-
proval openly [17]. Furthermore, the lower items in Fac-
tor Three for the staff (“Professional development”) were
included in Factor One (“Consideration and development
of individual”) for the nurse managers, which indicates
their respect for each staff nurse.
Higher scores in the 40-year age group and the group
with 10 - 19 years clinical experience relative to the 20-
year age group and tho se with three years’ experience or
less, respectively, underline the importance of Factor
Three as a recognition behavior. Nurses in mid-career
were defined as those who had been in practice for 11
and 22 years and those between the ages of 31 and 50.
Strong associations were found between retention and
control over nursing practice for nurses in mid-career
[18]. Thus, staff nurses aged 40 - 49 years have been
trained as experts in their profession; they have a strong
desire for career advancement as professionals and keen-
ly wish to receive recognition.
In the same way, for Factor Three, there was less
awareness of recognition behavior among university and
college graduates than among those with associate de-
grees and diplomas in nursing. This occurred because the
lower items are related to participation in hospital con-
ferences, selection as preceptors, and participation in
seminars, and graduates most likely desire more aca-
demic career advancement [19], which is not included in
these activities. This aspect of staff nurses’ professional
development needs to be considered by including it in
future training.

C. Miyata et al. / Open Journal of Nursing 3 (2013) 485-492 491
5. CONCLUSIONS
A Our results indicate that nurse managers assign the
maximum respect to such recognition behaviors as
“Nurse manager meets with the staff nurses to discuss
patient care and unit management” and “Patient eval-
uations that compliment ind ividual nurses on the unit are
posted on the bulletin board”; in this respect, staff
members’ and nurse managers’ responses were con-
cordant. However, staff nurses regarded “respect job
schedule preferences” as the most important recognition
behavior, indicating that there was different awareness of
this behavior between staff and nurse managers. Our
results also showed that marriage status, age, years of
clinical experience, and training background influenced
the awareness of recognition behavior as a “professional
job”.
We predict that the burnout of staff nurses, which can
be caused by in creased nursing duties and by difficulties
in interpersonal relationships, will increase in the future.
We believe that recognition behaviors are an effective
way to support nurses’ self-realization .
6. RECOMMENDATIONS
A The results of this study indicate what types of re-
cognition behaviors staff nurses expect from nurse ma-
nagers and what staff nurses consider important. The
results can also reflect the difference in awareness be-
tween the nurse manager and staff nurses and suggest
future directi o ns for the educat i on of nurse managers.
A nurse holds a patient’s life in her hands. It is a
professional job in which she or he must take care of the
patient and show a high degree of flexibility with me-
dical techniques and skills. For this professional job, it
has been reported that praise from the superior is more
effective than providing information or emotional sup-
port for preventing burnout [20]. This fact also indicates
that it is desirable for the nurse manager to be aware of
the importance of giving her staff and their work praise
and approval. Moreover, it has been shown that the
leadership of the nurse manager influences staff nurses’
job satisfaction. It has been reported that staff nurses do
not merely want the nurse manager to manage the ward;
rather, they want her or him to play a functional role
within the overall infrastructure in which they look to her
or him for leadership to ensure their status as inde-
pendent professionals [21]. In the future, transforma-
tional leadership will no doubt be required, including
such recognition behavior such as sensitivity toward the
staff and providing stimulation and motivation.
7. LIMITATIONS OF THIS STUDY
A Many interlinked factors, such as an individual sense
of values, regional characteristics, and job locations, may
be important to this study, but they have not been
discussed. In addition, regarding the survey items used,
changes in the environment surrounding treatment, and
changes in nurses’ working co nditions and training, need
to be considered in the futu re.
8. ACKNOWLEDGEMENTS
We thank all of the nurses who took time from their busy schedules to
participate in this study.
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