Gratitude, Kindness, and Joy: The Light Out of the Pandemic
APIC encourages healing in a meaningful profession
“At this point you might be asking yourself, is this really even possible in infection prevention?” said Heather Gilmartin, PhD, NP, CIC, a former IP who now is a research scientist for the VA health system. “The organizational and societal challenges can seem overwhelming. Every day, you wake up to something new in the paper and think, ‘How do we start?’ But the answer is ‘yes,’ there is joy to be found in infection prevention.”
Gilmartin spoke at a recent webinar held by the Association for Professionals in Infection Control and Epidemiology (APIC). She also coauthored a recently published paper with veteran healthcare epidemiologist Sanjay Saint, MD, that addresses the elusive nature of joy and the intentionality necessary to manifest it.
“It is logical to infer that joy is readily available but fleeting, while happiness is harder to attain but more enduring,” they write in a commentary piece.1 “Why are joy and happiness so elusive? Multiple authors have tried to answer this question. [One of them concludes] that ‘joy isn’t something we just find. It’s something we can make, for ourselves and for those around us.’”2
They emphasize simple practices such as “framing, gratitude, and kindness to remedy the effects of burnout and help us find more joy in our daily work.”
Framing in this situation is more accurately “re-framing,” putting a problem in a different light or context or finding another path to approach it from a less negative perspective. The old philosophical adage “the obstacle is the opportunity” emphasizes that one may feel positive about achieving a task that might be too daunting if it is perceived negatively.
“Be aware that humans tend to focus and frame experiences with a negative bias due to the evolutionary, survival advantage,” Gilmartin and Saint noted. “Evolutionarily speaking, the person with a negativity bias was the one who tended to survive.”
Regarding gratitude, they noted these moments can be kept in a personal journal or extended to a team with gratitude breaks periodically as a tonic against despair.
The simple act of kindness can be challenging in times rife with anger and division, but “studies have shown that when people are kind, they have lower levels of stress hormones and feel less depressed, less lonely, and happier,” the authors emphasized.
Hug of War
Crediting the Institute for Healthcare Improvement (IHI) for pioneering much of joy-work in medicine, Gilmartin said she originally was met with some skepticism from clinical colleagues.3 “They were like, are you kidding me?” she said in the APIC webinar. “‘This is squishy stuff. What do you want us to do, hug it out?’ And I was [thinking], yeah, hugging it out. That would be awesome. [Writer] Shel Silverstein used to talk about a ‘hug’ of war.”
Certainly, there is a lot of cynicism afoot in these hard-bitten times, but why should joy be such a far-fetched idea in healthcare?
“In healthcare, caring and healing are naturally joyful activities, in addition to being intellectually, physically, and emotionally demanding,” Gilmartin said. “Most of us have chosen healthcare because it brings us meaning, right? We could go work in a cubicle; we could do numbers. We don’t have to interact with humans, but we’ve chosen to.”
Such an old-school, timely message was welcomed by Pat Jackson, RN, MA, CIC, FAPIC, president of APIC.
“I think it’s a subject that we don’t really talk about a lot, because we think, ‘Oh, we just have to buck it up and we have to just keep going,’” she says. “But maybe this is the time and place to talk about what you can do in your job to bring more joy. I think we tend to think of it as this ‘frou-frou’ stuff — it’s all emotional — but there’s some really good science behind it.”
There’s no question of need. IPs were not spared the brutal psychological toll of the pandemic response.
As reported previously, an APIC survey in 2021 found IPs reporting widespread mental health concerns and symptoms. (See Hospital Infection Control & Prevention, December 2021.)
[We] found rates of depression of 21%, anxiety at 29%, and burnout at 65%,” Jackson says. “Three-fourths of the respondents said they had a definite worsening in mental health since the pandemic.”
A pandemic is not a singular event like a natural disaster or terrorist attack. It uncoils over time, affecting different populations at different times, Sarah Smathers, MPH, CIC, FAPIC, said at the APIC webinar.
“One thing that we are just starting to talk a little bit more about is that this was actually a collective trauma,” said Smathers, MPH, CIC, FAPIC, an IP at the Children’s Hospital of Philadelphia. “It’s a good time for us to think about how, if we’re ready to, we can prepare to help our teams do the really important work of healing.”
A Systems Problem
Although much of this healing is individual, there should be no confusion that burnout in its various expressions is evidence of a systems problem.
“Burnout is not caused by broken people,” Gilmartin emphasized. “We’re not weak. It is not that we just can’t hack it. It’s caused by broken systems. Yes, there are things that individuals and teams can do to address their own burnout, but we need leaders across the industry to take on the bigger challenges.”
Citing a few system changes that reduce burnout and open the locked gates to joy in work, Gilmartin said a common theme is that healthcare workers crave some level of autonomy and more control over their work-life balance.
“Maybe micromanaging isn’t the best leadership approach,” she said. “Can you allow your staff more flexibility about when and where they work? They were able to work from home for periods during the pandemic. Is that something that they can continue if they want to increase the stability of their staff and family schedules?”
Give healthcare workers opportunities to identify and solve workplace problems, while maintaining adequate staffing and reasonable workloads, she urged.
