The hall looks like any other busy hospital corridor in the U.S., with medical staff hurrying along the polished floors and the buzz of constant activity. But there, hanging from the wall, stirring in the breeze as people whiz by, is an eye-catching sight: a handmade “Gratitude Tree.”

Its foliage is a flutter of Post-it leaves, each bearing a handwritten note. Some of the notes begin with a printed prompt, “Today I am grateful for…,” and in the blank, the people who work along that corridor have written things like “being safe,” “being alive,” “good family and friends,” “my job,” and “our team who continues day in and day out.” One reads, “The OR says thank you. Great job!”

The display is the work of nurses at a hospital in Phoenix, Arizona, one of the 136 facilities run by CommonSpirit Health, a huge nonprofit system. As they go about their demanding jobs, nurses here pass the Gratitude Tree. And often, these days, even in the midst of the pandemic pressure and time restraints they face, they stop for a moment, to take in someone else’s gratitude, or add their own note of thanks.

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The campaign at CommonSpirit hospitals is the result of a Greater Good Science Center partnership with the American Nurses Foundation: Gratitude Practice for Nurses is a new initiative that encourages the cultivation of gratitude within the nursing profession. It’s intended to increase appreciation for nurses, help nurses deal with stress, and strengthen their well-being and positive social connections in the workplace.

The Greater Good Science Center at UC Berkeley launched the initiative following research about the role of gratitude in improving psychological health for both individuals and the organizations they work for. The Toolkit supplied to nurses and nurse managers offers research-based strategies aimed at fostering gratitude, even in busy health care settings. The tools in the kit include suggestions for writing a letter of thanks, keeping a gratitude journal, adding meaningful moments of gratitude to the workday, walking with a sense of appreciation, and creating a gratitude wall.

But how would that actually work in practice, given the pressures of the job? It’s a more-than-challenging time for the medical profession in general—and for nurses in particular. That’s pretty evident from current headlines. There’s also plenty of research showing that the simple practice of gratitude could make things better, and can help nurses maintain their resilience. After the Gratitude Practice for Nurses Toolkits went out, I contacted a number of nurses to see how they were putting the principles of gratitude into action—and to ask how it was working out. I found some lessons here for myself and for other professions. If gratitude can help nurses get through a global pandemic, it might help your own workplace to face its own challenges.

Phoenix, Arizona: Tools for gratitude

“Our health system has really embraced this campaign,” says Lesly Kelly, a Ph.D. nurse scientist at CommonSpirit. Even when pressed for time, Kelly says, “We are figuring out a way to practice gratitude.”

The nursing staff at CommonSpirit used the Greater Good Toolkit to kick off their campaign. “Ten of our facilities really came together and said, ‘We’re going to implement this and measure the outcomes,’” says Kelly. Each hospital decided which particular approach they wanted to focus on. “We coordinate together,” says Kelly, “and I work with them to measure outcomes.”

One group initiated a Thank Bank and Cheers for Peers activity, a way to show gratitude to fellow workers by offering a gift from the bank. During a meeting before annual evaluations, a manager began by having everyone write a thank-you, using a format from the Toolkit. “The whole team received thank-you’s from each other, and they were meaningful,” Kelly says. “It drastically changed the conversations that took place and the understanding that we truly care.”

Nonetheless, finding time in the nursing profession for anything extra is always a challenge and, given current conditions, more so. “We can’t get out of this COVID surge,” Kelly says. But that doesn’t stop her. “Gratitude is something to draw upon even if the surge is still happening. It provides something positive and an optimism in our work.”

Practicing gratitude has helped Kelly herself, as well. Even in the midst of challenges like cutbacks and changes in the health care system, she’s found that taking a moment can make a big difference. “Every time my paycheck hits my bank account and I get the notification, I pause and have a moment of gratitude: ‘I am thankful for my job.’ When my kids’ teachers email me, I take a moment to pause and be grateful for those teachers.”

The Savoring Walk idea—being aware and grateful for things along the way—has actually slowed her down a bit, too. “I’m a big walker,” says Kelly, “but I used to walk fast and be on my phone. Now when I get up from my desk, I take a moment, take a pause.” Then she walks around more slowly, pausing to be thankful for what she sees. 

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“So far it’s working,” she says. “One of the things we got from our data is that nurses are practicing gratitude, some said daily. We are grateful for our work, for our families, for our health. I’ve heard from our community that it’s a way for everyone to come together.

“It’s tough right now, but the gratitude is a bright spot,” says Kelly.  

Washington, D.C.: Checking yourself with gratitude

A few thousand miles away in metropolitan Washington, D.C., gratitude is also at work, in this case in a pediatric unit at Children’s National Medical Center. They have an artful paper gratitude tree as well, covered with “leaves” bearing handwritten expressions of thanks—for the health of someone’s family or for the support of colleagues in stressful times.

“That was the easiest and first thing that came to mind,” says nurse Shari Washington. “It’s right over the copy machine, so you have time to stand there while you are making copies and think about what you are grateful for.”

Washington, who has been a nurse for 36 years, working mostly in neonatal intensive care and pediatrics, currently works in nursing education and professional development with nurses in the pediatric resident programs, as well as with student nurses.

“We have seven people in the department, including support staff, so we are really tiny,” she explains. “But we currently have 40 or 50 leaves. Sometimes other people visit for a meeting and on their way out they ask for a leaf.” As winter nears, the current batch of leaves will be moved to the base of the tree, and a new stack of cut-out paper snowflakes will be set out, waiting for new expressions of gratitude.

