Why Work Makes You Feel Shitty

This edition is different.

I'm sharing something I've been working on for a while. It's longer than what you're used to here—and it's still a draft. The final version will be a "vacation reader," something you could take with you on vacation or just read when you'd rather be anywhere but work.

I'm sharing it now because I want your feedback. What landed? What didn't? Where did you get confused or lose interest?

(And one specific thing: there's a method in here—Notice. Explore. Try a Change.—that needs a visual. If you have ideas for how to represent that, I'd love to hear them.)

A couple of things to know: The Fresh Start Guide mentioned near the end isn't ready yet, so there's no link. And yes, it's long—but the idea matters enough to take the space. It's the most important thing I've ever written.

Thanks for reading. And especially for any thoughts you're willing to share.

No recording today. But I will record the final product. Here’s a Google doc link if you’d rather read/comment that way.

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1

Where are you right now? Airplane? A beach chair? Mountain cabin? Parisian café? Your own backyard with a good book? 

However you're spending this time away from work, I'm guessing you didn't completely stumble into it. You planned this. Or at least aspects of it. You thought about what you needed—rest, adventure, time with people you care about … and now you're doing it.

So with a little distance from the day-to-day, a vacation-infused perspective, and a moment to reflect, I'd like to ask you a question.

2

How's work?

It's a question I've been asking healthcare people, in one form or another, for more than a decade.

What frustrates a bedside nurse differs from what frustrates a CEO. But the underlying experience? Remarkably similar. Work isn't what most healthcare people want work to be.

You too?

3

I've been there. Frustrated. Stymied. Dissatisfied.

I've also been: Stressed out. Maxed out. Burned out. 

And it wasn't until I lucked into a work experience that was completely opposite from where I came that I had the space to explore why the work experiences at other jobs sometimes felt … not right! This new place supported me (can you believe it?), trusted me (wow!), valued me (that works?!). It felt … great. Dare I say, almost what it feels like to be … on vacation.

Work isn't vacation, yes, and this new organization wasn't without its challenges, but after the last two jobs it was as close to vacation-at-work as one might get. 

I discovered there are different ways to approach work—that what I'd experienced before didn't have to be because that's just "how work works." And while I could tell you what made it right, here's the thing: what made it right, made it right for me.

What I've learned from thousands of "How's work?" conversations with healthcare pros like you is this: "fine" is too often as good as it gets.

In fact, most of the time, for most of us, work feels like the opposite of vacation. It's what we go on vacation to escape from. There's a reason for that.

4

How we work makes us feel shitty.

That's not anyone's desire, of course. Work hasn't been intentionally designed to make us feel shitty. But it's too often the reality.

"Shitty" is an all-encompassing term to describe the undesired feelings produced by showing up and doing the work: including everything from irritated, to frustrated, confused, angry, and on through disconnected, disenchanted, drained, depleted, emotionally exhausted, defeated, worn out … soul-crushed ... all the way to complete burnout.

Which Shitty(s) is Yours?

So what's creating these feelings? What's the source of the shitty? 

5

It's how we work.

Our work playbook is built on the ideas of Scientific Management, invented by Frederick Taylor, and popularized to very profitable effect by Henry Ford in the early 1900s, among many, many others.

Industrialized management = much success.

While industrialized management created unprecedented efficiency and productivity, and let’s be honest, incredible progress, it was designed for a world of predictability and standardization.

Try as we might, healthcare is not that. Not today. The world isn’t either. And yes, while standardization has benefits, doubling down on standardization in situations laden with complexity, uncertainty, and constant change can actually serve to make problems worse.

This creates a fundamental mismatch between what the work requires and how we approach it. It's why you feel irritated by processes that slow you down, frustrated by systems that hold you back, and drained by work of questionable value. 

What it all means is this: how "we" conceptualize, organize, manage, and ultimately do our work is a mismatch for the environment it's happening in. Our work playbook is outdated. 

Healthcare changed. The whole world, too. But how we work mostly hasn't. 

6

By "how we work," I mean:

The unconscious patterns we've inherited—the automatic ways we approach work tasks: how we make decisions, how we solve problems, how we communicate updates, and the like; most of which we learned by watching others, accepting the defaults, assuming the way things are done is the way they're supposed to be done.

But these aren't just individual habits. They're patterns born from organizational mechanisms anchored in our outdated work playbook—naming a few: annual planning, approval hierarchies, performance management. 

These mechanisms control everything: how you structure your day, prioritize tasks, get approval; how meetings run, decisions get made, information flows; even the work itself—documenting care, completing status reports, creating slide decks. The industrialized management playbook is so deeply embedded it dictates your experience whether you see it or not.

