Patricia O’Malley I had a nurse, a young nurse, come to me in debriefings that we hold with our staff and the comment was to me, “When I signed on to become a nurse, I never signed up for this.” And no, no, none of us did. None of us did. This is a worldwide pandemic. Everyone is exposed to this same amount of distress, this compassion fatigue, this physical fatigue, the mental fatigue, and the caregivers in hospitals were particularly hard hit because they’re living a vigilant life all the time—it’s trying to avoid disease and give the best care I can give.
But then when I leave, I have to take care of my family and help them avoid disease. So it’s like a two edged sword for nurses, physicians, all of them. It was fighting COVID on two fronts, at work and at home. And, um: worn out. I think the two words I’ve heard constantly. I am worn out. So, the question that follows that then is: what can I do about that? What are we going to do about this? You know, is there something we can do? And yes, there’s things we can do to address this, to remedy this, and to put people back on a better path than the one that they’re walking now.
Emiliana Simon-Thomas Many of us have felt burnt out over the course of this pandemic, and that’s more than just feeling exhausted. It also makes us feel disconnected, ineffective, and even cynical. And for frontline workers, it’s all the more common.
I’m Emiliana Simon-Thomas, the science director at UC Berkeley’s Greater Good Science Center, and I’m filling in today for Dacher Keltner. Welcome to The Science of Happiness.
Our guest today is a nurse in Dayton, Ohio. Patricia O’Malley chairs the nursing research program for Miami Valley Hospital and Premier Health. She joins us after she and her team tried out a new resource that we produced to boost well-being. Later in the show, we’ll look at research suggesting how gratitude can help people with high-stress jobs.
Patricia, thanks so much for joining us on The Science of Happiness.
Patricia O’Malley Thank you for having me.
Emiliana Simon-Thomas So, I just want to say that I am in awe of people in the healthcare profession right now, especially because of all the heavy duty work that has been required over the past few years. Even before COVID, though, burnout was really high amongst health care providers. Can you give us a sense of what your work life is like, especially in terms of the stress and what it’s like right now?
Patricia O’Malley The way that the nurse-patient relationship is structured across our discipline kind of sets us up for this moral distress or burnout, this fatigue, because the relationship that nurses have with their patients is usually a very intimate relationship. It’s a relationship full of trust and it’s built on the nursing value—our goal, our core ethic if you want to say it—of relieving suffering, reducing suffering, and to do good with our patients. To help in their healing and to care for them in their illness. This was a difficult thing to do before because of the stress on the healthcare system. So, our health care system was stretched even before COVID came on board. But COVID has stretched nursing and all of the healthcare disciplines incredibly.
Emiliana Simon-Thomas Yeah, I hear you. That’s one of the reasons we partnered with the American Nurses Foundation to create an online resource that we call the “Gratitude Practice for Nurses Toolkit.” And it was designed to offer exercises and activities that nurses could use to create a culture of gratitude in their organizations. So when you came across the toolkit, what piqued your interest?
Patricia O’Malley I think every health care organization in the country is looking for science and pathways and ways to help staff overcome burnout, to build resilience, to keep people in practice and to find meaning in their practice and joy despite the stress of this pandemic. I took a look at your toolkit, the different things from your website, and the attraction was incredible because it’s from a platform of positivity and going forward rather than a pathway of survival. It’s a choice of activities and actions that have an evidence base to improve an individual’s mental, spiritual, physical health that comes not from a survival framework, but from a living-going-forward framework.
Things can be better. I’m not here just to survive COVID. I can grow through this as well and find some healing in this process: dealing with difficult emotions, how to cultivate positive emotions, and then how to change the workplace networks on their social connections so that there’s support, rather than everyone working alone with these really difficult emotions. I have tools that I can move forward despite this pandemic and I can find sources of happiness even in as difficult a time this is.
Emiliana Simon-Thomas Patricia, what do you tell your team if you’re in a meeting and you’re ready to share all of the motivation and inspiration that you’ve embodied around the potential for gratitude to strengthen a person’s resilience. What do you say to your team to sell this notion that gratitude is going to work for them too?
Patricia O’Malley We’re encouraging staff to pick out what might work on your unit, so some of our nursing units are doing gratitude huddles. Some nursing units are doing gratitude boards. Some of our managers are integrating this into staff meetings: “What are we grateful for today?” So, something to just get this kind of slowly integrated into our culture.
