Chief Happiness Officer, Sarah Ratekin

[00:00] Michelle: I was completely captivated by my guest this week, Dr. Sarah Ratekin. Sarah is the Owner and Chief Happiness Officer of Happines is Courage, LLC. I am all about the happy, and if there's one thing nurses need right now, it's more happiness. With a background in organizational ethics and a doctorate in business administration, Sarah helps or clients, which include healthcare institutions, improve the employee experience and, spoiler alert, it doesn't involve pizza parties. She explained, the formula of happiness at work is determined by only two factors, solid relationships with the people we work with and that the work we do is meaningful. I can't think of a healthcare professional who does not have those two factors on their radar. Sarah has been accused of being a pollyanna and vehemently rejects that label. Her approach to gratitude and happiness at work comes from both academic research and personal experience. Sarah's passion for transforming workplace cultures, as well as her optimistic outlook, has me hopeful for the future of nursing. In the five-minute snippet, watch out, Wilbur, Sarah's coming for you. Well, good morning, Sarah. Welcome to the podcast.

[01:42] Sarah: It is such a pleasure to be here, Michelle, thanks for the time today.

[01:47] Michelle: You're welcome. I'm really glad you joined us because you have so much to say on happiness. You're sort of a happiness expert, and I'm all about the happy, let me tell you, and the nursing profession in general, and a lot of us personally, we really need to find our happy again. So thank you so much for joining us. And I know you're going to bring a lot of value to my audience. So, yeah, let's get started. So I just want to know a little bit about you. I saw that in your history you are a veteran of the Navy, but give us a little backstory.

[02:25] Sarah: Sure. I did start my professional career as an aviation electronics technician in the Navy, which was actually not my first choice. I actually wanted to be either a journeyman like HR person or I wanted to work in healthcare. But they said, oh, your Astab scores are off the chain. We need you in this industry. So I jumped into that because I didn't know any better. I was 17 at the time.

[02:54] Michelle: Wow.

[02:54] Sarah: And my military exposure is not only from my own service, but then I married a nice young marine. So we became a house divided and we had a passle of children after that. Fast forward to today. My eldest is actually in the Army. So we love her dearly. We question her life choices. No, I'm mostly kidding. But it's interesting because she's actually a combat medic. She and her husband both are combat medics in the army. And so I want to make it really clear to your listeners, I personally am not a clinician. Other than putting bandaids and Neosporin on my own kids, I really don't perform clinical care. Right. But my daughter and her husband are medics. My dad's a behavioral psychologist. My mom's an RN. My dad's girlfriend's an RN. My brother is a hospice nurse of 20-plus years, starting with the military corpsman as well. I mean, I'm just surrounded by people in the industry, and so I'm really passionate about happiness generally. But as I've had the opportunity to both professionally and personally talk about the landscape of the industry, it freaks me out a little bit, quite frankly, because this is one of those spaces that we, as you all know, we cannot effectively outsource health care, and so we need to figure out a healthier path forward, pun intended.

[04:22] Michelle: Yes, I absolutely agree with that. And you come with all the experience of those around you, and so you totally get it and understand it. Do you think that your time in the Navy prepared you for what you're doing today at all?

[04:40] Sarah: Indirectly, or maybe directly, but inversely. So my passion really is right, that space where people love what they do, they're energized by their work, whether it's paid or volunteer work. And I will be honest as a woman in a field that had been historically male only because when I joined, women were women, and they still are. But women were very much a minority in the military, very much unwelcome. And especially in those more highly technical, specialized fields, we were seen as a threat. And it's really hard to feel like you belong when it's abundantly clear you don't. So I think that planted an awareness in my brain, but that was some time ago, and I didn't really think about that as a career pathway. Like, how do we fix that? Right? So I just suffered through it and got out as soon as possible. But then that pattern kind of reintroduced itself in my career. So I found myself working in manufacturing environments and again, a very heavy, male-dominated environment, and just wearing steel-toe boots and being able to swear like a sailor did not necessarily get me the belonging that I was looking for, spoiler alert, there really are only two factors that determine whether or not we love our jobs. And they are that we have good, solid relationships with the people we spend time with and that we see that the work that we are doing has meaning. And I'm sure we'll talk about that in today's conversation, but those are both really hard to do when you're not welcome in a space. And so, fast forward in my career, I was a nontraditional college student, having started life in the military instead. I didn't go to college until I was in my late thirties, and I was working on my first master's degree when I was studying organizational ethics. Not a super happy topic, honestly. And I ran across Shawn Achor's TED talk on the happiness advantage. And that was a really life-changing moment for me because seeing the science behind and the potential for happiness really in the professional realm sparked a light bulb for me. And so I thought back to all those experiences, both my military experiences and civilian, where it was just a toxic environment. And I thought to myself, we can do better. So I guess we could say the Navy inspired me, but maybe not in the way they intended to.

[07:13] Michelle: Very interesting. Yeah. And when you think about the military, when I think about the military, I think about discipline. Right. Very heavily disciplined. And I would say to get to the point where you are today, you had to have a bit of, you know, in my view, I feel like maybe the Navy did prepare you for what you're doing today in a way. But you mentioned the toxic workplace. So give us some signs of a toxic workplace.

