Gratitude: A Birthday Cake With No Fat And No Calories

True Story: The young Mexican-American man with Type 1 Diabetes patted the pistol on his belt and made it clear that we’d better give him what we wanted. The staff didn’t give him what he wanted, but rather politely asked him to leave immediately, and advised him that he was not welcome in this clinic again. Ever. He insisted on “discussing” the matter, but left when calling the police was mentioned.

My front office staff handled this situation so efficiently that I didn’t even find out about it until two days later. I was flabbergasted. Each member of the team figured someone else had told me, so I didn’t hear about it until someone mentioned casually that they had been “really scared when that happened.”

At that point they shared the full story with me in excruciating detail, of course, and I told each and every of them over and over how much I appreciated their calm, efficiency, efficacy, bravery and professionalism. I thanked them at least ten times each, and felt vaguely ashamed that I had managed to miss it so completely.

I want to focus on the gratitude in the above situation, and how it positively affected me, my team and morale at our clinic:

Raise your FLAG

Gratitude creates personal Fortitude, relational Latitude, improved Attitude and increased Gratitude.


Gratitude gives you personal fortitude. It increases internal strength, and allows you to deal with more crappy stuff coming your way. When you are aware of how many good things you have in your life and work, you will put less emphasis on the bad stuff, and think about the bad stuff less. In the above situation, the gratitude I expressed helped confirm the trust and faith I had in my staff, and I felt more supported as a result.


Expressing gratitude creates relational latitude. It strengthens your relationships with people you appreciate and makes it easier for people to approach you for help in the future, and vice versa. This is also known as “greasing the social wheels.” Does this feel fake? It shouldn’t. Only offer gratitude out loud when you sincerely feel it. People know when you’re lying about this kind of thing, so don’t bother. This works just as well on yourself as it does on others, too. In expressing gratitude for the above, my team better realized how much I value their contributions and felt more comfortable asking me for help.


Gratitude improves attitude. Your own happiness increases, as does that of those around you, and overall morale. It lightens the nasty gray-lensed glasses of burnout, depression and anxiety. When you sincerely feel gratitude to yourself and others, you are shining a spotlight on the positive happenings around you, which leaves less room for bad attitude.


Gratitude begets more gratitude. When you appreciate someone out loud, you create more gratitude for yourself and for them. You don’t even have to like the person to do this, and in fact it is even more powerful if you don’t, because it is unexpected. Don’t bother saying “I like you” with words or actions, because that would be insincere. Instead, just focus on verbally appreciating their action that made your life easier.

Raise Your FLAG To Others

“But… don’t they have to do something big for me to express gratitude?” No! Here are some common examples from my own practice: the MA got a piece of timely information that meant I was able to make a quick decision, the receptionist calmed down an angry patient, the referral clerk got an ophtho appointment within five minutes for a patient I suspected had ophthalmic Zoster, the maintenance worker fixed the water fountain, the practice manager went to bat for me with the administration on a clinical issue, and a fellow NP answered a burning question that I needed to know RIGHT THAT MINUTE.

All of those examples are people “just doing their job.” They might be going a little above and beyond, but not so much that you would notice. However, they made my life easier, so I shared my appreciation with them, and everyone benefited.

Raise Your FLAG To Yourself

We NPs tend to think poorly of ourselves, especially when we are feeling stressed and burned out. It is hard for us to change this, as it comes with the territory of a high-stress high-responsibility job, and is also a personality characteristic shared with other helping professionals. We can be conscious of it and work to counteract it though. For example:

Recognize yourself when you do something nice for your body, mind or soul. Appreciate yourself when you practice good self-care or successfully complete something small… even something tiny. Congratulate yourself for remembering a patient’s name, for taking a walk outside during lunch, for remembering where you put your pen, for saying “no” to an extra task, for asking for help, for remembering something important just before the patient walks out of the room.

So what’s the moral of the story?

Practice random acts of gratitude, and your whole clinic gets the emotional equivalent of a birthday cake with no fat and no calories. Enjoy!