Emiliana Simon-Thomas I would love for you to tell me a story about the gratitude huddle, Patricia. What is that like and what kind of feedback do you get about it?
Patricia O’Malley The gratitude huddle is informal. It’s called, especially, let’s say that a unit is in a particularly very busy mode for a particular day: they may not be able to do this. But, on other days that there looks like there’s a gap or getting close to a break time, maybe for lunch or dinner, it’s just a way to acknowledge and to kind of give that couple of minute break from the workload and go back to what we are doing and are providing care.
Emiliana Simon-Thomas I’m imagining a group of nurses together in a unit and it’s, as you described, a moment where there is a little bit of spaciousness and they decide to do a gratitude huddle. And I wonder if you could tell me what you think changes from the moment before they get together and share these sentiments about what it is they can bring to mind that makes them feel grateful to the maybe, I don’t know, four or five minutes after the huddle has ended. What’s different about that group of people at that point?
Patricia O’Malley Well, I think you foster relationships with the people that you were in huddle with. I know a little more about the other person in the huddle with me and I know what they’re grateful for. So, I’ve probably strengthened the relationship between the coworkers. And then the other thing is, I’ve probably offset stress for that nurse. Let’s say: I’m rushed to get to work, I have this assignment, I have all these sick patients or whatever. I had a respite. I had a break, you know this four minute or five minute break. This offset attenuates these negative emotions, these stress emotions. I think it breaks that stress wall that’s been building all day long or all morning long or whatever the time period is.
Emiliana Simon-Thomas Absolutely, and it’s a great illustration of how scientists break down what happens when a person feels grateful. It sort of shifts our attention away from ruminative, self-focused thoughts, right? It’s shifting our scope of attention, that little spotlight that brings to awareness a fraction of the information that could be in our mind at any given time. It shifts it towards things that are good and then the connection piece, that social bond piece, because gratitude is so often about acknowledging the role that others play in the goodness in our life. So when we connect those two kinds of information, there’s a stronger link between our ideas in thinking about other people and goodness in our own lives.
Patricia O’Malley We sometimes start our staff meetings that we have: “Tell us what the three things you’re grateful for today.” Each person shares that and it is a powerful, powerful exercise. It reframes the whole meeting.
Emiliana Simon-Thomas Sometimes, gratitude can be perceived as an overpromise. In other words, maybe being tone-deaf to the sorts of structural issues that healthcare providers in general have had to deal with over the course of the pandemic, and that it’s in some ways unfair to dump upon anyone an additional thing they need to do in the course of their overburdened days. When I get that kind of feedback, I absolutely concur to the extent that I do not perceive gratitude as a panacea that will fix all difficulties and problems in the world. The point is that gratitude is a way to shift your own mental state towards one that actually enables you to be more effective in advocating for what you know actually can improve your own happiness.
Patricia O’Malley Yes, very much so. And I’m not a prisoner of my circumstance. We need to acknowledge all this pain and we need to bring up all this pain that nursing and our patients and our families and our staff have gone through in the last 20 months or 22 months of COVID. And yes, that is part of this healing that we need to go forward.
But gratitude keeps us from staying there—focusing on that all the time—because unrelenting, constant rumination on all of the pain that’s happened, that will lead to more pain. You’re never going to get past it. You’ll never be free of it.
Emiliana Simon-Thomas Yes, thank you, Patricia. I wonder if you have any thoughts about what it is that makes gratitude so sticky in the sense that if I try it and it feels good, I then want to tell other people about it. What do you think that’s coming from?
Patricia O’Malley Our culture is so focused, I think, on a lot of negative. “What’s wrong? What can’t be done? What didn’t happen? This failed” or whatever. This is a 360 flip because this is saying: my happiness, my wellness, my health does not come from without—it comes from within. And, there are many things to be grateful for and this gratitude is a more powerful position to live in and restores more happiness than promoting pain.
To be released from that constant focus on what’s wrong is just the greatest release you can have, I think. It’s a different vision, it’s a different practice, it’s a different way of living that has incredible physiological, psychological, spiritual benefits going forward.
Emiliana Simon-Thomas Patricia, thank you for joining us as a guest on the Science of Happiness.
Patricia O’Malley Thank you for having me.
Emiliana Simon-Thomas The exercises we’ve included in the Gratitude Practice for Nurses Toolkit have been shown to have lasting effects for all types of people: teenagers, educators, romantic partners and most everyone in between. But, how do these tools especially help people dealing with high-stress jobs, like nurses?