[07:49] Sarah: Well, they're based in the real world. No, I'm kidding. But the truth is, toxicity is a complicated subject. Right. Because I think many times it's toxic due to lack of intentionality. Yes, we all have those quote-unquote leaders who do not have the skills and are just there to be bullies. I mean, those people certainly exist, but I think what happens in a lot of these toxic spaces is people have forgotten that there are other people involved in the workflows, and they have kind of subconsciously, unconsciously marginalized everybody else in an attempt to protect themselves. I kind of refer to it as the armadillo effect. Everybody's so stressed out today, and they have been for decades, that they've kind of rolled up into a little ball trying to protect their soft bellies. And as a result, they're not seeing the people around them as fellow humans also in a complicated journey. And so you see things like poor communication, you see not motivating people in ways that are actually motivational. Sort of the classic pizza party approach, which everybody knows and hates. Right? So, I mean, I think we see things like that. Of course, you see things like workplace violence, and that's definitely prevalent in the healthcare industry, both from a patient experience, but also coworker on coworker, there's some of quite a bit of that going on, too. I think we see aggression in these spaces because people just don't have the emotional intelligence to navigate through situations. But we also see passive aggression. And I think, in my opinion, that's, know, oftentimes we'll see people say things like, well, we lead with kindness here. And I don't think it's kindness. I think it's that sort of, bless your heart, that they do in the south, right? They seem nice. They seem nice, but they're not having the difficult conversations, the necessary, crucial conversations, if you will. And as a result, the challenges that are inherent in any environment just fester. And especially as healthcare providers, we all know you can't just let sepsis go. It's not going to fix itself. But we are certainly willing to let that happen in our organizations, which boggles my mind.

[10:09] Michelle: It truly does as well for me. And I would say that many nurses and other allied health professionals would say that they felt like over the last three years, and I know it's still continuing, that they felt like they were working in a toxic workplace for all of those reasons that you just highlighted. And I'll say that I was part of the great resignation. And when I say that, I feel simultaneously proud and sad because I left a profession that I absolutely loved. And I also had put nearly 40 years in, too. So I felt like, okay, is that enough to say, let's call it quits? But in retrospect, after being retired for a couple of years and really finally settling into that, I look back and I go, maybe I just really needed a pause. Maybe I didn't need to completely leave. Maybe I needed a six-month leave of absence. So I definitely identified that I was struggling with burnout. And I know so many of my colleagues are as well. So how can we recognize and address symptoms of burnout in ourselves and in others?

[11:38] Sarah: Well, I think it's that kind of physician, heal thyself space. And I want to say that I have a tremendous amount of respect and compassion for everybody who works in these hurt-centered, purpose-driven industries. I think healthcare is definitely one of those where people sort of become. Their identity becomes so much of being in this space. Right? And so when the stress levels get to be unbearable, it feels like a moral failing, not just like a professional lapse or something. And I know I've heard other guests of yours talk about their sense that the organization contributes to that, and that is certainly true. And I do not want this to come across as gaslighting. That's really important to me. But I think nurses and healthcare providers take on that sense of, I have no other way of being. I have to just soldier on. And here's the thing about that, right? If you had a patient who had a broken foot, you wouldn't just tell them to keep walking on it, right? But we will, and I've seen this happen time and time again. We will just continue to metaphorically walk on that broken foot because we feel like there's no other option. And so I think part of it is getting to a place where we can have open and honest and transparent conversations with leadership. But I have to say I think that's gotten harder and harder as healthcare has evolved away from small community care centers to large corporate megaliths. The decision makers are no longer really your tribe. They are some executive that may or may not be a healthcare professional themselves is certainly influenced by an accountant or a shareholder advisor, and that changes the dynamic radically. So I think when it comes to individuals figuring out what to do about burnout, the first step is really recognize that it's happening and acknowledge that it's not going to just go away. If you just keep pushing through it, you're going to probably do more harm than good and find the support systems that let you get to the root causes, because you can't just ice a broken foot either. Right. You have to actually treat it. And the same is true for burnout.

[14:15] Michelle: Yeah, those are really good points. And the nursing identity, as you spoke of that, it's really strong. I'll speak for myself. It was super strong, and I had a really tough time kind of disconnecting from that. And I think that is both good and bad to have a strong nursing identity. But I think today's nurse, they are really focused on becoming more well rounded, and I'm really happy to see that. And these huge megalith corporations, healthcare corporations that you were referring to earlier, you were saying, like, certain members of the healthcare community are feeling marginalized. I think as these corporations grow and healthcare is a business, right, it's a big business. And I think nurses, a lot of nurses were feeling very marginalized, like we're just a cog in the wheel of this huge business and we're not valued. And I think that led to many nurses kind of leaving in droves. From the profession. But have you seen an increase in workplace unhappiness since the pandemic, or has this always been something?

[15:43] Sarah: What I think is so interesting is actually for a bright, shining moment, about six months into the pandemic, Gallup, as an organization, tracks workplace engagement and to some degree, happiness. And there are other organizations that track workplace happiness. And there was this really interesting bubble that happened about six months into the pandemic, where actually, despite all of the shenanigans, and my goodness, they were legion, all of the stress of the pandemic, about six months in employee engagement, as a general trend across all industries, bumped up pretty significantly. And it's partly due to the fact that for the first time, sometimes ever, people were given autonomy, and in cases like healthcare, were given a lot of respect that had been missing. So people again want to be able to say that the work they do has meaning and has value, and people want to be respected as capable, competent adults and maybe even professionals, right? And they were. And it was sort of this message of just do whatever it takes. You're going to be able to figure it out. We don't know what's going on, so good luck to you. And people did. And so I think that sense of autonomy and accomplishment over more than balanced the other stuff that was going on. Not to diminish the stress that was happening, but it really did. But the problem is humans are incredibly adaptable. Well, maybe it's not really a problem, but it certainly is real. Humans are super adaptable. And so as sort of the world coalesced into the weird, then normal of mid-pandemic, that autonomy started to be taken back. And so for anybody who's familiar with the psychological impact of that, right, loss aversion is real. And I think that's part of the rebound effect that we're seeing now. So people were told they were heroes, and shortly after that, they were then crushed into a pulp by the wheels of corporate industry, and people were given autonomy for a little while, and then it was jerked away from them whether, and we're seeing that in other industries, too, where people are being forced back into 100% in-person roles, despite having rearranged their entire lives to meet the corporate missions and that kind of stuff. So did I see less or more happiness? I saw a little bit more happiness with the acknowledgment that all emotions do not exist in a vacuum.

[18:18] Michelle: Right.

