Use my busy work schedule to my advantage.  I have stress-eaten too many times while at work, grabbing unhealthy snacks in between appointments and surgeries to keep me going.  I thought that I needed the extra sugar and fat to keep me from feeling hungry during the day.  This was a bad habit that set in after I took an exercise and nutrition program at a local gym many years ago.  I was cautioned at that time to eat small portions no more than four hours apart to avoid becoming hungry and developing food cravings.  This tactic was fine when I was living in the gym two hours a day, but when not lifting weights or doing 45 minutes of cardio every day, the concept of never letting myself become hungry became a dangerous habit.  Besides, I get food cravings no matter how long it’s been between meals.  Since my work day is so hectic, I plan my lunches ahead of time, packing healthy food choices and telling myself under no circumstances will I buy fast food or indulge in the community doughnuts and cookies that seem to always be shared among the staff.  Staying busy actually helps me keep my mind off of food.

Savory yet Satisfying.  Many nutrition experts report that the brain releases dopamine, especially when we indulge in high fat and sugar foods.  Just smelling a bakery or fast food place can release this chemical, fanning the flames of fake famine that urges us to go ahead and indulge in doughnuts or French fries.  I finally realized that even after eating these foods, I wanted more.  These items had no bulk, no sense of filling, and it opened the doorway to wanting more and more foods just like them.  Maybe it’s a survival instinct, but even leaving one or two last cookies to go stale, or giving away the left over birthday cake was difficult for me. I viewed it as a waste of food. I had to train myself to view junk food as the enemy. I discovered an ally one day when a Greek restaurant opened next to my favorite fast food place in the food court.  For the first time, I said no to cheeseburgers and fries and yes to fresh made humus and babaganoush.  It had incredible flavor, satisfying texture, and was healthy.   Now, I really look forward to a lunch that contains humus and low fat crackers. The humus is so incredibly tasty and the mix of textures tricks my mind into believing that I have eaten plenty. The crunchy crackers add additional stress relief. Other tactics include using savory flavors such as meat rubs to contribute to the feeling of being satisfied with a meal without adding fat and sugar. Strong herbs like cilantro or rosemary coupled with a complimentary flavor like citrus is another trick to fool an addicted brain into signaling to the stomach that it is full. 

Pay attention to serving sizes.  Nothing is more discouraging than finding what you think is an excellent and tasty low fat recipe than to find that the calorie and fat content is based on dividing the dish into, *gasp, 20 servings!  Who can cut a cake or a pie into 20 pieces?  I have a hard enough time serving normal sized-slices of pie (they always turn into cobbler).  That’s less than a bite!  Reading labels has helped me avoid many calorie cataclysms.  Once, at a conference, I was at first delighted to find a big, thick, chocolate chip cookie in my lunch box, but, after reading the label, I discovered that there were 500 whopping calories and over half my daily allowance of fat in, well, just half of the cookie. I couldn’t even enjoy the whole thing without getting over 60% of my daily recommendations.  Deciding I didn’t need it, I gave it to someone sitting at the table.  Hope they like running!  That’s about the only way to keep that treat from sticking around.

Almonds are wonderful!  I started to find advertisements for almonds in magazines this past year.  The claim is that they have good fats and fiber which make you feel more satisfied. I actually am better able to say no to a lot of junk food after eating one serving of these sweet and crunchy morsels.  Just remember, pay attention to serving size.  About sixteen almonds, no more I particularly like the ones coated with cocoa powder – chocolate fix without added empty calories.

Use prunes to satisfy hunger and sweet tooth.  Okay, I was desperate . . . REALLY desperate.  Who in their right mind eats prunes voluntarily unless prescribed by their doctor?  I needed something with vitamins, fiber, filling factor, and sweet to keep me from overindulging daily.  I found my safety splurge in prunes.  I know, prunes have become sort of the red-headed step child of fruit.  To get over their bad rap, just think of them as dried plumbs (which is what they are).  Remember serving sizes, though.  Overeating prunes won’t overburden you with too many calories, but the consequences can still be undesirable.  I think that would qualify as a form of aversion therapy.

I don’t have all the answers, and I am not an expert.  I definitely have a long way to go.  But, I am making  a lot of progress.  It becomes easier and easier to say no to my favorite downfalls when I get compliments from my clients and when my clothes actually fit.  I have a higher quality of life the closer I get to a healthy body condition.  For any other food addicts out there, I hope some of these tips help.  The key is to find what works for a lifestyle change, not a temporary ‘diet.’

