I learned about the practice of gratitude when I was in recovery from an eating disorder.

In my mid-20s, I was broadsided by anorexia and bulimia. Part of my recovery process was to keep a gratitude journal for a month. I was assigned to find three things I was grateful for each day and write them down in a journal. At the end of the week, I was asked to reflect on what I noted and write about how the practice helped me.

I was able to find gratitude in a hot cup of coffee, the perfect song, or a walk with a friend. Taking time at the end of the week to reflect and journal allowed me to witness the good. When I hit my tenth year in recovery, I wrote and sent a gratitude letter to my therapist. Writing the letter allowed me thank her for giving me something tangible to hang on to when my life was in chaos.

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Learned in my 20s, this practice taught me to find gratitude every day. I look at my surroundings, and I’m grateful that I am here to enjoy them. When I hear my children giggling, I am washed over with gratitude that I have my health, and I am lucky enough to be here to hear them. When I am at my work as a nursing professional, I look at my colleagues and realize how lucky I am to have them and to have a leadership role in my organization.

The practice of gratitude helped me cultivate self-compassion, peace, and connection to others. Seventeen years into my recovery, I look back at that time and now see that those people who surrounded me saved me. Without their love and support, I would not have survived.

In the spring of 2020, when our world changed overnight, I found myself working at home alongside my two daughters and husband. I quickly realized that my family was gripped with fear. I brought the practice of gratitude to our nightly dinners with an activity called “rose and thorn.” For this practice, each person has to name one thing that was a thorn and one thing they are grateful for that day. We did this nightly for almost six months, and even now, when we all get stressed, it pops back up at dinnertime. 

In the depths of the COVID-19 crisis, gratitude might be the last thing on people’s minds. But from my own experience with gratitude in hard times, I knew better. So I set out to bring the practice of gratitude to the nurses I work with, who were facing an unbelievable test of endurance and heartache—to see if gratitude could bring them the same kind of connectedness, purpose, and peace it had brought me.

Gratitude stories from the front lines

I am a nursing professional who spent over 13 years working at the bedside and transitioned into a position where I could shape the future of the next generation of nurses. My current role in the professional development department is at an academic medical center as the coordinator of a nurse residency program (NRP). The mission of the NRP is to help new-to-practice nurses, who recently graduated and are just starting their nursing career, transition from advanced beginners to competent professional nurses. This year-long program focuses on nursing professional development, leadership, quality and safety, nursing scholarship, and self-care skills. For the past five years, I have taught the self-care curriculum included in the program.

Nursing is a stressful profession with or without a pandemic. Nurses are faced with ethical dilemmas, heavy workloads, communication breakdowns, and a lack of education on how to manage stress. When I started teaching self-care in the NRP, I focused on general activities like yoga, exercise, and journaling. I then expanded to mindful breathing techniques, as a tool the new-to-practice nurses could use in moments of high stress. During the height of the pandemic, the techniques were well received, and some even taught other nurses on their units.

But breathing techniques alone could not combat the impact of COVID-19 on our new nurses. What I noticed was a new level of exhaustion. Nurses would join our seminars, and you could see the exhaustion on their faces. Their exhaustion motivated me to search for ideas to help cope with the increased stress. I found myself on the Greater Good website and came across the Gratitude Practices for Nurses Toolkit, which summarizes scientific findings on gratitude and offers research-based practices for cultivating it. I downloaded the toolkit and started looking at what practices I could bring into our program.

  • Gratitude Practice for Nurses

    offers research-based strategies to support your well-being and help build a culture of gratitude in your organization

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I knew these new nurses did not have the energy to share openly, that level of vulnerability slightly out of reach with their exhaustion. I decided that I would talk to them about what a gratitude practice is and how to cultivate a practice for themselves. Then I asked them to write a gratitude letter to someone who impacted their life or nursing career. At the time, I was skeptical that they would write anything and even more skeptical that they would share what they wrote with me. But they blew me away. The cynic in me was silenced.

