You have probably heard of Burnout, but have you heard of the Healthcare Hangover?
What’s a Healthcare Hangover?
A Healthcare Hangover (HH) is the precursor to burnout. It is the ensuing tidal wave of fatigue, brain fogginess & irritable mood that hits you after a shift of giving your whole body, mind, and spirit to taking care of your patients.
Like a check engine light- a HH typically heralds the approaching limits of your individual mental and physical bandwidth as well as your ability to mitigate and compensate for the demands of increased intensity of work on your person.
A HH is a compensated state, but not for long.
To continue working with a HH is like driving on E. It may have a direct impact on the quality & quantity of your work going forward and may signal impending physical and mental decompensation.
Consider the Health Care System
In the business of healthcare, healthcare worker recovery and well-being are not worked into the business model.
Healthcare workers are routinely asked to continue to work with that check engine light on indefinitely.
Can you imagine taking a cross-country road trip with an empty gas tank? Nobody in their right mind would do that. Yet this is exactly what many healthcare workers are asked to do day in and day out.
So if we won't do it to our cars- that for all intents and purposes are not even alive, then why is it normal to do it to human health care workers?
How Did We Get Here?
When thinking about how we got here, I first considered all the abnormal things that are normalized in healthcare work.
Starting with the time that we spend at work.
Health Care workers’ hours worked are not equivalent to everyone else’s.
In a typical non-healthcare setting, employee fatigue is arbitrarily measured by hours worked without considering the degree of difficulty or intensity of the work, right? For most of the world, 40 hours = full-time hours no matter how you slice it.
This means that the number of hours someone works lets' say in an office setting, is directly proportional to the level of perceived fatigue your employer will take into consideration when setting expectations for your work schedule.
In health care, however, things are vastly different for health care workers.
First, imagine if the standard shift for someone working in an office was 12 hours. Right off the bat that sounds kinda inhumane, right? The image of a sweatshop comes to mind.
Yet for many of us health care workers, a 12-hour shift is just regular life.
Also consider that For us healthcare workers, hours worked and fatigue are not always directly proportional because the intensity and difficulty of the work we do may vary greatly from day to day or even patient to patient. That's not even considering the nature of the psychological effects of caregiving work when dealing with humanity at its veritable worst.
Yet, in terms of hours worked, it seems we are held to the same standards of perceived fatigue as the rest of the world’s workforce. A standard 35-40 hours is still considered full-time in healthcare today, without any regard for intensity, mental fatigue, or emotional toll.
There is also the element of the emotional toll that cannot be quantified. This comes into play when working in a setting such as healthcare, especially in the backdrop of a global pandemic, where we are routinely exposed to potentially traumatizing situations that when normalized have the potential to cause unfettered moral injury to our workforce.
Surely the inability to process the degree of morally injurious things we see working in healthcare these days can't be good for us in the short or the long term, right?
Hallmark Signs of HH
Working as a PA in a high-stakes specialty like Cardiothoracic surgery, I have developed the awareness that I am just one grueling surgery or one bad night of call away from being knocked on my proverbial ass.
Similarly, if you have been working in healthcare for a while you may also know the exact recipe of cumulative elements that have to come into play in order for one shift/patient/scenario to also knock you on your proverbial ass and land you in a HH.
What I have noticed, and you may have too, is that there is a pattern of behavior that lets me know that I have reached the limits of my ability to cope with my work.
A HH may also look like something like this for you
Leaving work in a daze
Sitting in your car for a long time after work because you’re too tired to drive or engage in your own life after work
Severe brain fog and having difficulty making simple decisions like whether you should shower or eat first or being utterly unable to decide what to eat. I once drove north instead of south on the highway after a particularly distressing day of losing a young patient on the OR table. I didn’t realize I was heading in the wrong direction for 20 minutes.
The inability you follow through with plans after work like working out, returning messages, house chores, or keeping deadlines.
Inability to be emotionally available to anyone, even significant others or family. This can be especially hard on relationships because when you get home they want to vent to you and you don’t have the capacity to follow along, much less give them attention or validation.
Feeling guilty about not doing enough outside of work because you feel like your personal life and responsibilities outside of work are always falling behind
Feeling the need to dissociate after work with mindless scrolling, binge-watching television, sleeping excessively, or relying on recreational drugs or alcohol to relax
You’re highly irritable after work and intolerant to any additional stress even what you may consider minor stress regularly. It’s not uncommon to have overreactions to added stressors. You may even find yourself being necessarily mean, cynical, or passive-aggressive with others for no clear reason. I once threw a laundry basket across the room when I got home because it felt like the universe was punishing me with laundry after a rough day at work.
You may have a difficult time identifying what the problem is, why you feel that way and how to make it better. The source of your fatigue and irritability may be a complete mystery to you, since you may have never been taught to evaluate or consider your own needs as is the case for many people in caregiving work.
Every felt any of these?
HH is Different than Burnout
The key difference between the two is the ability to recover and the state of being in a compensated vs decompensated state.
With a HH you are approaching decompensation but not yet decompensated. With quality rest, you should be able to recover from a HH to your baseline energy levels and mental acuity within a few days.
With burnout, there is an inherent inability to recover even with quality rest, the fatigue and HH symptoms persist long term. It’s almost like you remain in a permanent state of HH.
When hallmark signs of HH persist long-term they may even present with chronic physical symptoms like headaches, GI problems, and other somatic signs of prolonged exposure to stress by which you can no longer compensate for.
How to Recover from a HH
Allowing for a full recovery of a HH is key in completely preventing Burnout/Compassion Fatigue/Moral Injury.
Especially now with a pandemic, many of us may feel like we do not have a choice in when or how we get to recover.
We may even feel guilty, selfish or like we’re abandoning the team. This is not uncommon. From early in our training We have been conditioned to believe that as well as punished for taking or blatantly denied time off.
Recovering in the Short Term
First Get to know your Healthcare Hangover Rate of recovery (HHRR). This is the amount of time that is takes you to return to your baseline mental and physical state after a draining shift or shifts.
The timing varies from person to person and shifts to shift so the exact amount of time doesn’t matter necessarily as an absolute, as much as having intimate knowledge of your own rate of recovery as well as what levers to pull to get you there.
It can be subjective, but I like to note the time when I begin "to feel human", after allowing myself to recover from a HH. This typically heralds my need to shift from passive recovery like sleep, rest, and optimizing my basic human needs, to more active forms of recovery like body movement, self-care rituals, and play.
The next time you have a HH, notice the amount of time it takes you to get back to your baseline energy levels (willing and able to return to intense work again) with quality uninterrupted rest whatever that may mean for you.
For me, I’ve noticed it takes me about 3 days to fully recover from one bad night of call.
For me the first 2.5 days are spent at home in comfy clothes, maximizing sleep and minimizing decision fatigue by limiting myself to making binary choices when the decision fatigue is at an all-time high.