Personal compassion fatigue is a result of how much a team member is personally affected by the emotional work of care giving. Organizational compassion fatigue is not only how the practice culture is affected by employing personnel that are influenced by compassion fatigue, but also how the organization creates and maintains an atmosphere where acts of compassion are expressly expected, modeled by leadership in the practice, and rewarded by management.

The question is: does your practice create a culture of compassion? We are expected to treat our patients with compassion, but do our team members demonstrate compassion through their actions, and receive reprimand when they fail to act with compassion toward a patient? We are expected to treat our clients with compassion, but do our acts of compassionate client service get rewarded? We strive for our team to treat each other with compassion, but do we recognize that they need time to make connections with each other?

Compassionate Patient Care

A manager suspected compassion fatigue in her team. The reason she knew that her team’s compassionate care of patients was falling short was when she noticed, much to her credit, that her medical staff was no longer talking to the patients. One of the methods she used to enhance this relationship between person and patient was to purchase combs and brushes for the team to spend time grooming and loving on the patients. Now some people in a leadership position may look at a technician brushing a patient for a few minutes as a waste of time, but instead this should be recognized as a display of compassion, and it should be rewarded as a contribution to compassionate culture.

Compassionate Client Care

When we are faced with clients in difficult situations, whether it be an illness or injury of a beloved pet or even the fear and confusion of being a new pet owner, that person needs our time and attention for assurance that they can be good pet owners, or our time to pause and let them reflect on their relationship with their pet when that relationship may be coming to an end through death or euthanasia. Yet there are those in a leadership position that may chastise a team member for spending too much time with a client, when they should assumedly be in the back being productive. Compassionate care takes time, and this is often what our clients need most from us.

Compassionate Colleague Care

One of the ways to minimize personal compassion fatigue is to have a support system in place. Talking to someone who understands the emotional roller coaster that is veterinary medicine can help to reduce the personal symptoms of someone experiencing compassion fatigue. Often times, the best support system is staring us right in the face: the faces of those team members we work beside every day. Building connections and sharing stories and emotions is one way for the team to help itself, yet often the management team will observe team members talking with each other as “riding the clock” rather than being productive. Even chatting about what they did over the weekend helps to build the bonds that may be utilized to help one of them overcome a particularly emotional euthanasia or difficult situation with a client. Rather than discourage team members from making these connections, we should encourage a supportive atmosphere where the team feels comfortable turning to each other for help.

In order to reward acts of compassion, it is necessary that we recognize compassion when we see it, in ourselves and others. How do you know someone is being compassionate? If we are able to watch our team members as they interact with patients, clients, and each other, we can recognize compassion by their tone of voice, choice of words, and overall body language that is being expressed. Compassion is actively engaging and listening to the other person, or being perceptive to an animal’s nonverbal communication. Yet we also have to realize that often acts of compassion happen around us when we cannot necessarily observe the team member, such as when they spend extra time with a client in an exam room or on the phone, or take a break with another team member to talk about their day. We often want to jump to negative conclusions, rather than give our team members the benefit of the doubt. They may be trying to contribute to a compassionate culture, if only we can recognize and reward this behavior.

We also have to look for demonstrations of team members not being compassionate. This could be the technician that is hollering at the patient who is constantly verbalizing in the cage, the veterinarian who hesitates to offer sedation for radiograph positioning of an uncomfortable or agitated patient, or the receptionist who is more involved with the fax machine then the client who just approached the counter. We have to be aware that sometimes even our own company policies and expectations foster a culture that is not compassionate. If we focus more on the quantity of work produced rather than the quality of work produced, we are looking for something that can be measured rather than something that can be sensed or felt. We must step back to feel the culture of our practice. Our clients will experience certain emotions, or leave with a certain feeling, at the end of an interaction with our practice. By ensuring a compassion culture, we are creating a place where are clients want to return, a place where our team member feel supported, and a place where our patients can be assured of receiving the most compassionate care.