[18:18] Sarah: It was a complex time, and I think if we learned anything from the pandemic, it's that we can certainly hold multiple, sometimes conflicting, emotional states in our heads at once. But what we did see was a really large case study on how it could be done better. I just would like to see our leadership in whatever industry and organization acknowledge that the people on the ground actually figured out some pretty cool stuff, and maybe you should talk to them about whatever the new normal is going to look like for your organization.

[18:51] Michelle: Yeah. Get those people engaged, the ones that have lived through it. Right.

[18:55] Sarah: Weird, right? I know. Yeah.

[18:56] Michelle: And I was thinking about the timeline, how you were saying, like, about six months into the pandemic. I lived that as well as many of my colleagues did. For the first time, many of us in our careers, we were, as a group, acknowledged as heroes. And there were banners, and there was an outpouring of love from the community, and food would just show up on our units. And it was donated by people, and they donated, they made masks. That felt good. Right. And then there was just a really hard line where it all turned off. And for me, it was when there was talk about a vaccine, and then we saw a lot of divisiveness in the healthcare community. So you had to pick aside if you were going to get the vaccine or not get the vaccine. And then there were all those workplace restrictions, and it really turned ugly fast. So. Yeah. Really accurate on that. Well, let's talk about those three words that raise the hair on the back of our necks, and that is work-life balance. What do you want to say about work life balance? Can we just change the vernacular of that?

[20:29] Sarah: It's so messy.

[20:30] Michelle: Right.

[20:30] Sarah: Well, I think for one thing, in the modern world, the way we approach work and life has changed dramatically. There may have been a time, I don't know, I was raised by hippies on an off-the-grid farm, so there was no such thing as work or life. It was just all work. Right. But I think there was a time, or there's at least this sitcom narrative of a time when people went to work and then they came home and they were in their home life, and that was a reasonably balanced experience. But for sure during the pandemic and for sure since then, and I would even argue for about a decade and a half or more before that, it was actually a lot more fluid than that. And it's really interesting that when DEI became a focused topic for people, that the concept of your whole self became something we talked about, and you should bring your whole self to work. And I agree with that. I think there is a tremendous benefit to tapping into the whole brain, the whole human, the whole heart of your talent pool. And just as a person wanting to live a more fulfilled life, it is nice to be able to be you and talk about your home life or your kids or your interests to whatever degree feels good to you. And that varies from person to person, but that makes us more porous than we were previously. We're not putting on that same kind of Persona. And again, I do think that in some industries where trauma bonding has kind of been the norm, which I think healthcare is one of those graveyard humor and that kind of stuff.

[22:02] Michelle: Sure.

[22:03] Sarah: I think that that was more porous for a long time because it's a lot like being in the military, especially if you're on a frontline group troop, right? You have to be able to trust the people implicitly with your own well-being. And so that creates a different kind of dynamic. And so this myth of work-life balance, I think, is really damaging because it's really kind of victim blaming. Right. It's saying to the people who are burned out and stressed out, well, if you just had healthier boundaries, everything would be fine. But that's trash, especially in a world where we all. If you're on call, first of all, that changes things tremendously. But in a world where we all have cell phones and we are all checking, let's be real, we're all checking our email the day before we go in to make sure that we're not walking into a dumpster fire, and that's just real. And so work and life, I think we have to think about it more in the sense of who am I in all times in my life? And am I getting the support I need at all times? Because I think the other damaging thing about the work-life balance concept is that the stress that we experience in any aspect of our life, any aspect of our life, doesn't stop impacting us when we put on the uniform or take it off. Right. Whether we hang up the Volt phone and put it in this little recharger or whatever. So we really have to acknowledge that we're still us at the end of the day. And the things that charge us are going to be pretty diverse as well. So this myth of balance, I think it really just creates more harm than good, if I'm being honest, because we have this then fairy tale that somehow, some way, if we just do the right sequence of events, that nothing will affect us negatively. And that's not real. That's just not the real world.

[24:00] Michelle: Not a real world, for sure. And another word that. Because I think probably three or four years ago, if somebody had told me I was resilient, I would have felt a little bit of pride in that. But when the last few years, what we've gone through and being told you guys are so resilient, and getting, like you referred to earlier, the pizza parties, and it just feels so flat and it feels so disingenuous, how do we get past that? How do we actually foster true resilience where we feel good about it again?

[24:48] Sarah: Well, I think we start by burning every copy of that book about grit because I think it's really unhealthy, not to discredit the authorship or the scholarship of that author, but the concept of grit, which is kind of the ugly grandparent of the resilience movement, has been so misapplied. Are there times where we have to just literally suck it up and deal with a situation in order to get through it and then recover on the other side? Yes. That is real. I have four kids. Certainly, I had to survive the transition experience to get to the good part, which was having the baby in my arms. And sometimes you just have to power through it. But I think a lot of this resilience stuff is based on somebody reading an article on, like, Forbes or Becker's or something about resilience and not understanding what really creates resilience or what resilience is, and then taking people down this really weird pathway towards, quote, unquote, building resilience. And I will tell you, Michelle, I have sat in my fair share of awful corporate trainings around building resilience, and inauthenticity is a big piece of, again, and victim blaming. So do we as individuals, have a responsibility to do what's within our sphere of control, to manage our environment? Yes. Do our employers have a responsibility to create and nurture an environment where we are not being actively traumatized or maybe even are being supported, nurtured and have a chance to thrive also. Yes. Right. And so what I've seen happen is the individual part gets touted a lot.

[26:38] Michelle: Right.

