Snow? Flood? When is it OK to miss a shift?

Dear Director,
During a blizzard last year I couldn’t get in for a shift and I caught a lot of grief from my medical director about it. What’s my responsibility and what should I do if it happens again?

I feel your pain, but unfortunately, regardless of the weather, the shifts still need to be covered. Part of what separates health care workers, and in particular, emergency physicians, is that when disaster strikes, we run towards it, not away.  Everyone who works in a hospital knows that the ED is always open and the community and hospital leadership expect us to be staffed. It’s part of why I got rid of my sports car during residency and bought an SUV. Getting stuck at the hospital once was enough for me.

Part of our mentality as emergency physicians needs to be that we’re going to get to work to do our shift regardless of what else is going on. During one storm, I was called by a doc an hour before he was due in for work.  He said the weather was too bad and he wouldn’t be able to get in. When I asked him what he suggest happen, he was silent, waiting for me to offer to do the shift. If you can’t get there or you think it’s too dangerous to drive, why is it better to make someone else do it?

When you work in a 24/7 business, you know there will be personal sacrifices. You will miss your share of holidays, parties and other events. That sense of sacrifice – which we all signed up for and which makes the emergency department tick – has to be stepped up even higher in a natural disaster. Unlike planned events, these often require more time or even extra shifts in the hospital. That means sacrificing time with our families, the ability to care for our homes (shoveling out the driveway may not be fun but is a necessity), taking risks on dangerous roadways – all of which can take its toll on our households.

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Priorities
“I can’t make my shift in an hour because  . . . I have rotavirus, my kid was in an accident, my father had an MI, my wife is in labor, etc…” These are all fully acceptable to me for missing a shift and passing on the responsibility of finding coverage to the ED director. Since we all put our family first – and occasionally our own health – these types of problems are the perfect reason to have an on-call list for the group so that there is a clear person available and responsible to cover a shift in an emergency. But at some point near the top of  your priority list, you must include work and the team that you work with. Successful EDs are based on teamwork which requires an underlying sense of commitment and dedication to the job and each team member. There is certainly a time for putting family first, but be careful of what constitutes an emergency and be sure to have plans in place for the non-emergency situations (sick child home from school, etc…).

Responsibility
I was working a shift when my relief called me 30 minutes before shift change to say that a micro-tornado had blown through his neighborhood, knocking down several trees including one that blocked the only road off the small peninsula he lived on, and therefore he wouldn’t be coming in. It was a pretty reasonable excuse, but as he was laughing at the reason he couldn’t get to work, he was also passing on the responsibility of finding my own relief while continuing to see patients and wrap up the active patients that I had (we did not have an on-call schedule at the time). Once the schedule is out, you own your shifts. In this type of situation where you can’t get in, you should be making your own phone calls. Furthermore, weather emergencies, be it hurricane, blizzard, or wind storm, rarely pop up without warning. If you know it’s going to snow six inches overnight, get up an hour early to deal with the delays.  If you know it’s going to snow 15 inches in the eight hours before your shift, go into work that much earlier while the roads are OK.  Last winter, I had one doctor walk two miles to a car rental company because his road likely wouldn’t be plowed for several days and he couldn’t get his SUV through the three feet of snow on his side street.  Maybe he was dedicated; maybe he just didn’t want to lose pay for three days. But he did make his shifts. That’s taking shift ownership to a whole new level. One key element was this doc’s awareness of the limitations around him, namely his town’s inability to plow side streets in a timely manner. Limitations might relate to your personality, your car, your lifestyle or your distance from work. The more aware you are of these factors the better off you’ll be in an emergency.

In closing, we have an important job.  Our doors are always open, regardless of the emergency and or the environment. Without commitment, dedication, sacrifice, and teamwork, that is not possible. I don’t believe that everyone should own a Humvee to get to work, but I do believe that it’s important to recognize that we must plan ahead so we can get to work, we must take ownership of our shifts, and we must also recognize that work (i.e. shift coverage) must be one of the top priorities in our life.

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