Basics of Self Care: (~Patricia Smith, 2008)

• Acknowledge your needs and wants. Often as caregivers we are so busy taking care of others that we forget that WE have needs as well!  Yes, we also have wants, those activities or items that may just be the “icing on the cake” in life, so to speak. You may need to spend your day off doing special activities rather than chores and errands. You may want to spend an evening with a good book and bubble bath. There is nothing wrong with spending time exploring your own needs and wants. Then address them, obtain them, or spend time doing those activities that will reenergize and recharge you. Take time to identify you’re your needs and wants are and then embrace them.
• Clarify your goals and objectives. Where you are now in life is a direct result of goals and objectives you set and reached, or the lack of goals and objectives so that the wind figuratively blew you to your current spot. It’s time once again to look ahead one year, five years, ten years even and decide where you want to be. Do you want to pursue a veterinary technician specialty (VTS), do you want to become a leader in client service on your team, do you want to learn how to master QuickBooks? Whatever you need to do to move beyond the present time and into the future, you will reach it easier and faster if you set goals and objectives for yourself. We spend a lot of time just getting through the shift, the week, the pay period, and often lose sight on the years ahead and where we want to spend those. Define where you want to be in the future, both personally and professionally, and make a plan to get there!
• Educate yourself about pertinent issues. As you spend more time acknowledging your needs and exploring your goals, you may come across issues that stand in your way or make it more difficult for you to achieve success. Identify these issues and then set out to become educated about each one. If learning about compassion fatigue has been an eye-opener for you, there is more you can learn about minimizing its effects on your work and home life. If you determine you need to go back to school, attend continuing education, or do your own research you can tackle these pertinent issues head on. Identify these issues, particularly those things that may be holding you back, and make a commitment to overcome each one so you can reach your goals and objectives.
• Create a sustainable plan. We often have noble ideas about changing either ourselves or our lives, but we may set our goals too high for our particular circumstances. It’s important to create a plan that is sustainable. For example if we desire to obtain a secondary education, we must make sure our class schedule is one that we can maintain on top of our work and home requirements. If we set our sights too high and fail, we will be more discouraged about even trying. Yet if we create a sustainable plan, our small successes, one day at a time, will motivate us to keep moving forward. Focus on a plan that is realistic and attainable so you meet with success.
• Shift from other-directedness to self-directedness. “Other-directedness” is just another way of saying that we focus on others rather than ourselves. When we turn our energy toward ourselves and away from others, we can identify our needs, identify issues and create a plan. This can only happen when we begin to focus on the person in the mirror.
• Shift from issue-driven to mission-driven. When we are “issue-driven”, we spend our time doing what we all despise, and that is “putting out fires”. Instead of running around handling issues as they flare up, it is better to focus on the overall mission to guide your activities. If you believe in the mission of your practice, then you will center your work activities on being there for your clients and patients. In your personal life, it is important to have a mission as well to guide you to do the right thing for you. Take time to determine your mission, which can even take the shape of a written mission statement describing the type of life you want to create.
• Practice the art of confinement. When we suffer from compassion fatigue and/or burnout, we tend to dissipate our suffering by sharing it with those around us. This can be our co-workers who we “vent” to regarding difficult client interactions or patient trauma. It can also be our loved ones at home upon whom we purge our difficult days. While it is not healthy to bottle it all in, it also magnifies the issues and our emotions to continually share and relive those difficult situation with others. Find more healthy ways to deal with your own emotions, without bringing those around you into your negative swirl. As difficult as it is sometimes, also try to keep work issues at work, and personal issues at home as much as possible.
• Find your balance. We hear a lot these days about work/life balance. It’s not just a popular cliché; it’s a very important balance for us to strive for on a daily basis. Balance your needs with the needs of others around you, remembering to acknowledge YOUR needs. Stay on course using a sustainable plan that can help you succeed. Focus on your small successes to keep you motivated to live a happier, healthier life! There are resources out there to help you in your journey, because you are not alone on this path to compassion fatigue recovery.

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

As a veterinary professional, you may seek advice from your local veterinary association through their FaceBook page to connect with colleagues in your area and discuss medical issues. Or if you would like to connect to colleagues on a more personal level, you could try Google Groups or LinkedIn Group, where you can find groups on almost anything from medical specialties, support groups, or philosophical discussions on the state of veterinary medicine. Plus, if there’s something missing, you could create your own group!

As for the content you may want to create online, keep what you write on the Internet positive if you’re thinking about starting a blog, Facebook page or Twitter profile. Whatever you think is private really isn’t when you publish it online, whether it’s on FaceBook, Twitter or a blog.

For instance, discussing a general problem about communicating the importance of a healthy diet in a Pet is different than picking at the personal qualities of a client who’s in denial about his dog’s obesity. Another example includes talking about preferences of breeds or species, because one of your clients or potential clients is bound to take offense. Writing in a way that criticizes specific people can always be misinterpreted in the worst way possible. Remember that frustrations and annoyances are temporary, but what’s written on the Internet is not.