When she got Greater Good’s information for the gratitude campaign, Washington welcomed it. “We kicked this off to support the well-being of our nurses. It’s one very positive thing we do within the department,” says Washington. “Everyone is focused on the positive and the good rather than the challenges. COVID-19 has stretched everyone I know to the limit.”

When Washington leads classes for residents, she sets aside time for everyone to check in and say how they are doing. “Sometimes they are having a really tough time, staff leaving, and other stresses, and the comments aren’t very upbeat.” she says. “But I always try to do something positive and get some gratitude in there during check-in.” She adds:

Working with others makes me check myself every day, because you can’t be a hypocrite. You can’t talk to people about being grateful if you are complaining. I try to meditate every day—it depends on how early I am getting started—and that keeps me pretty grounded, as far as what’s really important and what I should be grateful for. It’s made me more aware of practicing the things I am preaching.

Sacramento, California: Saying thanks in a surge

Janet Sohal is director of clinical education practice and informatics at Kaiser Permanente in Sacramento, California. A 38-year veteran nurse, she welcomed the Greater Good program with great enthusiasm, and so did her staff.

“In June, 100 people participated in an introduction to gratitude practices,” she says. “We did a 45-minute session, and of 100 people there was nobody who said they did not benefit.”

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In July, Sohal led another group. “They had the ability to sit, do deep breathing, and self-reflect on what has happened in the pandemic, and what has happened to them. A lot of what they said they were grateful for was that they were well. Some had had family members who had died. Some had family in other countries they couldn’t visit. It was just the ability to be truthful and to be able to say what’s in your heart at that moment.”

The program started in July during a local dip in the number of COVID-19 cases, so Sohal thought it was time to try new things. But then came another surge and plans had to be cancelled. What was already a hard job has just gotten harder.

Still, Sohal begins staff meetings by inviting personal reflections on gratitude, and she ends with a minute of deep breathing. For her own well-being, she keeps a gratitude journal. “I also make sure I thank somebody at least every day, and I make sure I round with my nurses and listen and see how they are doing.

“I just wish I could do more,” she says. “There’s definitely a need. “

Dayton, Ohio: Finding what’s gone right

In Dayton, Ohio, Patricia O’Malley is another nurse who has been giving gratitude a lot of thought. “Gratitude is a deeper thing than just being thankful,” she says. “It involves putting yourself in a position where you recognize that you would not be where you are without the assistance of your community.”

Having worked in critical care and palliative care for 44 years, O’Malley is currently a nurse researcher/scientist. Her hospital, the Dayton flagship for Premier Health, was dealing with the COVID-19 surge in September, and care of those patients, naturally, was taking precedent. Nonetheless, she and her staff were using the Greater Good suggestions to work gratitude into their days whenever possible. “We’ve held a session on how to use gratitude science to build resilience and cope better, especially during this fourth wave,” she says. This has involved integrating gratitude practice into their nursing huddles, “when the staff gets together and plans for the day.” O’Malley describes the results:

We’ve done a lot in 90 days. Gratitude, I think, can be a powerful antidote to being a victim of your circumstances. I can have a different perspective. I can find meaning in my work. And I can provide care with intention and compassion. I am so glad I am a part of this group of nurses going forward, that I can be a conduit for all this work in Ohio.

It’s been very powerful to hear other people’s experiences integrating gratitude into their personal and professional lives, and bringing it to their families, as well. It’s a change of world view. There’s so much focus in our culture right now on what is wrong. This is another lens to say what is right.

O’Malley hasn’t experienced any pushback from participants. She says, “In fact, after a presentation, one nurse walked up to me and said, ‘You have no idea how I needed this. This is really going to help me.’”

Santa Clara, California: Getting permission to say thanks

“We often hear, ‘We’re too busy, we’re too busy,’” says Stacey Aggabao, a longtime nurse and currently emergency department director for Kaiser Permanente in Santa Clara, California. “I say, ‘Okay, let’s just take two minutes.’”

During a nurses’ huddle, she tries to encourage just a quick reflection, a quick moment of gratitude. “I think we have to give people permission. They don’t feel like they can take the time,” she says. “Patient volume is up, as we are seeing across the nation. Short staffing is an issue, and we’ve had a lot of people leave the profession and that’s been very challenging.”

Given such stresses, Aggabao has had to be resourceful, both to support her large staff, and to keep herself going. Now at the end of a shift, the group makes it a point to talk about what went well, turning the meeting into a “gratitude huddle,” besides just passing along necessary information to the next shift.

“We are really just getting started, we’ve been so busy with COVID,” she says. “We’re looking to revamp the gratitude wall, not just to have it in the staff lounge, but putting it where others can see it, including patients and colleagues in the medical center. It really gives staff the opportunity to recognize each other.” Practicing gratitude has helped her personally, as well:

When I wake in the morning, I am grateful that I have a day and that I get to do what I do. If I am going into a contentious meeting, I can reflect and I can be grateful for the opportunity to have that conversation, and can do a lot more active listening and ask small questions. It’s a privilege to do the job that we do.

It was heartening to hear about the many ways that nurses facing a pandemic were slipping gratitude into their busy days. If these health care providers can steal a moment to pen a note of gratitude, shout out a thank-you to a colleague, turn an otherwise practical huddle into a quick pause of reflection and thanks, what does that say for other people under stress—restaurant workers, teachers, sanitation workers, parents?

“We have to take those small moments of gratitude when we get them,” says Stacey Aggabao. That seems like good news—and good advice—for the rest of us.

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