“Burnout is not unique to healthcare, but it’s really concerning for the people who lead our world, because healthcare is a giving place and if we have nothing left to give, that’s a problem,” Gilmartin said.
The IHI and other researchers have found that expenditures to address these harms improve staff retention and reduce adverse patient outcomes, including healthcare-associated infections (HAIs). Investments in prevention circle back to the bottom line, but the onus is on IPs to underscore this connection.
“The prevention paradox is that people never know about all the things that we prevented,” she said.
What Brings Joy?
As part of the APIC webinar, IPs were asked via a Twitter poll how often they experience joy in their work.
Some of the individual responses shared include this comment from an IP: “Joy is most abundant for me when I’m making healthcare safer on the front line.”
This speaks to joy through meaning, a return to the values that drew many to the profession in the first place.
“We’re still trying to keep our patients safe — we don’t want our employees to get sick,” Smathers said. “Sometimes we do start to feel a bit burned out because there are obstacles, and it feels like an uphill battle.”
Another IP answering the poll gave an example, saying “mindless paperwork” is a killjoy, but opportunities to use the full skill set of the profession — knowledge, problem-solving, and communication — make the job quite enjoyable.
Barriers and daily irritants can be addressed proactively through team meetings and emails in a process Glenmartin calls “pebbles in the shoes.”
Here we pause to caution against airing petty grievances — particularly if they involve patients — on social media. A hospital in Georgia fired four labor and delivery nurses after they posted a TikTok video filmed at work that mocked patients they found annoying. (See Hospital Risk Management, February 2023.)
The exercise Glenmartin describes involves having colleagues write down or speak aloud these little irksome things that cloud their job experience.
“Make a list of these ‘pebbles’ in the meeting, prioritize them, and brainstorm,” she said. “Then organize a little plan-do-check cycle to address each pebble.”
Another IP answering the poll about joy said: “It is a struggle, but on the days I find joy in my work, I feel better. It is like a gratitude journal every day. You need to find the joy in something.”
Gratitude is a mainstay in all manner of mental health approaches and wisdom teachings. It can range from the appreciation for a simple gesture to a very deep, almost spiritual expression of thanks.
“It requires us to see how we’ve been supported and appreciated by others,” Gilmartin said. “Hundreds — and I mean hundreds — of studies have documented the social, physical, and psychological benefits of gratitude.”
It comes more naturally to some than others, but gratitude is a skill that can be developed, a muscle that can be strengthened.
“There is a lot of unspoken gratitude in healthcare that many feel, but we don’t express it out loud,” she said.
“Give staff an opportunity to verbalize gratitude. You can end a daily huddle or a meeting with a moment for everyone to say something they felt grateful for. You can ask, ‘Does anyone have any gratitude they want to share?’ And then you can give an example yourself.”
A corollary practice is the “three good things” method of writing down positive incidents or feelings daily for a week, Gilmartin said.
“The science behind this is: After seven days of identifying three good things that happened every day, you actually see a positive increase in your outlook in life,” she said.4
Connection
In the IP Twitter poll discussed at the webinar, another IP said, “I get a lot of joy from meeting and interacting with other IPs. The connections and friendships I’ve made will last a lifetime.”
Indeed, make an effort to positively connect with colleagues, although this does not mean your “best friend” has to be a coworker, Gilmartin says, anticipating the pushback she often gets on this recommendation.
“We know that developing respect for the work of others and creating positive connections with our colleagues creates joy at work,” she said. “We also know that high-quality work relationships are energizing. They increase the team’s ability to cope with stress, and they are a source of well-being.”
This connectivity can be particularly challenging to the single IP in a small facility, so the first recommendation is to “find your people,” Smathers said.
“While you may be one IP, there are people whom you probably work with routinely who can be important in helping your influence, sharing some of the accountability for some of the work that needs to get done,” she said. “So, you can kind of form your own team. They may not be IPs, but they really understand and can promote your work.”
Gilmartin added that she started as a singleton IP in rural Colorado and drove two hours to the closest APIC chapter meeting. Clinical lab colleagues were particularly helpful in showing her culture results that could indicate HAIs. Such connections will increase competency, knowledge, and, yes, joy.
“But you have to create that,” she said. “You have to do the legwork. You can’t be behind your desk the whole time.”
REFERENCES
- Gilmartin HM, Saint S. Commentary: Finding joy in medicine: A remedy for challenging times. NEJM Catalyst. Published Sept. 1, 2022. https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0215
- Lee IF. Joyful: The Surprising Power of Ordinary Things to Create Extraordinary Happiness. Little, Brown; 2018.
- Perlo J, Balik B, Swensen S, et al. IHI Framework for Improving Joy in Work. IHI White Paper. Institute for Healthcare Improvement; 2017.
- Greater Good Science Center. Three good things: A way to tune into the positive events in your life. https://ggia.berkeley.edu/practice/three-good-things
With approximately 80% of counties in the United States reporting “low” COVID-19 transmission levels as this report was filed, the pandemic has slowed to a still point. Infection preventionists reflect on the damage done and the work that remains.
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