Nurse Stories of Meaning and Joy: A Qualitative Study

Purpose: Global healthcare transformation is guided by the triple aim of improving health, enhancing the patient experience and reducing costs.¹ Experts have recommended the addition of a fourth aim, improving the experience of providing care.^2,3 They advise that achievement of the triple aim will only be possible if we create the conditions where healthcare workers can find meaning and joy in their work.⁴ Nurses’ experiences with meaning and joy in their practice have not been well described. In an effort to fill this knowledge gap, nurses throughout the United States recently participated in a qualitative study to share their experiences with meaning and joy in their nursing practice.

Methods: The study utilized a narrative inquiry⁵ approach with a lens of appreciation to elicit and interpret nurses’ stories. Nurse participants responded to an opening statement and were asked to share their experiences of meaning and joy as they defined it. The interviews were recorded using StoryCorps ®, a publicly available platform for peoples’ stories with a focus on the human experience.⁶ StoryCorps ® offers a smart phone app for recording interviews conducted in alignment with their published principles of respect, care and dignity. Following the interviews, the nurse participants had the option to consent to have their stories archived and made publicly available. This innovative and transparent method for data collection utilized technology and provides a historical archive to inform current and future generations of meaningful nursing experiences in the voices of the nurses themselves.

Twenty-seven Registered Nurses, with a minimum of one year of practice experience in the United States, were invited to participate in the study in 2017. A snowball sampling approach was employed and participants were recruited until data saturation was achieved.

Results:

The nurses’ stories provided rich insight into meaning and joy in nursing practice. The study captured contemporary themes that crossed practice settings, and generations across the United States. Four themes emerged from the narrative analysis including: Fulfilling Purpose-“I am a nurse,” Meaningful Connection, Impact-The Wow Factor, and The Practice Environment. The Practice Environment theme included three subthemes: Teams Work, Leaders Model the Way and Opportunities to Learn and Grow. The themes will be described and illustrated with participant quotes.

Conclusion:

The study findings build on published evidence related to meaning in nursing practice and our conceptual understanding of joy.^7,8 Results align with recommendations for defining and focusing on the fourth aim to improve the practice experiences of nurses so they can more fully contribute to achieving the triple aim in healthcare and to their own well-being. Specific implications for leaders, leadership education, and supportive practice environments will be discussed. Examples include: learning about nurses as individuals and what led them to nursing; creating opportunities for storytelling and sharing meaningful experiences; recognition and appreciation; engagement in shared decision-making; interprofessional collaboration; and healthy practice environments. In addition, recommendations for future research will be provided including: replication globally to describe the universal themes related to meaning and joy in nursing practice; instrument development; and exploration of linkages between nurses’ experiences and important healthcare outcomes. Educational implications will focus on the development of nurse leaders at all levels to inform the co-creation of conditions to cultivate meaning and joy in nursing practice.