By: Linda Roszak Burton

If you knew expressing gratitude to a fellow nurse would improve their health and yours, would you do it more often?

Logic says you would, however research shows the existence of a gratitude gap in the United States — we consider ourselves to be grateful, yet a significant gap exists between feeling grateful and actually expressing it.

There are several reasons why, as a nation, we’re not very good at expressing gratitude. The simple fact that our brain has a built-in negativity bias, keeps us focused on what’s going wrong or could go wrong. In a clinical setting, this focus saves lives! Interpersonally, as part of a nursing team, this hardwiring can lead to a high degree of negativity, destroy trusting relationships, enable passive aggressive behaviors, and potentially, cause harm to patients.

One reason cited for not expressing gratitude is the extreme number of distractions at work and in your personal lives. How often do you find yourself leaving work and recalling someone you meant to say thank you to? Your intention to express gratitude was overshadowed by the number of distractions you encountered during your shift.

Another reason expressing gratitude is often absent in our daily interactions with family, peers, direct reports, and leaders is the mindset of expressing gratitude as a sign of weakness, soft-stuff, and leads to complacency.

The good news about overcoming this “gratitude gap” is the growing research on the important health benefits derived from developing your own gratitude practice. By applying various evidence-based techniques, you have the ability over-ride your negativity bias, increase your attention to what is working well, and contribute to your personal health and wellness.

“Gratitude is a vaccine, an antitoxin, and an antiseptic.
A vaccine against the invasion of a disgruntled attitude.
An antitoxin against the poison of fault-finding and grumbling.
A soothing antiseptic in the spirit of thanksgiving.”
—John Henry Jowett

Gratitude Research

Timing is everything! If you examine current research on the health benefits of gratitude you find significant alignment with the five domains in the Healthy Nurse Healthy Nation (HNHN) – Grand Challenge: physical activity, rest, nutrition, quality of life, and safety.

Gratitude, by definition, is an affirmation of goodness and a recognition of goodness outside of yourself. Much more than feeling thankful, it is a profound appreciation of what is good in your life, which in turn creates greater awareness and positivity.

According to research, by practicing gratitude, your overall health and wellness improves over time. Gratitude:

• Fosters higher levels of positive emotions;
• Supports greater life satisfaction, vitality, and optimism;
• Enables more hours of sleep and better quality of sleep;
• Fosters healthier eating habits and better self-care.

There is also growing research in the role gratitude plays in having more resilience when dealing with difficult and challenging life experiences. Psychologists define resilience as a commitment to find purpose in whatever’s happening, to believe in your ability to create a positive outcome, and to be better prepared for the inevitable set­backs that occur. Easier said than done, and yet practicing gratitude is proving to be essential in creating greater resilience and leading to such positive outcomes as:

• Greater mental and emotional well-being;
• Greater resilience to trauma;
• Lower rates of post-traumatic stress disorder (PTSD) and an increased sense of purpose;
• Lower levels of depression and stress.

Several studies focused on nurses highlight the positive impact of gratitude. One study showed gratitude to be a consistent predictor of less exhaustion, cynicism, and fewer absences due to illness. Another recent study looked at the positive effects patient gratitude had on several dimensions of nurse burnout. In particular, emotional exhaustion, personal accomplishment, and depersonalization.

So, with all the health and wellness benefits demonstrated by practicing gratitude, why the gap?

Cue the Neuroscience

Your brain views the workplace as a social system. When you feel unappreciated or treated unfairly the pain regions of your brain are activated. These feelings are as powerful as if you had a physical blow to your head. The effects are strong and long lasting. Compound this with daily stress and feelings of overwhelm, and you’re caught in a downward spiral of negativity and pessimism with long-term, harmful impact on your physical, emotional, and mental health.

You may have heard the term “neurons that fire together wire together.” That’s where neuroplasticity – the brain’s ability to form new neural connections aids in discovering the health benefits of gratitude. Thinking back to the brains built-in negativity bias, it’s easier to only notice the negative because those neural pathways are well traveled. The good news is, by shifting your brain’s focus through a sustained gratitude practice, you will begin to create new and strengthen existing neural connections. The stronger your gratitude circuitry becomes, the more hopeful you become, and the better equipped you are to cope, heal, and reenergize yourself.

The Role of Neurochemicals

Several good neurochemicals—dopamine, serotonin, and oxytocin—are released in your bloodstream when you write, reflect on, or express gratitude.

C₈H₁₁NO₂ Dopamine – when expressing gratitude, dopamine is released in your blood stream and it feels good! It triggers positive emotions, you feel more optimistic, and it fosters camaraderie.

C₁₀H₁₂N₂O Serotonin – when you reflect on or write down the positives in life and at work, your brain releases serotonin. Serotonin enhances your mood (think anti-depressant), your willpower, and motivation. And yes, serotonin has also been called both the happy molecule and the leadership chemical.

C₄₃H₆₆N₁₂O₁₂S₂ Oxytocin – being grateful to those in your life releases oxytocin, important in building safe connections with others. Oxytocin facilitates trusting, prosocial behaviors while inhibiting the stress hormone cortisol.

Back to the opening question: If you knew expressing gratitude to a fellow nurse would improve their health and yours, would you do it more often?

Studies show gratitude is reciprocal, in that when you (the giver) do something good for another person (the receiver) you actually experience the same sense of elevation (an uplifting feeling) and health benefits as they do. What’s more, the receiver appreciates the goodness they’ve experienced, and they’re motivated to do something good for someone else – the “pay it forward” impact.

The Practice of Gratitude

There are a variety of ways to personally practice gratitude, some are listed below. There is however, a “prescription” for achieving the greatest benefits from your practice.

1. It’s important to reflect on specific people, experiences, and behaviors that are meaningful in your life.
2. Whether writing or reflecting, describe specifically why you’re grateful for the person, experience, or behavior.
3. Finally, describe how you have benefited and specifically characterize the intentions, actions, and possible sacrifices made by the giver.

Using this level of specificity, consider the following recommendations for creating and sustaining an individual gratitude practice:

• Keep a gratitude journal, journal once a week or up to three times a week. Daily does not increase the benefits;
• List all the people in your life for whom you’re grateful for… then write or tell them using the prescription above;
• Write a letter of gratitude to someone, deliver it or call them, and read it to them;
• Write down three good things that went well in your day and describe why;
• Find time to simply reflect on a positive emotion you felt in the last 24 hours and consider why you’re grateful for this emotion.

Choose practice techniques that feel most comfortable to you and not just something to put on a to-do list. With the changes in healthcare and the demands on you as a nurse, your self-care and overall health is of utmost importance.

Will you take advantage of the great alignment between the five domains of HNHN and the research in gratitude?

Perhaps start with this one question – What one action can you take today to tap into your own gratitude circuitry?

Linda Roszak Burton BS, BBC, ACC, is the Founder of DRW Coaching and a Certified Executive Coach. She is the author of Gratitude Heals ~ A Journal for Inspiration and Guidance.

Are you ready to get your gratitude on? Join in our discussion here.

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