Writing in a positive tone can also assuage some of the anxiety you may have about making yourself open to online criticism. Note that even if you decide not to communicate online, someone else will do it on your behalf and you may not like what is written about you. By taking on the online space first and writing positively, you set the tone on how you communicate with your clients and colleagues.

We all can relate to this, particularly when the work load overwhelms our ability to do it all…and maintain a good attitude at the same time! The good news is that burnout is a process, not an event, and is marked by physical, emotional, and behavioral indicators that can be easily recognized. If we remain aware of our response to the increased workload, we can keep burnout in check by utilizing these coping methods:

• Accept that the situation itself is stressful
• Share your feelings with a trusted friend or colleague
• Enhance your communication skills to lessen feeling of being unheard
• Initiate positive action to change your environment
• Suggest solutions to proper management
• Care for your personal needs (i.e., good nutrition, hygiene, exercise)
• Take time away from your stressful situation, and allow others to help

So then what is this new term, compassion fatigue? As a perfect example, burnout and compassion fatigue were contrasted by member of the “human” medical profession: Burnout results from stresses that arise from the clinician’s interaction with the work environment…while compassion fatigue evolves specifically from the relationship between the clinician and the patient.  ~Kearney et. al., 2009

When the workload is heavy, the hours long, the coworkers grumpy, the equipment shabby, those are all examples of the work environment causing stress, i.e., burnout. But compassion fatigue is different; it’s about personal relationships with your clients and patients. It would stand to reason then that you have some measure of control over burnout. You can use some of those coping methods listed above, and make appropriate changes to your work environment. In fact, you can change your work environment altogether by quitting and getting a new job. Burnout is more about WHERE you work.

But compassion fatigue is more about the work you DO, and as long as you remain in a care giving role, you will need to be able to recognize and minimize compassion fatigue. First, how do you diagnose compassion fatigue? Here are the some of the symptoms:

• Bottled up emotions
• Impulse to rescue anyone (or anyTHING) in need
• Isolation from others
• Sadness and apathy
• Feeling the need to voice excessive complaints about management and coworkers
• Lack of interest in self-care practices
• Reoccurring nightmare, flashbacks
• Persistent physical ailments
• Difficulties concentrating and mentally tired
• Prone to accidents

As you may imagine, these personal effects also spill over to affect the organization as a whole. So how do we change to a healthier emotional status? It’s mainly about sustainable self-care. We must turn our care giving inward to provide for ourselves, so we have the energy to sustain our care giving role in the profession. Here are Eight Laws Governing Healthy Caregiving, from Patricia Smith, founder of the Compassion Fatigue Awareness Project:

• Sustain your compassion
• Retain healthy skepticism
• Learn to let go
• Remain optimistic
• Be the solution
• Embrace discernment
• Practice sustainable self care
• Acknowledge your successes

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

I try infusing a little humor into everything I do.  Here are a few ideas to help your team get through the day.  PLAY WORK BINGO:  Simply fill out a few cards for your team members with spaces that have items such as “answered the phone in 2 rings,” “made a client smile today,” “signed up a Pet on a wellness plan,” etc.   Once the card is full, the team member yells bingo and gets a prize.  PLAY WORD INFUSION:  First pick a product such as Firstshield and offer a challenge to your team who ever is able to infuse Firstshield flea and tick education into the most client interactions today gets a Starbuck’s coffee break. Finally, my favorite game is SPECIMEN KING, where  each associate saves the best or weirdest or grossest specimen to show the doctor. 

Fun can be a great motivator, release tension and even create communication and trust. Enjoying work can lead to productivity, higher retention and owning your place of business.  I work harder when I am having fun. So then next time  you are at work I challenge you to try a little levity. Maybe tap a co-worker on the shoulder and yell “TAG YOUR IT!” and run away.  Think about it.

Almost 80% of new veterinary school graduates are now female.  

Fewer veterinarians are going into large animal practice.  

Fewer veterinarians have practice ownership as a goal.  

Many have speculated on how these changes will affect our profession overall.  I can not speak for all veterinarians, or even all female veterinarians of course.  But I can, as a female veterinarian, give my perspective on some of the issues we as individuals and a profession have before us.