7

These inherited patterns aren't neutral—they're actually the reason work isn't what you want work to be. 

Some examples:

• Twenty-minute patient appointments exist not because that's the time required, but because that's what the budget demands

• You attend status meetings not because they advance the work, but because that's how information flows up the hierarchy

• Change happens to you rather than with you not because your input doesn't matter, but because that's how top-down systems operate

The result? You work harder and feel less impact. You spend more energy navigating systems than solving problems. You drift further from the reasons that brought you to healthcare. And paradoxically, organizations get worse outcomes too—slower innovation, lower engagement, worse patient experiences, increased turnover, and financial performance below what’s possible.

But we’re not here to talk about the organization you work for. We’re here to talk about you. 

8

While industrialized management has been remarkably successful from an organizational perspective, it also destroys the very conditions needed to do quality work in our modern world of complexity, uncertainty, and constant change.

Here's some of what it does to you as an individual:

Yet the absolute worst part is this: How we work treats people like interchangeable parts in a machine, the metaphor at the heart of the industrialized organization.

Think about that.

You're viewed as a part in a machine. But work today needs your humanity.

This is the tension you're feeling. You need to use your curiosity, creativity, and judgment to solve problems, you need them to care, too, but the system requires you to please the bureaucracy, often over doing the valuable work you know needs to be done.

9

It was Dr. David Rock who finally connected the dots for me. Because feeling shitty at work is not some wimpy woo-woo interpretation of a woe is me situation … it's the natural human response to trying to do value-creating work within a system designed for something entirely different. That's what makes you feel shitty.

Not occasionally. Regularly. It’s accepted as normal. It shouldn't be. 

Dammit.

You follow a process you know is inefficient—one that wastes time and adds no value—because challenging it requires more energy than you have left.

Later that afternoon, you learn the protocol you helped develop has been overridden by administration to cut costs—and no one consulted the clinical staff. 

The next morning, you learn about a reorganization through the rumor mill.

Status threatened. Autonomy squashed. Certainty gone.

You're not being dramatic. This is neuroscience. Your brain can’t do its best work when these social threats activate. The decision-making, creativity, and clear thinking your job requires? Compromised.

So, yes, work makes you feel shitty. And you can't do good work when you feel shitty. 

Dr. Rock's research identified five social needs. When any of them becomes threatened, your brain diverts resources from the prefrontal cortex—the area you count on for good decision making, clear thinking, creativity, and emotional regulation.

And when you're operating in that state—when you're less empathetic, when you have less patience, when you're working from a defensive position—you make more mistakes, respond poorly to change, burn out …

The Social Threats in Modern Workplaces

10

But my argument isn't about not feeling shitty, it's actually about feeling good.

And while feeling more like you do on vacation has value in its own right, feeling good at work serves a deeper purpose: professional effectiveness. It's an argument backed by extensive research in management, psychology, and neuroscience.

That research is absolute and abundant: You do your best work when you feel good.

When the social threats from SCARF become social rewards—when you feel valued rather than diminished, when you have clarity instead of uncertainty, when you have autonomy over your decisions, when you feel connected to colleagues, when you experience a sense of fairness—your brain operates in a balanced state allowing you to do your best work. 

Here's more evidence: Positive emotions expand your thinking, psychological safety improves performance, and positive work experiences make you more effective. Studies across multiple research streams—from neuroscience to positive psychology to organizational behavior—all point to the same conclusion: feeling good at work enables the clear thinking, creativity, and judgment that solving problems and caring for patients demands.

Your judgment is sharper when you feel energized, clear, and purposeful. Your creativity flows, you're more empathetic, you're a better collaborator. You solve problems faster. You make better decisions. You're more confident. You're better at your job.

The Feel Good Factor

That’s what I call it.

The Feel Good Factor is this simple truth: You gotta feel good to do your best work.

So if feeling good is essential for doing good work, and industrialized management systematically prevents people from feeling good, why don't we …?, why can't we …?, what's the …?, … well, that's our conundrum. 

12

This is where most people get stuck.

We, and that's the collective royal we, have come to so fully and faithfully accept that the way we work is the only way to work, we assume there's nothing we can do because fixing the situation requires organizational authority we don't have.

And, to an extent, that's true. Industrialized management systems don't just extract value—they also create learned helplessness that prevents people from recognizing their own agency.

If someone has realized there is a problem, the common responses are predictable. Some give up. Others try a new organization. Still others burn out working against the system. But that's no way to spend a career, the new place often has similar problems, and burnout is not an acceptable outcome.

