Every holiday season the radio waves are filled with the crooning voice of Andy Williams singing that famous Christmas song, "It's the Most Wonderful Time of the Year." The notes ring out, and the words of the song remind us that this is "happiest season of all." Except, I don't think Mr. Williams ever worked in an operating room...
In the OR, this time of the year is busy. It's stressful. There's a mad rush on to pack in as many cases as possible before the end of the year, and our schedules are stretched to the max. The witching hour is upon us, and January 1 is right around the corner when insurance deductibles will be reset. Understandably, patients rush to have procedures completed while they can afford to have them done. How often do we hear, "I'd already met my deductible for the year, so I decided to get this procedure done before the year was over."
The busyness takes its toll.
The dread that builds up inside of us is tangible as we watch our caseloads grow past the point of anything realistic. And yet, the cases keep coming, and the add-ons get worked in wherever they may fit . The call team is suddenly tasked with finishing scheduled cases late into the night, and late shifts are just the norm for all of us as we try to get cases finished each day.
We notice an uptick in cases as the year comes to a close, with a steady rise in case volumes during the 4th quarter as we push toward the end of the year. This isn't anything new. We all know what's coming - extra shifts, requests for volunteers, late days, long nights, weekend shifts, and a marked lack of holiday spirit as we trudge through "the most STRESSFUL time of the year."
Which brings me back to that famous song, and why I find it ironic that it's the theme song to a season that is so hard for so many of us. And really, it's more than just the OR. This season can be hard for anyone working in healthcare, and what about retail workers? Honestly, I'd rather work a crazy day in the OR than deal with angry shoppers for 12+ hours...
I've never worked retail, so I can only sympathize and imagine the stress retail workers endure during the holidays. I have, however, worked in the OR and worked in Med-Surg during this time of year. It's exhausting, stressful, and frustrating. And when you're experiencing any of those emotions, or all of them at the same time, it's really hard to find any of that Christmas spirit or joy that the holidays are supposed to bring.
Since we can't reschedule Christmas for January, though I've often wanted to, and since deductibles frequently drive when our patients have their procedures, how do we deal with the stress of the season? How do we handle the crushing case loads, the exhaustion, the fatigue, and the frustration?
First, I think acceptance is important.
The fourth quarter craziness is part of working in the OR. That doesn't make it ok, but recognition of how the cycles flow in the OR helps us to manage our expectations. The first quarter is generally slow, holidays are always associated with trauma cases (the Fourth of July + fireworks = multiple hours of trauma call for hand surgeons, for example), summer brings an influx of cases as patients work in surgeries between the school year, and the 4th quarter brings the mad dash to the finish line before everything starts over again.
It's GOING to be crazy. Face it head on, get through it, and I promise it will slow down again.
Second, plan accordingly.
Leadership needs to plan for the hectic pace of the holiday season. We know that just like the holidays come with surprising regularity, so, too, does the busyness of our ORs. It happens every year; it's not a surprise. Our staffing models should accurately reflect the workload and the case volumes. With the current staffing crisis we find ourselves in, this is even more challenging. Ask for volunteers early, so staff can plan. Offer incentive and shift differentials for those who are willing/able to work extra. Be prepared to throw on some scrubs and help out when everything hits the fan and your team needs help.
Planning is important for our personal lives as well. It's not always possible to make it to Christmas parties or other events that we may want to attend. Family and friends often don't understand why we "can't just take the day off" or why we can't guarantee what time we'll be able to leave work. It's frustrating to miss parties and other events. Check your calendar early and swap shifts with a friend if there's an event that you just can't miss. Find someone to cover for you so you can leave early, and then return the favor when they need help. Asking early and planning ahead is much more likely to work out than waiting until the last minute, so check your calendar early and often to make sure that you can get coverage if you need it.
Take care of yourself.
I know we've all heard it a thousand times, but you have to take care of yourself if you're going to be able to take care of others. We spend our work days exhausted, slightly dehydrated, and running on too much caffeine, I know. However, whenever possible:
Go to bed early
Enjoy a hobby
Spend time with family and friends
Talk to a friend, counselor, or religious advisor to process feelings and stress
We can reduce the stress we're experiencing, give our bodies the nutrition they need, and focus on what's truly important in our lives when we take the time to take care of ourselves. As a side note, the extra money from an overtime shift is not always worth it. It's not worth it physically, mentally, emotionally, or spiritually. Remember that when you're asked to cover a shift. It's OK to say no. It's OK to prioritize yourself. If you don't take care of you, no one else will, and you won't be able to keep running on an empty tank.
The end of the year is fast-approaching.
The holiday season is in full swing, case volumes are reaching their max, and the mad dash has begun. Accept the crazy, plan accordingly, but most importantly, take care of yourself.
You can do this.