[26:39] Sarah: And that's the main thrust of it. You should just do self care, you should do yoga, you should meditate. You should get an additional 10,000 steps on top of the 22,000 steps you're already getting as a nurse. Right? Come on. I recently saw this employee engagement bingo game, and one of the things was, get 10,000 steps. And I was like, what nurse doesn't? I don't know anybody who doesn't get. So it's like, this out of touch with the reality of what's happening. So what is resilience? Right? Resilience is the ability to literally. It's the bounce-back ability, right? Can we experience a difficult situation and bounce back from it relatively unscathed? As we all know, there's a big difference between healing from an experience in a positive way and developing a tremendous amount of scar tissue that actually hinders us going forward. Either of those is possible. But what I'm seeing in the corporate space or in the workplace space, generally, manufacturing floors, et cetera, is the scar tissue is what's happening. And let's just be really real. Humans need to process psychologically and physically need to process negative experiences if we're going to move into the next phase of life in a manageable way. And I don't know too many people who have had a chance for sure, to process the pandemic, certainly not in healthcare, because we're still dealing with it. I mean, it's still there, right? And not just the literal coronavirus part of it, but all of the weird policies and changes. The change has been tremendous. The social pressures, as you identified, the loss of colleagues, the loss of family members, the community shenanigans that have cropped up in all kinds of unexpected ways. There's a lot of change and grief that has just not. We've not had a chance to even look it in the eye, much less process it. So we're not even really. We say, well, thank God we're on the other side. But psychologically we're not. We're still right in it, and our bodies are in reaction mode. We're all on amygdala overdrive. Everybody's cortisol levels and adrenaline levels are through the roof. No wonder nobody's happy. We can't be. We're literally in fight or flight, maybe fight and flight simultaneously, and we have to pause, take a deep breath, metaphorically, maybe literally, and have these conversations, and that's going to be complicated. And people might be unhappy because, my gosh, they've experienced really horrible things. And as biological organisms, we're wired to fixate on the negative because it's a survival instinct. So we can't even get to the gratitude, experiences, or appreciation for each other, even if it's authentic. And it's all too often not right. It's literally the executive team sits down and they all write thank you cards to people. They have no idea who they are. And you get this card from somebody you've never actually met. That doesn't represent your life experience, and it just feels fake because it is. So we can't do better if we're not going to be authentic about our intentions to build community, to build connections, to see each other as humans, and to acknowledge the very real human complications that are keeping us from getting over this particular hump. When we do that, those of us who survive the experience with some kind of sanity and physical well-being intact will have developed a new set of tools in our toolbox. Because the truth is, there is something else coming. We just don't know what it is. That's how life works, and that's what resilience is designed to do. Right. It gives us the tools to navigate the next challenge, theoretically, with a little bit more grace, ability, or at least to have less trauma coming through that next experience. We got to have the time to do that, and we're not being given that luxury.

[30:43] Michelle: So true. Yeah. And I feel like nurses have a high degree of emotional intelligence, and I feel like you can't really fool us. And a lot of those things that the corporate world was doing and upper management and stuff, like you said, so relatable. Getting a thank you card from somebody that you've never met that has no idea who you are, what you do. Yeah, we can spot a fake pretty easily. And that didn't feel, you know, on your website, you say, ask me why. I say happiness is courage. So, Sarah, I'm asking you, why is happiness courage?

[31:30] Sarah: There are many ways to get to bravery, right? So we have all seen the story of the mom picking the car up off of her child after an accident. That surge of adrenaline that gets us through that catastrophic incident, that is absolutely an avenue to tap into that core of strength that we need in an experience. And biologically, that leaves us with some pretty difficult stuff to process. It's a great thing if you find yourself in a truly life threatening situation. Adrenaline and all that good stuff serves a purpose in that moment. I think humans like to want to distill things down into super simplistic algorithms for life. And so, well, we've got this hammer that works in this stressful situation. So we're going to use it for every stressful situation. So what we've learned is a mechanism for tapping into that sort of panic response to deal with everything. Well, that's gotten us to a really kind of scary place as a species, as a culture, and there are other ways to do that. So I like to think of happiness, or it's sort of nugget of center of optimism. As another avenue for finding that wherewithal to navigate situations. So I'll give you an example. My dad lives in Mexico, and I go to visit him as often as I can. And I was traveling back Thanksgiving weekend a couple years ago, and our flight was delayed, and I found myself at the wrong airport because our flight got routed to a different airport completely. So my car wasn't there, my luggage wasn't there. There were, of course, no Uber or Lyft to be found because it was Thanksgiving weekend and an entire plane full of people had just been rerouted to the wrong city. So that was super exciting. Now, I probably could have tapped into the panic mode in that moment, right? But instead, I just thought to myself, wow, I'm safely on the ground, and I'm so lucky to be in a position that I'm not in a rush to find a lift. I can wait for the ride. If it takes 12 hours, I can wait. Worst case scenario, I have options, right? And to find that place of gratitude and positivity kept me calm, and it really helped me process through the situation and navigate to where I needed to go.

[34:01] Michelle: Okay.

[34:01] Sarah: Now, that is not a life altering situation where adrenaline would have been called for, but it could have been. I could have tapped into that panic response, and a lot of people around me.

[34:10] Michelle: I would have.

[34:12] Sarah: Absolutely, right. And people did. And I get it. Right. I get it. I don't blame anybody for that. But I know that the after effects of that, if that's all you ever tap into, are really damaging. So happiness and optimism and hope are another way to find that space forward. And at least for me and for the people that I convince of this process, once it becomes sort of muscle memory and it becomes the thing that you reach for when you're in stressful but not life threatening situations, it changes everything. Because, as we all know, when we freak out, we really kind of shut off our thinky think part of our brains, right? We go into survival mode. Great. Except when it's not. And I would argue that that's part of why we see so many terrible decisions happening in administration offices, because they're also in reactive mode and not in logical thinking mode. So bringing ourselves collectively back from the brink of the panic cliff would benefit all of us. But from a more personal perspective, it really gives us a more pleasant, honestly more manageable and more sustainable way to tap into the strengths that we need. Because life is hard, there are a lot of challenges that come up every single day. Flat tires, sick kids, job changes, unexpected news of whatever sort, those are all constant attacks on our equilibrium. And if we're always reaching for panic, that sucks. And it doesn't have to be that way.