13

So it was in that first moment back at work, when the vacation glow was still fresh but fading, that the vacation-planning paradox became clear. I had spent weeks thoughtfully crafting conditions for a perfect escape from work and it hit me: what if I designed my work experience with the same care I designed my escapes from it?

By work experience I simply mean: how you feel at work. That's it. 

Do you feel good at work?

That question has led me to help others explore the same possibility. We devote the majority of our waking hours to professional pursuits, yet typically invest more thought in planning our vacations than in shaping our experience at work over a four-decade career.

This paradox reveals the path: if we can design conditions for feeling good on vacation, we can design conditions for feeling good at work.

14

Work can be what you want it to be.

You already have everything you need to begin.

Your work experience can be actively shaped rather than passively endured. No, it's not always easy. And, yes, it requires work on your part. But it's possible. I've seen it happen—with nurses, operations directors, project managers, case managers, IT professionals, HR leaders, physicians, VPs ... 

15

And you can make the us-up decision, too.

Since change in your work experience is unlikely to come from action by the top of the hierarchy, you can start to improve your work experience from where you are right now.

When you realize that systems around you are influencing your experience, you can make changes within yourself—how you think about work and how you work—to cope, improve your situation, and influence the system back.

It’s The Good Work Life.

The Good Work Life

The Good Work Life is a work mindset that enables your best work. It's about creating the conditions that make the Feel Good Factor at work possible, even within the paradigm of industrialized management.

Here's what makes it different:

Most solutions to job discontent come from the same thinking that created the problem. Your organization launches another initiative, redesigns a process, conducts another engagement survey—all using industrialized management to solve problems created by industrialized management.

Or it gets put on you. Find your purpose. Build resilience. Find a better job. Useful advice—but incomplete without acknowledging the system you're working in.

The Good Work Life says something different: take ownership of shaping your work experience right where you are, using your agency, even within systems you can't fully control.

It starts by explaining why work feels shitty in the first place. Then it gives you a practical approach for shaping your experience anyway—not by waiting for organizational change or finding the perfect job, but by working with what you have right now.

The Good Work Life rests on this premise: very few of us will luck into perfect work experiences for the entirety of our careers. So instead of hoping, giving up, or job-hopping, we accept we work in an imperfect world and decide not only to work in the system (do our jobs), but to work on the system as well (nudging it toward our preferred work experience).

How It Works

The Good Work Life has three parts: a philosophy, principles, and a practice.

Philosophy

The philosophy is simple. It's what we've already covered:

The system you work in was designed to make you feel shitty. But you gotta feel good to do your best work. And your work experience is yours to shape.

That's it. Everything emerges from those three truths.

Principles

The principles define what you need to feel good at work. Five things, specifically. Here's what each looks like in action.

Worthy Work

A program manager felt disconnected from her work. She was good at it, successful by every measure, but something felt hollow. She was spending her days on work that looked important but didn't feel meaningful—at least not to her.

She started asking herself a question: What mission am I actually on? Not the organization's mission statement. Not what her role "should" be about. What work deserved her time, energy, and creativity?

The answer surprised her. The administrative coordination that filled her calendar wasn't it. What mattered was work that made a tangible difference—the kind of problem-solving that removed obstacles and created space for better work to happen.

She reframed what she was already doing. That resourcing meeting? It became an opportunity to protect her team's time. That budget review? A chance to redirect resources toward what mattered. Same tasks. Different meaning. And gradually, she started saying no to work that couldn't be reframed and yes to work that naturally aligned.

The shift reignited something she thought burnout had extinguished.

That's Worthy Work—work deserving of your time, energy, and creativity.

A strategy manager stops attending status meetings that add no value and redirects that time toward improvements that actually solve problems. A pharmacist declines another committee assignment that looks good on paper but knows will go nowhere, choosing instead to focus on medication safety work that matters. A service line director recognizes the endless slide decks aren't the work—implementation is—and adjusts accordingly.

Same job. Different focus. Better experience.

Powered Perspective

An operations manager felt stuck. The system wouldn't budge, her boss was overwhelmed, and nothing she tried seemed to make a dent. She'd present ideas that went nowhere. She'd identify problems that never got addressed. She started thinking of herself as powerless—someone things happened to, not someone who could make things happen.

Then something shifted. Not in the system—in how she saw herself in it.

She stopped thinking "I'm stuck in a broken system" and started thinking "I have agency within these constraints." Same problems. Same limitations. But she started acting from the power she already had instead of the power she wished she had.

