NurseWeek: Tangled up in the blues

Tangled up in blues
How nurses cope with the pressure of the holiday season

By José Alaniz
December 18, 2000
Photos: Photo Disc

Many caregivers report one effect of the season they do find difficult to cope with: Tragedy feels all the more tragic during the holidays.


	You've read the article. Now tell us what you think. Related Sites Avoiding Holiday Depression and Stress Tips on avoiding holiday stress from the Mayo Clinic Coping with holiday stress Happiness during the holidays doesn't necessarily depend on marital status. The most important factor in helping nurses cope with the holiday crush, say nurses and managers, is a work schedule that treats everyone fairly. "Relationship status is not as much of a factor. I see mothers working busy schedules, having to get a lot done, and I see singles doing the same thing," said Sandra Davis, Ph.D., RN, director of ambulatory care services at San Joaquin General Hospital in Stockton, Calif., and president of the Association of California Nurse Leaders. "Certainly, traditional staffing models in the past, which considered only seniority, have had a negative impact, but today we need a team plan, something fair and firm. Most staff members know by July what their holiday plans are. The 12-hour shift allows flexible schedules. By planning ahead, we can enjoy ourselves during the holidays, not crunching numbers and schedules in a panic two weeks before." Being single may actually have been a plus during the holidays in the past, said Linda Hidalgo, MA, RN, who works in the obstetrics and gynecology ward at Kaiser Permanente Hospital in Westminster, Colo. "When I was starting out as a nurse 20 years ago, and I was single, I felt like the holidays were actually more of a time when I got to do real nursing," Hidalgo reminisced. "We would send a lot of people home, so I didn't have to scatter myself out over 40 patients. I could give more of myself and my time to the patients who were there, and to my colleagues. It was more relaxing. It is busier now, though." Those were the days. Still, a few simple ideas can help smooth out the demands of the season. Hidalgo suggests making nutritious snacks such as nuts and fruit available in the work area for energy boosts and general well-being. She also recommends taking a day or a week off before the holiday crush gets going. Making the workplace more festive with decorations and parties helps, too. But Hidalgo, now married with children, is not the gift-buying type. She therefore cautions against any formal gift exchange at the office. "That's just more stressful," she said. For the more consumption-inclined, Donna Anderson, LCSW, director of social services at San Joaquin General Hospital, has these suggestions: -Make shopping lists well ahead of time. Budget for each item and stick to the list. Family craft projects are a less expensive and social way to give presents. -Ask your hospital to hold stress-management workshops on-site, at which staff can learn techniques to deal with mounting pressures. -Be realistic. Don't overextend yourself with commitments or spending. -If you feel lonely during the holidays, try volunteering. Lots of community and charity groups could certainly use your services. -Don't forget to take care of yourself, maybe with a special bath or meal. Caregivers tend to serve others until they're wiped out. Not good. -If you have lost someone during the year, the holidays can be a sad time. It's OK to feel that way. Seek the support of family, friends or the church. -At work, have a tranquil place you can go to every once in a while for a few minutes: A patio, the roof, the chapel. Reflect on things or just relax. Recharge your batteries before jumping back into the craziness. "Another source of depression during the holidays is unmet expectations," Anderson said. "Your holidays as a child may have been very disappointing, so you are determined to have the 'perfect Christmas.' I am sorry to tell you there is no such thing. What you can do is begin your own holiday traditions that fit your lifestyle and have special meaning to you." ~José Alaniz

Beth Haden, RN, clinical manager at Childrens Hospital Los Angeles, remembers well the scene from a Christmas past.

"We'd had trouble finding this family, since they moved around a lot. When we found them, they were living in a converted one-car garage-eight or nine people, including grandmother and kids. And having to deal with a chronically ill child … I mean, these are the kinds of people who need Christmas."

Thanks to the hospital's Elf program, they get it: toys, clothing, furniture, trips to Disneyland-up to $600 worth of Christmas cheer. Now in its seventh year, the staff charity drive has gone from serving a handful of patients' families to more than 230 families. They "adopt" a family, find out what's on their wish list and set about procuring the items through donations, hand-me-downs or by their own resources.

A joint venture between nurses, social workers and the community, the Elf program serves as a model of what caregivers can do to experience the true meaning of the season.

"It gives you great perspective," Haden said. "It's all about giving to someone else. Frankly, it increases holiday stress, but it's good."

Giving to the needy
Years ago, Haden instigated the program. "It's grown to the point where employees would be disappointed if we stopped the program," said Mary Dee Hacker, MBA, RN, vice president for patient care at Childrens Hospital Los Angeles. "Rather than give potpourri or candles to a co-worker, it seems more humanitarian to give to a needy family. It brings us back to the basic purpose of the holidays, which is giving."

The season of Christmas and other year-end festivities-including Hanukkah, Kwanzaa and the winter solstice–are supposed to be a time for warm family gatherings, gift–giving and a general sense of well-being. That is, unless you're not at home to celebrate these special occasions. Work schedules can induce feelings of guilt and loss among nurses cut off from those Norman Rockwell scenes.

As expectations rise, the time for meeting them may shrink. The holidays often end up being about stress: pressure to get the shopping done on time, to arrange family get-togethers, to survive the family get-togethers. Then, there are the pressures to manage personal and work schedules, to get it all done perfectly and, of course, to look fabulous.