[35:46] Michelle: Yeah, I love that message. It doesn't have to be that way. And as you were recounting that story probably ten years ago, I would have jumped into that panic mode. Oh my God, I'm stuck here at this airport. I don't know this city. I can't get an Uber. And I would have started heavy breathing and sweating and I don't know if it's just wisdom or age or work on. Hey, stop. Think, breathe. It's okay. Everything's going to be okay. You're safe. Like you said, you're safely on the ground. Because flying for me is a big stressor. So yeah, when I do land safely, I always give thanks and practice the gratitude. But yeah, it's a trained response. And I think in healthcare I will venture to say that a lot of us, because of the situations that we're handling, and alternately in the military as well, it's like you just go into that response so quickly, that fight or flight, and you really have to train yourself to not respond that way.

[37:02] Sarah: Well, I get accused all the time being a Pollyanna, and the truth is I am not. I'm really not. I do believe in the power of positivity to give us the tools that we need to navigate life in a more manageable way. But there's a time and a place for that panic response to exist. And I think the other piece of this that's really helpful to consider is if you're always tapping into that battery pack of stress and fear to deal with every single situation, when the thing happens that is going to require that to be the right response, you may not have what it takes. I think that's a part of what's going on with burnout today too, is everybody's been drawing from that well so consistently that they're just drained. And so there are still moments in all of our careers and in all of our lives where we really do need that extra rocket boost of adrenaline, but we're so frazzled and our neural pathways are so exhausted that it's not really as effective as it needs to be in that moment either. So how do we allocate resources more effectively?

[38:11] Michelle: I guess if a meme is worth 1000 words, it would be the one to describe. Burnout is like, I have no more fucks to give, right? It's like getting to that place where you're just completely exhausted. And you're like, I don't really care what happens. I'm not invested anymore. And I think a lot of us have gotten to that place. But thank God that you're here, because you are the chief happiness officer of happiness is courage, and that's your coaching business. And I imagine you have coached executives and corporations and healthcare organizations. So how has your message been received, and what kind of feedback have you gotten from those people?

[39:04] Sarah: Well, usually when somebody hears I'm a chief happiness officer, their head snaps around and they say, I'm sorry, what did you say?

[39:14] Michelle: I love it.

[39:15] Sarah: It's a great icebreaker, because people don't even know what to make of it, right? So it snaps them out of autopilot. So that's the first reaction. I will say. I live in the Midwest, and if there is ever a place where happiness at work is not understood, it is certainly the midwestern part of America with that kind of put your head down, grind until you die. That's how it's supposed to be mentality. And so it's often a pretty heavy lift. And I have been advised by very respectable mentors to consider changing my message. So I became a chief happiness officer, and that is an actual credential that I earned. I actually convinced a former employer that we needed to change something in our environment because it wasn't working. And they agreed to send me to Europe. I went to Copenhagen, where I studied the scientific research behind happiness in the workplace specifically and what it takes to create those environments. Now, Europe has a very different framework around that because they actually have employee well-being laws under the EU, so that helps. Right. But the science behind it is still valid, whether or not we have a legal framework to support it. So I brought that back with me. And although I would probably have a larger portfolio of clients or it'd be a faster sales pipeline if I rebrand it as, like, resilience and well-being. The truth is, those things are the lagging indicators. And I also think it's really important to point out I don't actually think that happiness is the goal at all. I think that happiness is the quote-unquote, symptom of a healthy workplace. If people more often than not are happy at work, whatever that means for them, because that's a very personal emotional experience, then something's going right. That's all emotions are, right? They're just the dashboard of our life. So a lot of times it's a hard sell because people don't really think they themselves have internalized or accepted the belief that work is going to be miserable, and that's just how it is. And they have to just suck it up and almost blank it out to get to retirement. And we all know the statistics on that, right? People retire and then they die, like, 18 months later or something. So what a travesty to spend in our world, right? In our world, we're looking at, like, 40, 50, 60 years of being in the workforce before we can retire. And that's a long time to suffer for 18 months, maybe, of theoretical happiness, if you're not burned out.

[42:00] Michelle: Theoretical happiness?

[42:02] Sarah: Well, shoot everybody. I mean, it feels like by the time you get to that point of your life, everybody's just like, get off my lawn. There's not a lot of joy in that space. They've lost the mental capacity to experience happiness or something. I don't know. What typically changes the conversation for me, though, is the conversation around turnover. And nursing is an excellent example of a place where turnover is catastrophic. And it's not just the financial cost of turnover, although that is atrocious. And any organization, every organization is measuring that and tracking their turnover expenses and hiring and retraining and all that stuff. But it's also, I believe, a big part of why we are seeing decreased patient outcomes, lower HCAP scores because your workforce has churned so much at this point that a good portion of your seasoned nurses have left the industry altogether. They just said, to heck with this. I can't take it anymore. And they've gone on to do, like, I don't know, Scentsy or wood burning projects, like resin art or something. They can't even handle it anymore. For their own well being, they have to leave the space.

[43:19] Michelle: So you've lost all the Scentsy distributors.

[43:23] Sarah: Hey, nothing wrong with the side gig. I make freeze-dried candy on the side for fun. Right. I get it. But if you've left your passion space for something else, that's a telling sign, right? That's a problem. And more importantly, the brain drain on the industry is catastrophic. I mean, I know a ton of organizations who have preceptors, and I use that term lightly because they've been in their role less than a year, which, as a patient, scares the dickens out of me. I'm like, I'll just get some duct tape. I'm good. Please don't take me to the. Just. I think we have to address this, and in some ways, it's already too late. Right? We've lost a big chunk. We're really in a rebuild mode. You have to now develop and intentionally invest in developing a new cohort of will be eventually skilled enough to be leaders, people. But what's the average tenure of a nurse right now? Not very many years, right? And they're rolling in and out of these roles so fast and no blame, no shame, because it's a horrible space to be in. But as leaders, people really need to be thinking about that if all they care about is their bottom line, cool. That is being damaged by the decisions that they're making. I care about the well being of the people involved. I honestly don't care if healthcare system x makes another billion dollars. I just don't care. I acknowledge it's a business. I'm sure somebody cares about that. But I think this and education are the two industries where that should not be the primary decision point because we cannot outsource either of those jobs. And it shouldn't take it being the hospital president's mom receiving subpar care because all the experience nurses have quit for them to have that epiphany.