Kathryn Adair We are very focused on: how can we prevent burnout, how can we reduce burnout both at the individual level and implementing changes at the institutional level?
Emiliana Simon-Thomas More on the science, up next.
Welcome back to the Science of Happiness. I’m Emiliana Simon-Thomas, the science director at the Greater Good Science Center here at UC Berkeley and I’m filling in for Dacher Keltner.
Today, we’ve been exploring how the practice of gratitude can support people with really demanding jobs. Burnout rates in healthcare have always been high, and COVID-19 has only intensified things.
Kathryn Adair How can we prevent burnout? How can we reduce burnout, both at the individual level and implementing changes at the institutional level? What does the evidence have to say? Because, this is becoming an even greater problem and hopefully more and more people are going to be paying attention to it.
Emiliana Simon-Thomas Kathryn Adair is a researcher at the Duke Center for Health Care Safety and Quality. She and her colleagues compared the effects of different gratitude practices on the wellbeing of healthcare providers.
Kathryn Adair We are very interested to see which tools are making a statistically significant impact on people.
Emiliana Simon-Thomas First, they all filled out a survey measuring aspects of their mental health.
Kathryn Adair So emotional exhaustion, happiness, depression symptoms, and thriving and recovery—these two aspects of resilience.
Emiliana Simon-Thomas Then, they zeroed in on three exercises for enhancing gratitude: one called “Looking Forward”...
Kathryn Adair We’d text them a link. They go in and they enter something that they’re looking forward to at various times in the future.
Emiliana Simon-Thomas Then, the “Three Good Things” practice…
Kathryn Adair We sent them a text message in the evening every night for two weeks where they clicked on a link and then simply entered three good things that happened that day.
Emiliana Simon-Thomas And finally, writing someone a “Gratitude Letter”.
Kathryn Adair They wrote their five to seven minute long gratitude letter, and then we checked in with them a week later.
Emiliana Simon-Thomas People chose one of these exercises to try, and then they filled out the same mental health survey afterwards.
Kathryn Adair We found significant improvements in depression symptoms, gains in optimism, and improvements in their thriving and recovery aspects of resilience.
Emiliana Simon-Thomas People’s moods improved. They felt better about the future, and a little more okay during difficult moments. And, they were better at bouncing back after feeling down. Of all the gratitude exercises, the “Three Good Things” practice had especially good results.
Kathryn Adair We saw improvements in emotional exhaustion, happiness, depression symptoms, as well as recovery. So, we’re pretty excited that even a tool that takes only two to five minutes a night for a couple of weeks seems to have an impact potentially 12 months later.
In healthcare, we often see this badge of honor culture where people feel like in order to demonstrate their commitment, they have to work crazy long hours and sacrifice their personal life. Unfortunately, we know from the data, that tends to lead to burnout and burnout predicts patient safety errors. So, we need to shift this culture to one that supports wellbeing: to making it safe for our colleagues to go home to recharge, to take breaks, make sure there’s staffing, make sure there are the resources needed for folks to do the amazing work they’re capable of.
Emiliana Simon-Thomas You can check out the Gratitude Practice for Nurses Toolkit at gratitudefornurses.org. It includes a number of research-based activities to support nurses. And even if you’re not a nurse, it can help.
On our next episode of The Science of Happiness, we explore how reflecting on our best possible self benefits wellbeing.
Youngmi Mayer All my life, I only worked in restaurants. What happened in my early 20’s is I met my ex-husband and he became very successful as a chef. So basically, I really fell into the caretaker role without really thinking about it and all my actual dreams sort of had to take a backseat. So that’s how I was living my life until I would say around three years ago, which is when I started comedy. I started doing open mics and I just never stopped.
Emiliana Simon-Thomas I’m Emiliana Simon-Thomas and thanks for joining us on the Science of Happiness. How do you envision your best possible self–in the new year, and beyond? Share with us by emailing email@example.com
Our Senior Producer is Shuka Kalantari. Our Producer is Haley Gray. Our Associate Producer is Kristie Song. Sound design by Jennie Cataldo at BMP Audio. Our Executive Producer is Jane Park. Our Editor in Chief is Jason Marsh. The Science of Happiness is a co-production of UC Berkeley’s Greater Good Science Center and PRX.