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The Positive Effects of Expressed Gratitude

Maureen Hermann, DNP, RN

Faculty Focus

March 8, 2023

The Positive Effects of Expressed Gratitude

In today’s world, gratitude is essential. The benefits of gratitude in practice can lead to better stress management, greater optimism, increased self-esteem, increased resilience, and better work relationships (Hills, 2021). Gratitude is defined as “a positive emotional reaction to the receipt of a benefit that is perceived to have resulted from the good intentions of another” (Tsang, 2006, p. 139). The implementation and promotion of gratitude can improve patient outcomes, nurse retention, resilience, and job satisfaction, while promoting a healthy work environment (Conley et al., 2022). Receiving gratitude can be transformative for the nurse, and practicing giving gratitude has been shown to have positive long-term effects (Aparico et al., 2022). Faculty nurse educators have the opportunity to make a positive difference in not only their students but the community. The implementation of the practice of expressed gratitude can greatly benefit the healthcare organization by improving care for clients and ensuring mental and physical wellbeing of all (Cumella, 2022).

The need for appreciation exists

Among nursing students, fundamentals is often the first clinical experience or opportunity for students to demonstrate gratitude. This is the student’s first opportunity to work with a healthcare team and residents at a skilled nursing facility. Historically, nursing students are exposed to a tremendous amount of stress during their clinical practicum, and it is essential to understand that gratitude is one of the greatest predictors of stress levels, relationship formation, and satisfaction (Moon & Jung, 2019). It was brought to my attention that the healthcare team members at their first clinical site were overworked, tired, and did not have the desire to mentor students. As their nursing faculty, this situation has given me a tremendous opportunity to make a positive difference, not only for the students but for the clients and the healthcare team. Together, with the students, we decided we could make that positive difference by focusing on gratitude

Gratitude to decrease stress and burnout

Nearly 60% of healthcare providers have identified feelings of stress and burnout, and if a nurse resigns in the first year, it can cost the healthcare organization up to three times the nurse’s annual salary (Melnyk, 2019). Burnout symptoms can range from physical feelings of exhaustion and low energy to emotional feelings of low worth. When burnout exists, there is a high risk for not only nurse turnover but a fragmented culture that can lead to negative client outcomes (Cumella, 2022).  Gratitude has been correlated with the exhibition of increased personal and organizational appreciation, and an improved sense of self-worth, grateful moods, positive affirmations, and emotions (Camero & Carrico, 2022). As nursing faculty, we have a wonderful opportunity to make a positive impact and employ interventions regarding the concept of gratitude in practice. Faculty must engage students with the ability and understanding of the need to give gratitude, and receive appreciation. After all, there is no cost to be kind and express gratitude to those with whom you interact with little commitment—an opportunity to make a positive difference for many exists.


Journaling has been a very popular and relevant application of one’s ability to document gratitude.  Journaling can include letter writing, thank you notes, and personal reflections.  A thank you note is a way to show gratitude as a means to cultivate a culture of gratitude (Camero & Carrico, 2022). Journaling is a valuable resource that individuals can implement to support positive self-health and wellness, understanding, self-compassion, and self-awareness.  Reflective thinking, proposed by journaling, can help individuals express their thoughts, increase compassion, and increase confidence in critical thinking, and can be used as a tool to assist in situational self-analysis (Dimitroff, 2018).

Our plan of action!

Our first day on the unit, the students were not met with much engagement and the healthcare team was very quiet and slow to warm up to the students. Upon arrival, we were not greeted with many smiles, but the amount of hard work being completed by the staff was observed. We did our best to smile and create a positive environment for all. As future nursing professionals, the students were ready to make a positive difference. At this time, objectives were created and as a team, we were ready to make a positive difference. The objectives were as follows:

Students will be able to apply the concept of gratitude and formulate a plan to identify the need for gratitude in their practice and care.

Students will demonstrate an increase in understanding and application of the need for gratitude in socialization and interactions with the health care team.

Students will complete a weekly journal with notes of thankfulness for the healthcare mentors.

Each clinical day, the students included a thank you note to their healthcare team within their reflective journal. At the end of the clinical day, I would send the thank you notes to the skilled nursing facility’s manager. The manager, in turn, would share the notes with the student mentors. 

Below are examples shared:

I just wanted to say thank you to ________ for being such a great mentor and CNA! Being with you and watching/helping really does make me sure I am in the right spot. Thank you for allowing us to follow you around, ask lots of questions, and help when we can. I truly can’t express how grateful I am for you and people like you. The world needs more caring people, and you are doing AWESOME! 