[45:17] Michelle: Right? Yeah. That's another thing that we see is like, people only start caring when they're personally affected, right? And when they're not, they wouldn't give flying. You know what? Okay, let's talk about appreciation, because you just recently did a blog post, I love your blog, by the way, and you did a blog post on microaggression, and so you kind of turned it around to micro appreciation. And I just love that. And I loved the visual of the pill bottle label on it. I was like, this is genius. I love this. Where can I get some of these bottles and fill them with M&M's  and take them everywhere? Because I'm a big fan of appreciation. And so I'm going to give an example. So when I was working one of my duties, and I was talking to Alex Whitefield the other day, he's going to be coming on in a few weeks, but he's The Break Nurse, and he invented Breakalgo, which is a software program designed to help nurses get their breaks easier and it's easier for organizations and so forth. So we were talking about breaks, obviously, and one of my responsibilities as the developmental care nurse and the lactation nurse in the NICU was being the break nurse. And I did that almost every day through the last two years, three years of my work. But one of the things I would do, so when I would approach the nurse that I was relieving, we had five minutes for handoff, and each nurse usually had their papers that had all their patients information on and so forth. And so I was just sitting there for 30 minutes watching their patient. I would write little notes to the nurse of things that I saw them doing. Yeah, I love doing that. And I had a red pen. And usually red pen is associated with bad, right. When you were a kid, you never wanted to see a paper that you returned circled in a bunch of red pen. But I did that on purpose. And I took this red pen, and I would write somewhere on their paper, very small, like, I love how you really worked with this mom on breastfeeding, or you are amazing at grand rounds. I love what a patient advocate you are. And I would write these things, and they got a lot from that. I could see just how valuable it was to them. And it was really valuable to me, too, as the giver. But just talk about the five languages of appreciation.

[48:25] Sarah: First of all, I want to say thank you to you for being intentional about that. And the reason that's so powerful is there are unlimited opportunities to do that. Right. I see a tendency, especially in North American culture, to wait for something massive, like a Daisy Award or something, for somebody to receive appreciation. Those are usually the accumulation of weeks, years, decades of effort expended and absolutely mean something and absolutely should continue and only happen maybe once in a career. Right? Maybe once in a life. And if we have to wait for an entire lifetime to be appreciated, that stinks, right? Appreciation at its core. So I studied this. My doctoral work was looking at the impact of intentional appreciation on job satisfaction and other organizational metrics. And a spoiler alert. When people are authentically appreciated, they like their jobs better. This shouldn't be a big surprise, right? But it's really impossible for it to have an impact if it's only going to happen once every 5,10, 25 years. So micro appreciation really is an opportunity to engage in intentional interaction with our people, with our tribe, whether it's our family or the barista on the corner or our coworkers. And there are so many opportunities like you just described, and they aren't the, wow, mind blowing, amazing things. They're the millions of little things that add up. So there are two things that are powerful about this. One is people are being acknowledged for the work that they're doing, which contributes to that feeling of that work being meaningful, which directly drives job satisfaction and personal life satisfaction. So that's awesome. And because there are literally limitless opportunities for that, if we look at it as a way to change the way we work, we can shift it from what is commonly a culture of looking for the mistakes like in a quality improvement process to catching them while they're being good. So I think both have value. I mean, we obviously want to identify when there are challenges and correct those. And it's super important to psychologically and literally balance that out by also having lots of opportunities to say, yay, that was awesome. So the general consensus is that humans are wired on a one to three ratio. It takes three positive experiences to outweigh one negative. So that's a lot. Right. And we're also instinctively wired to focus on the bad. Well, okay, so we can't expect that we will organically look for opportunities to say positive things to each other. So microappreciation gives us an easy, approachable, and always accessible way to start to change the way we think about our interactions. The appreciation languages should be familiar to anybody who is familiar with the love languages. And I will say, like, just about every personality style profile out there, the love languages and the appreciation languages have gotten a little bit of bad press lately because they've kind of become the pizza party of the personality profile world. People take these assessments and they attach a tremendous amount of value to them, and they say. They take whatever assessment, and they say, oh, I'm a purple alligator. And that is supposed to indicate some kind of a personality? Well, the problem is, you're probably only a purple alligator or whatever that is in this moment of time because of the environment you find yourself in. We all evolve a lot, and you are so much more than just a purple alligator. You are also all the other things. You may be an extrovert and an introvert and an EMTJ and all the things, right? Like, you could be anything and all the things all at once. So what are they really saying? So what? The appreciation languages are, right. It's quality time, words of affirmation, acts of service, physical touch, and gifts. Just like the love languages. I want to point out that physical touch is commonly left out of workplace conversations for obvious reasons. I appreciate, as a woman, myself, and somebody who has been physically harassed in the workplace as well as other places, that that's a complicated conversation. And we are still human, and we still do actually need physical touch in consenting, appropriate ways. That being said, these concepts are really just saying. There are lots of different lenses through which we can and do experience life. And for all of us, some of those approaches work better than others, right? Some of us like to learn by listening to audiobooks or podcasts. Some of us prefer to read a book. Some of us prefer to do the thing with our hands. That's pretty well established. So figuring out how we most efficiently and effectively navigate the world is helpful. And understanding how the people with whom we're interacting also move through the world lets us do that with less friction and with more efficiency, and it just ends up with better results. I think we can pretty comfortably say that there is no cheek swab or blood test that tells us what characteristics embody us as humans. But I do think that the love language or appreciation language framework is a pretty solid first go at chunking up how we interact with the world and how we most feel seen and valued, with the acknowledgment that just because quality time or acts of service works for me today doesn't mean that in ten years I might need something different. So the caveat is we really have to be emotionally intelligent enough and self aware enough to recognize when we have changed and when the people around us have changed. But that doesn't mean that the tool itself is invalid. I really think it's an excellent way to start the conversation around how we can better support ourselves and others.