As I read over the letters, I was overwhelmed by their words. I laughed, cried, and had this incredible feeling of peace and hope. The letters all had a common theme: gratitude, growth, and kindness. Here are some examples:

“Thank you for reaching out to ask me if I’m doing alright and helping when you can.” —Nurse Amy

Something as simple as just reaching out and checking in made such an impression on this new-to-practice nurse. My guess is the nurse they were speaking about did not even realize what they were doing was so impactful. But once the dust settled, it made a significant impact on how the new nurse felt in that moment: important and valuable. At the end of the day, don’t we all want to feel that!

Some of the letters I read were more personal and vulnerable. It surprised me that the nurses were willing to share with such openness.

“Thank you for reminding me that even amidst the chaos and trauma, that I was meant to be successful. Before you, I never really understood what it meant to say yes to things and how important self-love is in a field where your love has to be given to so many people in so many different ways. I get to sit with people when they hear good and bad news, I feel so special and privileged, and none of that would have been possible without you.” —Nurse Soniya

I remember when I started nursing, and I was not mentally well. It was challenging to juggle learning to be a nurse and recovery. Like this nurse, though, I was motivated by seeing how important and special I was to my patients. Nursing is physically, mentally, and emotionally draining. But nurses are privileged to get to share in this intimate patient relationship.

Our overall health is an integral part of that relationship. Often nurses are too busy caring for others and forget to care for themselves. The concept of self-love often gets viewed as selfish. I stress to the nurses I interact with that self-love and self-care are not selfish and are necessary to your career as a nurse. You can’t care for others with an empty cup. You must fill your cup first. Then it is easier to care for others.

“People do not understand just how challenging the nursing profession is unless they work in it. No one sees what we see or does what we do and then comes home and tries to leave it at the door like it didn’t happen. I am fortunate enough to have a fellow nurse whom I can call at the end of a crazy day and just vent. Sometimes it is nice to know that I am not alone in this. I can’t thank you enough for always being that person for me.” —Nurse Devon

The first time I meet with new nurses, I tell them they will hear, do, and say things they never imagined. Then they are expected to go home. It’s important for nurses to find someone who works in nursing, maybe someone from college, a family member who is a nurse, or someone from your unit. You will need them! As this nurse stated, no one truly understands what it means to be a nurse, except for another nurse.

This letter reminded me of my work family. My work family is vital to my success and ability to cope with the stress of the profession. They understand my day-to-day stress with such intimacy, and I know they will just listen and show me compassion. Sometimes you just need to vent and have the other person say, “Yeah, I understand how you feel.”

Reflections on gratitude

I have only done the reflective gratitude writing twice with my NRP groups. Still, after receiving multiple emails from the nurses thanking me for giving them time to reflect and show gratitude, I know I will continue. I did encourage the nurses to send the letters, because even when I read them, they made me feel awash with gratitude.

While I can only imagine how the practice affected these nurses’ interactions within their unit, I know that reading their letters influenced me as a nurse and as a leader in the nurse residency program. I’ve continued the gratitude letter reflection and added information about other gratitude practices they could try, such as a gratitude board on their unit.

I am also inspired to start a gratitude practice in my department, like a gratitude huddle at staff meetings. We are a small group of nurses working closely to ensure our nurses are adequately prepared at the bedside. Throughout the pandemic, we relied on each other when we learned new technologies, worried about our families, and questioned why we do what we do. We never stopped and appreciated what we were to each other during that time.

The pandemic shined a light on an issue that has always existed in health care: a culture that ignored burnout. Throughout the years, nurse researchers have written and spoken about the importance of nurse well-being and how the conflicts that nurses face put them at risk for burnout. But the pandemic led to a hyper-focus on the well-being of nurses and a renewed call to action.

Nurses, like all employees, deserve to work in an environment that values them as people. Leadership at my institution started programs throughout the pandemic to address nurse well-being and fully supported the practices started in the nurse residency program. Practicing gratitude is part of my contribution to addressing this problem, and it’s something nurses can do themselves, but it’s only a small part of the solution.

Sometimes I stop midday and wonder: How did I get here? I reflect on those who guided me on this journey—parents, friends, therapists, professors, peers, mentors, and my spouse—and I realize how fortunate I am. I once had a psychiatrist tell me that, statistically speaking, I should not have survived all my mental health issues. Yet here I am, and I know I did not get here on my own. For all those who aided me, I want to say thank you.

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