She looked for small decisions she could make without approval. She found allies who were also frustrated and started coordinating with them. She experimented with different approaches to presenting ideas to her boss. Some worked, some didn't. But she was acting.

The system didn't transform. But her experience in it changed. She felt less helpless and more capable. Not because circumstances changed, but because her relationship to them did.

That's Powered Perspective—a clear-eyed view of workplace realities combined with confidence to shape your experience within them.

A nursing director stops waiting for permission to improve a clunky process and just tries a better approach with her team. An HR director recognizes she can't fix the culture but can absolutely influence how her department operates. A nurse educator stops complaining about lack of resources and figures out what's actually possible with what she has.

Not naive optimism. Realistic agency. Seeing what you can't control, then acting on what you can.

Enabling Conditions

An operations director felt low-level anxiety leading her into every meeting. She'd be asked for updates, and even when she knew the information, she'd feel that moment of panic—where was that data? What exactly did we decide last week? She'd scramble, deflect, or worse, look unprepared. The feeling was exhausting, and it made her dread the meetings that were supposed to be where she added value.

She had a realization: The pace wasn't slowing down, the meetings weren't getting fewer, and no one was going to organize her information for her. Most people either live with this low-grade stress or blame it on "too many meetings." Frustrated, she made the decision to show up differently.

She started simple. She implemented a basic system for taking notes and tracking decisions and action items. Nothing fancy—just consistent notes and a weekly review. She started preparing for meetings the day before to give herself more time to anticipate what would come up. The changes felt almost too small to matter.

But the shift wasn't just about organization—it was about understanding what was actually creating her stress and recognizing she had agency to change it. That constant background anxiety? It dissipated. She gradually transitioned from feeling scattered and defensive to feeling more prepared with growing confidence. She started contributing more in meetings because she wasn't spending mental energy on damage control. The work is still demanding, but she's getting her arms around it.

That's Enabling Conditions—recognizing your environment profoundly impacts your ability to thrive. She didn't change her job. She changed the conditions she was working in.

A quality manager blocks the first hour of her day for deep work—no meetings, no email. A case manager rearranges her desk so she's not facing the hallway chaos. An IT director stops scheduling important decisions for late afternoon when his brain is fried. A nurse takes a centering breath before entering each patient room, creating a transition between the chaos outside and the patient inside.

Same principle. Different applications. Each person shaping the conditions they need.

Prudent Congruence

A nurse with young kids stopped volunteering for every extra shift and committee. For years, she'd said yes—partly because the unit needed help, partly because she wanted to be seen as committed, partly because she didn't know how to say no without feeling guilty.

But she was running on empty. She'd come home too drained to be present with her kids, too exhausted to enjoy the time she'd been trying to protect by working so hard in the first place. The math wasn't working.

She set boundaries. She didn’t apologize for them. She protected family time without explaining or justifying. It felt uncomfortable at first—like she was letting people down.

But here's what happened: Her effectiveness at work improved. She showed up more focused, more energized, more capable. She was a better nurse because she wasn't depleted. The boundaries she set to protect what mattered personally made her better at what mattered professionally.

That's Prudent Congruence—thoughtful integration between your professional work and what matters personally.

A change management consultant stops checking email after 7 PM, creating space for the hobby that keeps him sane. A physician protects one evening a week for dinner with friends, recognizing connection matters more than staying late for work that can wait. A project director takes her vacation days instead of stockpiling them, returning recharged instead of burned out.

Not balance. Integration. Creating coherence between work and life so neither destroys the other.

Social Support

A pharmacist was drowning. The work was relentless, the politics exhausting, and she had no one to talk to about it—at least no one who understood. Her friends outside healthcare meant well, but they didn't get it. Her colleagues were in the same mess, too overwhelmed to process anyone else's struggles.

She needed something different. Not therapy. Not venting. A place to think out loud with someone who understood healthcare but wasn't in her immediate situation.

She reached out to a colleague from another hospital—someone she'd met at a conference and liked. They started having coffee once a month. Those conversations became essential. A place to process challenges, test ideas, remember why this work mattered. The person wasn't solving her problems. But the connection sustained her through them.

That's Social Support—your network of relationships, both professional and personal, that nurtures your resilience and success at work.

A project manager joins a virtual community of healthcare ops people who share what's actually working. An HR VP finds a mentor outside her organization—perspective without politics. A physician starts having lunch with a colleague from another department, building a relationship that becomes crucial later. A nurse gets involved in unit-level improvements, finding purpose in collective problem-solving.

Not just networking. Connection. Relationships that remind you you're not alone and help you stay grounded in what matters.