[54:57] Michelle: I just love how you broke it down. Thank you so much for that. Let's talk about gratitude, because your book, Silver Threads, is all about gratitude. So do you want to talk about what that book is about?

[55:12] Sarah: Absolutely. I love gratitude, obviously. So it's much like the micro appreciation concept, right? So I had a time in my life when everything turned inside out in the most horrible way possible. And it all happened in about 18 months. And in that time, I was talking to my grandmother, and she was the wisest human on the planet, like most of our grandmothers probably were. And she said, well, just find one little thing to be grateful for. It'll give you something to hang on to, and everything changes. That's all you need is an anchor point. And so, as a personal practice, I started actively seeking out those micro moments of appreciation. Now, for anybody who's been through any given radically rough time in their life, you may have heard the expression, look for the silver lining. And the truth is, I hate that saying because it's well intentioned. It really is. I believe it's always well intentioned. And when you are on your third consecutive shift and your kids are sick and your mom has the flu and can't watch them, whatever the catastrophic environment you find yourself in, the Stepford wife approach to just pretend everything's positive is horrible, and it's very diminishing to the experience of the person who's in that difficult moment. And life is complicated. So you can be in the worst experience of your life, and there will still be micro moments of things to be grateful for at the exact same time. I think the author of Peter Pan Barry, said that fairies are so small, they can only have one emotion at a time. But humans are much bigger and much more complicated. We actually do experience multiple things. So the concept of a silver thread was that those are those little, tiny, shiny moments in the middle of what could be an otherwise disgustingly gross time. And if we collect enough of those silver threads, what our brain starts to do is look for them, actively seek them out. And so it's like any other change, right? We're all wired to watch for danger, but if we make ourselves look for the positive. And that's why gratitude journaling, or gratitude, like hashtag daily gratitude, is a great practice because it gives our brain something to chew on. So we're scanning the horizon for both the danger and the good stuff. And the good stuff is where the magic happens. So there's a ton of research on how gratitude impacts our bodies, our brains, our well being, our communities. And again, it's pretty darn amazing. Gratitude says, I see you. I acknowledge that you're a positive influence on me on some way. We are connected, and I think most of us are familiar with the surgeon general's and his work on isolation. And if not, I highly encourage people to check it out. I think Dr. Murphy's work on isolation and his platform around it is powerful, because that's a really big problem, and gratitude is an antidote to that. Gratitude instinctively connects us to people. So what I wanted to do with that book was make gratitude approachable, make it feel like it was less of a burden. Gratitude is not forcing your kids to write thank you notes to their grandparents. Gratitude is teaching ourselves to acknowledge that we are not alone in the universe and other people have a positive impact on us. And that is a wonderful and beautiful thing to be celebrated.

[58:34] Michelle: Amen. I agree, and it's on my reading list, so thank you so much for that. And I have to agree with you about grandmothers being the wisest people on the planet. I was super connected to my grandmother and miss her dearly, and she gave me some of the best advice in my life that I took and have been very happy. When I went to her as a 21 year old pregnant, unwed Catholic. Those are some heavy words, right? And felt very trapped, like I was going to have to marry this person. And she very matter of factly said, you have a choice. You are not trapped. You have a choice and you don't have to marry him. And I didn't. And it was one of the best decisions that really changed the trajectory of my life. So shout out to grandmothers everywhere with your wisdom and your honesty. And I strive every day to be the grandmother to my grandkids that she was to me. So, gosh, thank you for acknowledging that and for talking about your books. Your book. So we're going to get ready to kind of wrap up here. And this is a new question that I've been asking my guests. So I will ask you, is there someone that you recommend as a guest on this podcast?

[01:00:12] Sarah: There are so many amazing people out working in this space. I think if you can get Dr. Wendy Dean, I don't know if you've had a chance to read her book if I betray these words. This is a powerful conversation around moral injury. And although as a heavy topic, I think her honest approach to that conversation is incredibly impactful, I think that book should be required reading for anybody who's even considering a career in healthcare, and for sure for all healthcare administrators because it changes the conversation tremendously. It's a very powerful piece of work, and she's very eloquent in how she approaches a very difficult topic.

[01:01:01] Michelle: Well, that's great. Thank you so much for that recommendation and also for the book recommendation. And I'm going to make you a bookstore on bookshop.org with your book and Dr. Dean's book. So thank you so much for that.

[01:01:15] Sarah: Thank you.

[01:01:17] Michelle: Well, Sarah, where can we find you?

[01:01:20] Sarah: So I'm actually pretty easy to find. I'm all over the Internet. The best place to start is my website, which is, as you might expect, happinessiscourage.com. I love connecting with people. I'm on LinkedIn. If anybody's out there and wants to connect, I'm routinely in the trenches arguing and advocating for my nursing friends because you all are doing amazing work and somebody besides yourself needs to help carry that burden. So happy to be in the fight with you all.

[01:01:47] Michelle: Yes, and I have all your social media links and your LinkedIn, so I will put those in the show notes, your website, your book, all of that so people can find you. And Sarah, this has been a very enlightening conversation today. I have learned a lot, and I don't know, when you think about happiness, you have a certain view, and you have really brought so many different perspectives into the conversation today. And I appreciate the work that you're doing because I know you are working with healthcare professionals and organizations and it's something that we really need, and I just appreciate you so much. So thank you.

[01:02:32] Sarah: Thank you so much, Michelle. Keep doing the good work you're doing.

[01:02:35] Michelle: Thank you. Well, we have five minutes at the end for the five-minute snippet, and it's just a bunch of fun. So are you ready for that?