I really want to thank ______ for talking with me during the clinical day and being extremely helpful—teaching us about showers and feeding the residents. She was so friendly and I was not afraid to ask her a question at all. She really wanted to help my clinical partner and I learn, and I was very thankful for that because she made my day on clinical.

_________ helped me understand the entire medical cart and gave me an accurate representation of what she does to deliver medications to the residents. She was extremely helpful and even quizzed me when she was bringing out medications. It was a great experience to understand her role in the nursing home and she walked us through her routine. She gave me real-time experience which I feel grateful for.

________, Thank you so much for letting us be with you today during our clinical. I really appreciate you taking the time to explain and show things to us. I really did learn a lot from you. It was such a cool experience for me to get to see wounds in-person. Thank you for letting us be involved, too. You are such a kind and caring person and I am so thankful to have met you! You made my day great! Thanks again for everything you did, we appreciate it so much!

________, Thank you for working with me during my clinical. You were a huge help in allowing me to practice what I am learning, and I loved to see the way you work with residents. You were always smiling and cheerful when greeting them in the morning, and I thought that was something special to note because I feel that is a small, yet important gesture that can really brighten someone’s day. Thank you.

Practicing implications and developing positive relationships

Upon our arrival for the next clinical, we were greeted with smiles and welcomes. Many staff shared their appreciation for the kind student thank you notes. The staff immediately came to get their assigned students and started mentoring them right away. The excitement for all was palpable, and everyone was energetic and happy. When leaving this day, the staff verbally expressed great gratitude for the students’ assistance in providing care to the clients. Every day after this was a wonderful day. Each week, when the students arrived at the unit, they greeted every individual and were met with smiles and a refreshing appreciation. At the end of the clinical rotation, the students were met with a celebration of their great work, and many were asked to consider working at the unit upon graduation. 

Gratitude beyond clinicals

As nurses, we are considered one of the most trusted occupations. Nurses should be positive and always give an effort to go the extra mile for lasting results. It is who we are, who we should be, and what we want to mentor in our future nursing professionals. Through this exercise of displaying gratitude, the students left having a strong understanding of the need to apply the concept of gratitude to their daily lives, and the importance of positive interactions with their healthcare team. We had the opportunity to make a positive difference for not only ourselves, but also for the mentors, the staff, and the clients who received our care. We must always remember that one’s ability to give and receive gratitude leads to positive feelings of satisfaction and accomplishment (Chen, 2022). Gratitude is free, requires minimal effort, and has great ability to make healthcare and our world a better place.

Dr. Maureen Hermann earned her BSN (1995), MSN (2011), and DNP (2016), with an emphasis in leadership from Saint Francis Medical Center College of Nursing in Peoria, IL.  Dr. Maureen Hermann currently works as an assistant professor in the Department of Nursing at Bradley University, Peoria, IL.  Her focus is teaching the undergraduate fundamentals and health assessment theory courses, as well as graduate courses including a variety of health promotion, healthcare policy, ethics, and DNP project courses.


Aparicio, M., Centeno, C., Robinson, C., & Arantzamendi, M. (2022). Palliative professionals’ experiences of receiving gratitude:  A transformative and protective resource, Qualitative Health Research, 32(7), 1126-1138.

Camero, I. & Carrico, C. (2022).  Addressing nursing personnel burnout in long-term care- Implementation of a Gratitude Journal, Holistic Nursing Practice, 36(3), e12-e17.

Chen, C., Liang, M., Chen, Z., & Wen, P. (2022). Gratitude expression to supervisors and subjective career success of civil servants:  Evidence from China, Public Personnel Management, 51(1), 48-70.

Conley, P, Ohnoutka, D. & Enriquez, M. (2022). Perception of gratitude among new nurse graduates:  A mixed-methods study, Nursing Management, July, 36-42.

Cumella, K. (2022).  Gratitude journals can improve nurses’ mental well-being, Nursing2022, 52(12), 58-62.

Dimitroff, L. (2018).  Journaling:  A valuable tool for registered nurses, American Nurse Today, 13(11), 27-28.

Hills, L. (2021).  Fostering a culture of gratitude in your medical practice:  Never underestimate the value of a simple thank you, Podiatry Management, 123-127.

Melnyk, B. (2019).  Making an evidence-based case for urgent action to address clinician burnout, American Journal of Accountable Care, 19(6), 12-14.

Moon, H. & Jung, M. (2020). The relationship between a disposition of gratitude, clinical stress, and clinical satisfaction in nursing students, Perspectives in Psychiatric Care, 56, 768-776.

Tsang, J. (2006). Gratitude and prosocial behavior:  An experimental test of gratitude.  Cognition and Emotion, 20(1), 138-148.

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