These aren't five separate things you need to master. They're five principles of a work experience worth having. Sometimes you're working on one, sometimes another. Sometimes they overlap. Sometimes one leads to another.

The Practice

So how do you actually take action on these five dimensions? That's where the practice comes in.

The practice centers on a method: Notice. Explore. Try a Change.

Notice what's happening—within yourself, in how your organization operates, in how people work together. That Sunday night dread. The meeting that drains you. The work that feels pointless.

Explore what you've noticed with curiosity rather than judgment. Why does that meeting drain you? What about this work feels pointless? What would make it better?

Try a Change based on what you've discovered. Small. Specific. Something you can control.

Sometimes the change works. Sometimes it doesn't. Sometimes you need to try three different things before something shifts. Sometimes one change opens up possibilities you didn't see before. And sometimes your work experience improves just through noticing and exploring—understanding what's happening changes how you experience it, even when the situation itself doesn't change.

That's how The Good Work Life happens. Not all at once. Not perfectly. Consistently, over a career, in moments that compound.

Five Minutes at a Time

Now here's what it takes to work that method: five minutes.

Five minutes in the car before you walk into the building. Five minutes at your desk before the day starts. Five minutes during lunch when you'd otherwise be scrolling.

Here's the thing: you're already spending more than five minutes on workplace shittiness. The Sunday anxiety. The complaining with colleagues. The mental energy spent navigating frustration. That time is already spent—often unproductively.

So yes, The Good Work Life is one more thing. But it's redirecting time you're already spending toward something that can lead somewhere better.

Think about how you planned this vacation. You didn't book everything in one marathon session. You thought about destinations over morning coffee. Researched flights during a break. Asked friends for recommendations. Small actions accumulated until you had something you were excited about.

The Good Work Life works the same way. This isn't something that happens through a weekend workshop or a single afternoon of professional development. It's about developing capacity over the entirety of a career. 

Five minutes at a time.

That’s the commitment. Not to a specific activity, but to the time itself.

It’s enough time to notice what you're feeling, understand why a meeting drained you, reflect on whether your work aligns with your mission, or decide on one small change to try. Stack a few five-minute moments together and you can work through deeper exercises like getting clear about what mission you're on.

The point isn't perfection. It's not about doing everything. It's about claiming five minutes and letting it grow into something that serves you over the rest of your career.

This is how you work The Good Work Life.

The Fresh Start Guide

When you're back at work and ready to begin, the Fresh Start Guide is waiting for you.

It delivers a checklist of encouragements—five-minute moments to develop the work mindset. Reflections. Guidance. Prompts. What you do with it adapts to where you are. You decide what works for you and when you're ready for more.

You can find it here: [Dear Reader: I’ll share it here first.]

Everything you need to begin is there.

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Organizational approval isn't required to begin. You don't need your boss to sign off. HR doesn't need to be involved. You can just start. Right where you are. That's all the permission you need.

And … getting started can wait until your return. Because I want you to get back to your vacation … after these last few thoughts.

Here's something I've learned: everyone is making it up as they go. Your difficult colleague, your overwhelmed boss, the executives making puzzling decisions—they're all navigating the current environment, sometimes not all that well. This isn't failure. It's the reality of working in complexity, uncertainty, and constant change.

Another way of saying making it up as they go is: making sense of an always-changing world.

Once you internalize this … it's easier to approach workplace challenges with curiosity instead of resignation. You can look for possibilities instead of just problems. You can give yourself permission to try a change.

Yes, it's completely reasonable to be critical of workplace shittiness. And definitely go to happy hour to vent. But when that criticism becomes automatic negativity—when you're closed off to any possibility of improvement—you've already eliminated any chance to make it better.

We're not ignoring reality. We're not pretending individual effort is the solution to systemic problems. But we are taking action on what we can influence.

The Good Work Life starts with a simple choice: Are you someone who notices what's possible?

21

I started by asking the question I've asked so, so many healthcare pros like you: "How's work?", and chances are your answer revealed potential for something better.

Here's what I hope you now realize: that answer doesn't have to be permanent. It can change through intentional choice.

Work can be what you want it to be. 

Not because the next job is going to be the perfect one or because your organization finally sees the limitations of industrialized management, or because you finally implemented the perfect resilience practice, but because you can actively shape your work experience with The Good Work Life.

And when we meet and have our own "How's work?" conversation—your answer can be different. 

That work is now yours.

Thanks for reading. Hit reply and let me know your thoughts.

How To Work is healthcare-focused work design inspiration (from the experts!) to nudge your perspectives and practices into better alignment with the world of work as it is, and away from what it was. Here’s my take on what we’re working through.