This is absolutely not a criticism of the nurses themselves who are required to evidence positive feedback, and who may need to include in their folders any thank you cards etc. they may receive, or else look like they didn't get any positive patient feedback, but… I'm kind of slightly uncomfortable about the fact that this is something which is expected of healthcare workers when they do their revalidation/evaluation/renewal portfolio thingies.
To me it feels as though an expectation by the system that thank you cards should be utilised and presented to assessors as evidence of positive patient feedback turns something that, in the past, would have been valued just as a human-to-human expression of appreciation into something that also has a measurable external value, and giving it an instrumental value can change what it is, how it'll be received, and if the sender is aware of this practice, how they go about it. If the sender isn't aware of the fact it might be shared with others beyond the intended recipient(s) for purposes the sender didn't anticipate, it seems… somehow not right, to me — almost like pinning a card that was intended only for staff on one of those public noticeboards that some places have for pinning thank you cards (presumably with the giver's implicit or explicit consent).
Of course I would want staff whose work I appreciate, and who have helped me, to receive recognition of the fact that their hard work is appreciated by patients, and I try to find some kind of channel to communicate that (there's usually a "comments, compliments, complaints" link somewhere; I once managed to find one specifically for the phlebotomy service so I could praise a great phlebotomist).
It just feels odd somehow that someone might write a heartfelt note thinking they're communicating something for the recipient(s) personally to read (which might contain quite private info, though maybe this is redacted when used for evidential purposes), without realising that within the healthcare system their personal expression of gratitude is just another metric to be pulled out, shown around, and exploited in an evidentiary capacity.
Given that the system is how it is and that I know cards and notes may be used this way, and knowing that healthcare workers are under all kinds of ridiculous pressures to evidence this, that and the other, I am glad if any card or note I might give could be of benefit to the person I'm thanking during their revalidation or equivalent process. But although I know it's silly, there's something at the back of my mind saying that the expectation that thank you cards will be put in folders as evidence might have changed how people feel about receiving them, so rather than thinking something like "How lovely, it's nice to know they appreciated my hard work," they might care less about my appreciation per se than about its evidentiary value. And though the latter is actually more tangibly helpful for the person I'm grateful to, it could make the note/card feel almost like a payment in kind, rather than the human connection and expression of gratitude or appreciation that was intended.
So… yes. On the one hand, it's nice to feel there's a way I can give back practically. On the other, the practice does make me feel uncomfortable.