As a nurse you receive a salary, raises, promotion opportunities, bonuses, healthcare coverage and maybe a 401K plan as part of your total compensation package. These are the organization’s way of recognizing you for what you do. They are important. They satisfy to different degrees and motivate for various reasons. Employers have other nonmonetary types of recognition including award programs to recognize excellence in care, special nursing celebrations, quality achievement and patient satisfaction awards, service award programs. But words of gratitude and thanks from patients and their families are important to us in a very different way; they are constant reminders of why we wanted to be part of healthcare in the first place.

“My mother’s death was one of the worst moments of my life, but the way you were there for me during her last days somehow made it all more bearable. I can’t thank you enough.” “You and your staff are simply amazing. I can’t tell you how grateful I am for the way you coordinated my wife’s care over the long illness.” Sound familiar? As nurses, you and your colleagues often receive letters of recognition and thanks with words like these. Each time you do, I’m sure they touch you and motivate you to keep giving excellent care. Then, there’s the unwritten expressions of gratitude from patients and their families. Remember a quick thank-you hug from the mother of a scared little girl in the emergency room? Or the grateful smile from a son of an elderly patient who wouldn’t take her meds from anyone but you?

Maybe you don’t think of them as such, but each of them is a unique, special kind of “pay” you can’t take to the bank or use to pay your bills.

A letter of appreciation to an ICU care team perfectly exemplifies how part of our payment comes to us from grateful families. The letter, which appeared in the New York Times last October, is what prompted me to share these thoughts with you. Written by a young husband in Boston who is also a writer, the letter was sent to staff at Cambridge Hospital. It was a beautiful, honest and personal note of gratitude meant to recognize and thank the staff for the care they provided to his young, dying wife. His words were picked up by news outlets and social media and are likely written in the hearts of staff at Cambridge forever.

Nursing compensation is never complete if we don’t stop to consider the nonmonetary elements it includes. These elements are earned in different ways and can’t be computed or printed on our W2 forms or tax returns. Often, we’ve heard our profession called a vocation or calling, and we know it is. Somehow we learn from our early days of practice there is another special kind of compensation in our work that doesn’t come in our pay checks. It is the kind that comes in the grateful words of patients and their families who say things like “job well done” or “you made something terrible a little better” or “I will never forget what you did for my grandchild” or simply, “thank you.” I hope these thoughts resonate with you and remind you that although salary and benefits are important, our pay is not always green. As nurses, we wouldn’t have it any other way.