How often do you walk into work hoping it will be a good day or at least not a bad one? What if it didn’t matter what happened and the good/bad was entirely in your control? In today’s episode, Christina Shenvi MD, MBA, PhD gives insight and specific strategies for a nearly perfect shift.
Guest Bio: Christina Shenvi MD, MBA, PhD is an emergency physician at the University of North Carolina, Chapel Hill. She is president of the Association of Professional Women and Medical Sciences, director of the UNC Office of Academic Excellence, and a world-class time management coach www.timeforyourlife.org. A selection of her previous Stimulus episodes includes Procrastination, Habits, and ‘Too Much on My Plate.’
Registration is now open for the Flameproof Course
Scott Weingart and I are launching the FlameProof Course in September 2023. This is a small cohort six-month course specifically for emergency and acute care clinicians that will build and strengthen tools for career longevity, strategies for well-being, life balance, and so much more. Learn more on the brand-spanking new website.
If you’re interested in 1 on 1 coaching: Start here
Mentioned in this episode:
We Discuss:
How do you define a nearly perfect shift?
If it’s all about things that are out of your control, then it’s up to fate and fortune how your shift turns out. You have no agency.
If it’s about how you approach the day, then you DO have agency.
Identify where you do and don’t have control
Where you do have control is your thoughts, judgments, opinions, and initiation of action.
When you relinquish control of trying to control other things that you can’t, you can be more fully present and ahvet agency, t calm, and not be frustrated by external things.
What to do when you can’t get something done or things don’t go your way.
Example: It’s 2am and you are ready to discharge a patient back to the nursing home (from where they originally came). The nursing home says they can’t take the patient back for another 8 hours (or won’t take them back at all!)
Acccck! Why can’t they come pick up their patient? Why is this my responsibility to hold this bed?
It’s natural to feel frustration, but what we do with that frustration is the secret sauce. Do we ackboledge the feeling and accept the situation or keep perseveating on how unfair this is?
We can’t change that circumstance. No banging of our heads will change that circumstance, and yet mentally we, we try to control it by perseverating, by continuing to grumble about it.
Reframe it considering what is and isn’t in your control: This nursing home’s staffing is outside my control. There is no longer any effort that I can put in that will change that circumstance. So instead, I’m going focus on my own thoughts. My thoughts are going to be, “Despite having this bed tied up, I will maintain presence, or I will continue to do the best I can with the resources that I have.”
This doesn’t mean suppressing the thoughts or emotions. Doing that will paradoxically make them even more potent
Why do we experience frustration?
Discordance between how we want to care for patients and what the system will allow.
Misalignment of aspiration and expectation.
Powerlessness
The irony of power and powerlessness
We try to control things that we can’t, and relinquish control of things that we can.
We bang our heads against reality, trying to change things. We can’t. And yet we give away control of our own emotions or our own thoughts, and allow other people to unduly influence them.
Happiness and freedom begin with a clear understanding of one principle. Some things are within our control and some things are not. It is only after you have faced up to this fundamental rule and learned to distinguish between what you can and can’t control, that inner tranquility and outer effectiveness become possible.
Epictetus
Point of care frustration reversal
Shift from ‘what if’ and catastrophbizing to ‘what’s next?’ Identify ‘what’s next’ in the sequence of events.
Consider how you’ll think about this in a week
Try to view the situation from the perspective of an astronaut in space. How important does it seem?
Even out your standard deviation and raise your mean
Imagine a graph with each of your shifts plotted on the vertical axis, how good it was.You would have some day-to-day variation, maybe some that are really bad, maybe some that are great, but it would average out to an even line. And there would be some variation. So that’s your standard deviation. How much day-to-day do your shifts vary?
By definition, always 50% of shifts are going to be below average. But the question then is, where is your average?
You’re going to have shifts that are below average, but what can you do to raise your mean? And then also what can you do to even out your standard deviation, meaning less variability so that you don’t walk in thinking, is today going to be great? Is today going to be terrible?
The goal is to have more control so that you have less variability. You what you’re getting into because you’re the one bringing it.
Mental contrasting with implementation intentions
Pre-planning for anticipated obstacles with a WHEN – THEN statement. Create a habit by pre-planning for the day.
When I feel myself spiraling out of control and getting crazy busy, then I will remind myself to b present, or take five 4-7-8 breath.s
When I feel myself getting annoyed, then I will draw a circle and put what is in my control in that And then afterward, when you look back and ask, “Was that a good or bad shift?” Owning that. If that was a bad shift, that’s on me. If that was a good shift, great. Maybe that was on me too.
If our goal is to feel calm, collected, managed, present, and the reality is we feel frustrated, angry overwhelmed, et cetera. When the waiting room rapidly fills with patients, then I will huddle my team to triage priorities and tasks.
When I start to feel overwhelmed, then I will remind myself that my shift ends in three hours.
Be careful how you are talking to yourself because you are listening.
Lisa Hayes
Be Water
Bruce Lee was frustrated, trying to figure out the core philosophy of the martial arts.
He was sitting by a lake and (probably in agner) punched the water.
As he saw his hand enter the water, he found the secret. Water will adapt. If you put water in a cup, it becomes the cup. If you put this water in a bowl, it becomes the bowl. But water can get into any crack. Water can overcome any obstacle. So in whatever situation, be water, be flexible and responsive, and form your response to what’s happening.
You don’t have to try to bend reality to your will because you can be flexible and become whatever the reality needs.
Identify the opposite outcome
What is the exact opposite of what you want to happen?
What are the barriers that you have in place to prevent that outcome?
Exaple: the outcome we don’t want is to be flustered, distracted, and ineffective
Barriers to that: our training, an excellent team, ability to adpatt to challenges, continual learning, our ability to maintain calm and presence.
Change your own mind
When we’re in situations of feeling powerless, we can’t change this external circumstance, the only thing we can do is change ourselves.
That thought of ‘everything’s gonna go to crap and everything’s crazy right now.’ is just a thought. That’s not reality. We can create a new thought, which will create a new reality.
Our actions may be impeded, but there can be no impeding our intentions or dispositions because we can accommodate and adapt so we can change.
Marcus Aurelius
Don’t minimaize but also to maximize
There is real suffering and tragedy, but a lot of what distrubs us in our day-to-day lives are the small things.
The longer we dwell on our misfortunes, the greater is their power to harm us.
Life is thickly sewn with thorns, and I know no other remedy than to pass quickly through them.” – Voltaire
Life is thickly sewn with thorns, and I know no other remedy than to pass quickly through them.
Voltaire
Kevin McLendon says
There is talk about the things we cannot control on shift, such as system issues. Many of us have more power to effect change than we give ourselves credit. I think there is a very important distinction we must make. What can I control – in this moment. Can you fix the NH patient hold in the ED right now, no. Can you potentially work on the macro system at a later time or a well timed example to leaders about how this issue is a hinderance in patient care or goals (i.e. throughput etc.) accompanied with a suggestion on how it can be remedied. Don’t fret over the here and now, but don’t just accept the issues as they are, and keep some of that energy and use it to make the biggest impact we truly can within our systems.