There is a ritual in medical schools to hold a memorial service to honor those who have donated their bodies or body parts to advance medical education and research. In spite of advances in instructional technologies, the dissection of human cadavers remains a staple teaching strategy in gross anatomy in medical schools. There is no doubt, dissecting cadavers teaches more than just muscle insertions and blood vessels. It invites the future physician to contemplate on our collective humanity, to acknowledge the inescapable reality of disease and death, and to ponder upon the virtue of gratitude.

It’s proper and good to eulogize the people who donated their bodies to medical education. To give thanks to those who continue to give, post-mortem, is a moral obligation. Organ donors, both live and cadaver, evoke similar heartfelt thanksgiving. A donated organ can save a life, but a donated body paves the path to save many more. The gift of the dead, both physical and spiritual, will continue to manifest in the lives restored under the care of a learned and skillful physician.

Nurses don’t dissect cadavers to learn their craft. And the dead do not endure. Before the advent of high-fidelity simulation, the education of nurses required mostly the willing or unwitting participation of live patients and live patients remain a cornerstone of our education. To excel at what we do as nurse clinicians, we poke, prod, pinch, and prick patients as nursing students. Our patients brave the uneasy idea that novices are practicing on them. Now, doesn’t that deserve our utmost respect and gratitude?

Thank you patients!

A predominant theme during celebratory events such as pinning, white coat ceremony, and commencement exercises is giving thanks. Rightfully, the role of the family, faculty, friends, and financial aid (the four “Fs” of academic success) is acknowledged.

Conspicuously missing in the exaltation of gratitude giving is the recognition of patients’ tacit role in the education of nurses. I don’t think this oversight implies ignorance; it is simply forgetfulness or lack of awareness. Here is a hint: for the last 16 years, nurses have been rated highest in honesty and ethical standards among 22 professions, according to Gallup polls. To be truly honest means to be authentic. It demands faithfulness to our implicit social contract with the public. To be ethical (that is, to do what is right) we must be grateful to those who trust us—in sickness and in health.

Being grateful is great for you and your patients

Inexperienced nurses and nursing students are inexorably polite and grateful. Whether they are aware of this or not, they are doing something great for themselves and their patients. Studies indicate that gratitude and compassion have been tied to better academic performance, a greater willingness to exercise and eat healthy, lower levels of consumerism, impulsivity, and tobacco and alcohol use. Research also shows that when people feel grateful, they spend more time helping anyone who asks for assistance. From a systems perspective, one can surmise that grateful and gratified healthcare workers are better at teamwork and consequently produce better patient outcomes. Studies have shown that people tend to gravitate towards grateful and justifiably confident people. In other words, we are more likely to cooperate with grateful colleagues. When added with compassion, gratitude makes us less selfish and helps us build supportive relationships with colleagues. When people feel grateful, they will spend more time helping anyone who asks for assistance. In healthcare, the benefits of this are incalculable. The generosity of time and expertise that some healthcare workers perform, outside their official job descriptions and patient assignments, are the markings of a grateful provider.

Gratitude, when coupled with authentic sense of pride, directly increases self-control and delays gratification. This knowledge can be harnessed to enhance collegiality and promote civility at work. One of the ways to disarm perpetrators of incivility is a warm “thank you” when deserved. Hard as it may seem, even uncivil people do worthy deeds. A study reported the ameliorating effect of gratitude expression on threatened power holders’ (for example, the bully nurse manager) tendency to denigrate subordinates is mediated by increased perceptions of social worth when shown gratitude.

Efforts to counter bullying and incivility should include training staff to cultivate gratitude and dispelling hubris. Unfortunately, value education is not considered a priority topic in nurse’s education and hospital staff orientations. For this reason, the nurse should make a conscious effort to practice gratitude. A study showed that people who kept a short weekly list of the things they were grateful for enjoyed significantly greater life satisfaction than those who listed hassles or neutral events. Wouldn’t it be refreshing if at the start of every patient care handoff nurses would recount grateful events of the shift first? It’s simple common sense: Choosing to focus on good things makes us feel better than focusing on bad things.

Much obliged

Expressing gratitude can bring out the best in those around us, including our patients, based on the idea that genuinely happy nurses would sincerely give thanks for past and present patient care experiences such as about the time a patient unflinchingly allowed the nurse to give their first injection. If we mindfully acknowledge gratitude towards our patients, it’s likely that we will show our appreciation and loyalty by providing them better care. The same goes to the people we work with; we will be kinder to one another. Gratitude takes nothing from us. It gives away itself. The next time we skillfully execute a treatment, perform an assessment maneuver, insert a needle or a catheter, comfort the bereaved, or confidently hold the hand of a dying patient, think of all the patients who came before them and whisper “thank you for your trust and for teaching.”

Fidelindo Lim is a clinical assistant professor at the New York University Rory Meyers College of Nursing.

Selected references

Cho Y, Fast NJ. Power, defensive denigration, and the assuaging effect of gratitude expression. J Exp Soc Psychol. 2012;48(3):778-782.

Dickens L, DeSteno D. The grateful are patient: Heightened daily gratitude is associated with attenuated temporal discounting. Emotion. 2016. http://dx.doi.org/10.1037/emo0000176.

Emmons RA, McCullough MA. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84 (2):377–389.

Gallup News. Nurses keep healthy lead as most honest, ethical profession. 2017. http://news.gallup.com/poll/224639/nurses-keep-healthy-lead-honest-ethical-profession.aspx?g_source=CATEGORY_SOCIAL_POLICY_ISSUES&g_medium=topic&g_campaign=tiles