Add to that pressure the sorrow of illness and tragedy at a time when society emphasizes the positive, the surge of flu patients and the need to cover every shift, and you might find more than a few nurses looking askance at the "holiday joy" messages.

Some have found ways to diffuse the dark feelings that are liable to arise during the winter holiday season by participating in toy drives, warm-clothing drives and projects such as the Elf program.

Nurses, who are used to organizing their time well, are one up on most people for handling holiday stresses, despite all the obstacles, said JoAnn Appleyard, Ph.D., RN, a San Francisco consultant on ambulatory health care systems. "In times of personal pressure, nurses have training and lots of experience in dealing with other people who are undergoing stressful situations," Appleyard said.

"Nurses know how to temper aggravation, so often they have a personal toolbox of coping strategies for the holidays. They're used to organizing their time and having to deal with multiple priorities," she said.

Still, there are everyday concerns. While nursing shortages and family needs make it more difficult to meet staffing goals, planning ahead and remaining flexible can work wonders for everybody.

"The worst thing you can do is ignore the fact that the holidays are a different time, and that nurses have particular needs and stresses. To be insensitive to that is a mistake," said Richard Brock, MA, RN, nurse administrator at Northridge Hospital Medical Center in Van Nuys, Calif. "The last thing you want to do is put out a time sheet and that's it, not allowing people to make changes or request days off, essentially saying, 'If you don't like it, lump it.' "

Some hospitals have policies against taking vacation between Christmas and the New Year to avoid short-staffing. Others offer incentives such
as bonuses for working extra shifts. However, Brock and other managers insist that good planning can achieve the same effects, without ruffling anyone's feathers-and it can promote team spirit.

"We work it out months ahead of time: Who wants what days off, who has seniority, such as 'I had this holiday off last year, why don't you take that day off this year and I'll work it,' that sort of thing," said Linda Hidalgo, MA, RN, who works in the obstetrics and gynecology ward at Kaiser Permanente Hospital in Westminster, Colo.

"Sometimes the older nurses take all the holidays, but I suppose seniority has to count for something. At the same time, I feel the process should be collegial, with more give and take."

Working a holiday is not without its perks, such as sharing free food and developing camaraderie.

"We bring in turkey, decorate the ER for Christmas, dress up in Christmas attire. One consolation of working a holiday is that at least you're with your 'second family,' " said Eileen Longoria, RN, an ER nurse at University Hospital in San Antonio.

"Nobody's pissed off unless they're working on a day they really wanted off. But that's why we organize the schedule or trade shifts to make sure everybody's there by choice that day as much as possible."

Unavoidable stress
Many caregivers report one effect of the season they do find difficult to cope with: Tragedy feels all the more tragic during the holidays.

"We had five kids, aged 17 to 21, come in on Thanksgiving after a car accident," Longoria said. "They'd been driving drunk. One of them died. It was horrible, and much more sensitive on that day dealing with the family, because we knew they would associate the holiday with this for the rest of their lives."

The holidays are a time of such added and unavoidable mental stress, Hacker agreed. "We send our children home for the holiday if we possibly can, because it is unpleasant for everyone, caregivers and parents alike, to deal with something so sad when the culture tells us we should be concerned with poinsettias and tree ornaments."

These cultural demands, shouted out at us from television programs, storefronts and those around us, are at the root of much of the season's stress. For single, divorced, widowed or bereaved nurses, the holidays can seem oppressive–a season when society allows little space for personal pain and loneliness. It's no surprise, then, that depression, drug and alcohol abuse, and even suicide rates spike during the holidays. Nurses are not immune to these ills.

For many, not fitting into some ideal image of the season produces intolerable anxiety, said Donna Anderson, LCSW, director of Medical Social Services at San Joaquin General Hospital in Stockton, Calif., who has counseled troubled staff members, including nurses.

"I would have people come in during the family holidays telling me that they felt stressed because their mother needed to go into a nursing home, or their drug-dependent brother was having an episode, and they had trouble coping at that particular time. That sort of ugly stuff seemed even worse, because they just wanted everything to be OK for the holidays.

"The culture tells us how we should feel in this season, that we should be in a couple, or with our families holding hands around the fireplace, exchanging gifts. But of course it's not that way for a lot of people.

"In fact, some call the holiday season the 'Black Days.' They would tell me that [they] start around late October with Halloween, the first holiday, and just go downhill from there. 'Oh, now I'm going to have to go through Thanksgiving,' they would say, and then Christmas. And, of course, they saw New Year's as the worst day of the year.

"It's important that we understand that some vulnerable people, for many different reasons, see this time of year in that way."

Employee assistance programs at many hospitals can help with counseling and referrals to psychiatrists, Anderson said.

One final solution for Christmas stress: Just opt out.

Elizabeth Ochs, MSN, RN, who works in a San Francisco hospital, said the holidays do not stress her out inordinately, partly because, as a practicing Jew, she does not share the religious traditions of Christmas.

"I don't feel the stress like Christians, or all those people shopping around me," Ochs said. "Hanukkah is not a big major holiday; it's really more for kids, and the gifts are not so extravagant. Some people are just horrified if you don't celebrate Christmas, but when I see all those people at Macy's going crazy, I'm glad I'm on the periphery."