[01:02:44] Sarah: I'm ready.

[01:02:45] Michelle: All right. Starting the timer. Favorite movie snack?

[01:02:55] Sarah: Popcorn with extra butter.

[01:02:59] Michelle: Would you rather team up with Wonder Woman or Captain Marvel?

[01:03:04] Sarah: I mean, I'm a collaborator. I don't know that we have to pick one. Let's do both and have an amazing party.

[01:03:11] Michelle: That's amazing, girl. I love it. Okay. Favorite ride at an amusement park.

[01:03:17] Sarah: Oh. So I think I mentioned I'm not really an adrenaline junkie, so my favorite ride is probably the park bench waiting for my friends to come back from their adrenaline rushes just watching.

[01:03:29] Michelle: Right.

[01:03:29] Sarah: People watching is the best.

[01:03:31] Michelle: Yes, it's the best. Okay. Are you a nurse? Because I think you. Gosh, you just seem so much like my colleagues.

[01:03:40] Sarah: That's such a compliment.

[01:03:41] Michelle: Oh, you really get it. Okay. Would you rather stay in during a snow day or go outside and build a fort in the snow?

[01:03:50] Sarah: Oh, my gosh. I grew up in northern Wisconsin, and although I'm getting older and the cold is a little less fun, I'm still definitely more of the fort builder. Maybe snowball fight haver.

[01:04:00] Michelle: Oh, sounds so fun. Favorite burner on the stove.

[01:04:08] Sarah: I need a bigger stove. I love to cook. And so I guess my favorite burner is the front left because it's most versatile on my particular model of stove.

[01:04:21] Michelle: That's so funny. We're soul sisters.

[01:04:24] Sarah: Okay.

[01:04:26] Michelle: Would you rather be an extra in an Oscar-winning movie or the lead in a box office bomb?

[01:04:36] Sarah: I think I would rather be the lead only because it would lead to some funny stories afterward, other than the stress of fame, and I'm not sure I'm ready for that.

[01:04:49] Michelle: I love your spin on that. That's great. Favorite vacation destination?

[01:04:55] Sarah: Yes. I love to travel, and I don't care where, just anywhere.
Michelle: I know I've seen you and your husband's exploits and stuff. That's very cool. Would you rather always have BO and not know it or always smell BO on everyone else again?

[01:05:15] Sarah: I grew up on a hippie farm, so I think I'd rather the second. That's a familiar space and doesn't really bother me that much.

[01:05:22] Michelle: Me too. I'm always like, what is it with our obsession with smells and inventing other smells to cover smells that are normal? I don't know, maybe that's a nurse in me. Okay, favorite piece of artwork.

[01:05:42] Sarah: Oh, boy. Well, there's an asterisk on this. My current favorite piece is actually a picture of orchids that was painted by one of my stepdaughters. But I have a new grandson who's not quite of art-creating age yet, so that answer will probably change the minute the first refrigerator art arrives.

[01:06:04] Michelle: It does. My refrigerator is plastered right now.

[01:06:09] Sarah: That's awesome.

[01:06:10] Michelle: Yeah. I have a craft room, and so whenever the grandkids come over, there's paints, there's markers, there's paper. We make cards. It's just a fun fest. And now the latest thing that my nine-year-old grandson is doing, he's drawing me pictures in pencil, and then he's leaving them for me to color in.

[01:06:33] Sarah: Oh, cool.

[01:06:34] Michelle: So sweet. Yeah, love it. Okay, would you rather have a pause or a rewind button in your life?

[01:06:41] Sarah: Oh, pause. Absolutely not going back. Pause.

[01:06:45] Michelle: Okay, favorite season.

[01:06:50] Sarah: I don't have one, and I mean that very intentionally. I love different things about every season, and I live in Indiana, and I'm allergic to something different in every season, so they all have their ups and downs, but I wouldn't say I have one that I favor over the other.

[01:07:03] Michelle: Okay, that's totally fair. A couple more questions. Okay. Would you rather hunt and butcher your own meat or never eat meat again?

[01:07:13] Sarah: Oh, that's easy. Again. Grew up on a hippie farm, I butchered my own fair share of critters over the years. And while I wouldn't say I thoroughly love it, it's actually kind of satisfying to be able to provide for my family. So that's fine.

[01:07:26] Michelle: I think it would be great.

[01:07:27] Sarah: Skill to have on the apocalypse. I'm your girl. Yeah, absolutely.

[01:07:33] Michelle: Okay, last question. Favorite local cuisine.

[01:07:38] Sarah: So I live in Indiana, and we moved here about 15 years ago, and my kids said, mommy, it's cold here and the food has no flavor, so the local cuisine does not make my list. That being said, I am a foodie. So what I'd like to do is find the secret hidden ethnic restaurants, it doesn't matter which ethnicity, and try the most radically unusual thing that they've got to offer, because I just want to know what it's all about.

[01:08:02] Michelle: I love that. Yeah. Indian food, Brazilian. Like, whatever.

[01:08:06] Sarah: Is this Ethiopian? Bring it on. I'm going to try anything. There's an Icelandic dish that's fermented shark that I understand is absolutely terrible, but I just want to try it because I'm so curious.

[01:08:18] Michelle: Yeah, just like your mom told you when you were little, you can't say you don't like it unless you've at least tried, right?

[01:08:25] Sarah: Exactly.

[01:08:27] Michelle: You sound very adventurous. I like that.

[01:08:30] Sarah: I try.

[01:08:32] Michelle: Well, thank you, Sarah. You did great in the five-minute snippet. I knew you would. You've got fun plastered all over you, and it's just a bit of fun. So thank you so much for indulging our audience today. And thank you for everything that you've brought. I love what you're doing, and I'm so excited to get your word out because it's so worthy.

[01:08:54] Sarah: Thank you, Michelle.

[01:08:56] Michelle: Yes. Well, you have a great rest of your Monday.

[01:09:00] Sarah: You, too. Thanks so much.