I will start with what I know best, my own present experience, and work backwards to when I first knew I would end up here, though I did not know exactly what this would look like.  Today, I am a female veterinarian in my thirties.  I graduated in 1998.  I am a wife and a mother of two daughters.  I love our profession.  I love my part time job and the family-friendly hours that I work.  I need you to understand that I am as hard-working and dedicated to veterinary medicine as you are.

I am a small animal veterinarian in the city.  I apologize for not being the buyer for the practice on which you are relying for retirement.  I apologize for not taking over the care of the large animal patients you now tend, or being there for the small town whose veterinary needs you have met for all these decades.  I need you to figure out a Plan B. 

I am home with my newborn on maternity leave.  It is my first time away from full time veterinary work since I started my career.  I need to be included in team meetings and continuing education opportunities, and to be kept up to date on cases we treated together, and told about new cases you are seeing. 

I am only a few years into practice and considering starting a family.  I need you to consider flexible schedules or job sharing or part time employment as I look forward to my new life as both a mother and a veterinarian.

I am a veterinary school graduate searching for my first job.  I do not expect you to ignore the possibility that I may decide to procreate at any time, but I do not want to be interrogated about my family plans or asked to make promises that have no bearing on whether I am the best person for the job you have available.  I need you to believe me when I say that I will give your practice my very best if you hire me. 

I am a twelve-year-old girl in your waiting room with my sick friend in my lap.  I want to be like you when I grow up.  I need you to tell me that even though you do not know exactly what that will look like, you do know that it is possible.

I am the future of veterinary medicine.  We are the future of veterinary medicine.  I need you to walk through this new chapter of our profession alongside me.  We will combine our strengths and work through the upcoming challenges, making our profession better than it has ever been.   Even though I do not know exactly what that will look like, I do know that it is possible.

Consider volunteering a few hours at your local animal shelter.

I know you already spend a ton of time with animals, but volunteering at an animal shelter can do a lot to brighten an animal’s day, not to mention provide well-deserved relief for a weary kennel worker. And if you have a niece, nephew or children of your own, bring them along! Giving back will give you the satisfaction that only comes from helping others, (not to mention get you in the holiday spirit) and will set a philanthropic example for our rising citizens.

Be a part of the Season of Suppers Campaign.

Banfield Charitable Trust (BCT) and Meals On Wheels Association of America (MOWAA) are teaming up this holiday season to help homebound seniors feed their pets. Helping keep companion Pets well fed, healthy and part of the family for as long as possible is the primary focus of this initiative. You can donate Pet food or money at your local Banfield hospital. You may even want to support a Season of Suppers fundraising event in your community. All proceeds will be donated to the Season of Suppers Campaign.

Give to your favorite Pet-focused charity.

There are tons of them out there, so I did a little research and came up with six well-deserving and reputable organizations worth considering:

• The American Society for the Prevention of Cruelty to Animals
• Humane Society of the United States
• World Wildlife Federation
• Dogs for Deaf and Disabled Americans
• Delta Society
• National Association for Search and Rescue

Hope this information is helpful. Remember, even the smallest of efforts can bring about a measurable difference in quality of life. If you have a few minutes, I would love to know how you plan to give back this holiday season.

Dealing with sick animals, bereaved clients, newly hired team members, managing the practice and trying to be the family person you want to be is a tall bill.  Being a veterinarian is rewarding and yet, absolutely taxing – physically and emotionally at times.  You love, and are devoted to, your family and your job, but the demands of both get to you, maybe more often than you’d like to admit, even to yourself.

Renee Rucinsky, DVM, DABVP, and contributing writer for dvm360.com, refers to the feeling of emotional overload in her article, Compassion Fatigue. What is compassion fatigue?  We know that compassion is about feeling for others while fatigue is related to a lack of energy. Dr. Rucinsky believes that compassion fatigue is a state of complete exhaustion that leaves a person feeling physically and mentally overwhelmed.

No doubt, we’ve all experienced extreme stress at times, but veterinarians are more likely to suffer from compassion fatigue for a number of reasons: 1) the profession inherently calls upon vets to deal with many intense emotions on a daily basis 2) vets are innately caring people which means they feel for others on a very deep level, and 3) vets tend to be perfectionists, which causes them to expect too much from themselves.

What can you do to combat compassion fatigue? First, know the symptoms. In Dr. Rucinsky’s article, her list includes, “excessive complaining, isolation, compulsive behaviors (excessive spending, eating or other addictions), poor sleep habits, poor hygiene, apathy, difficulty concentrating, recurrent infections or chronic aches and pains.” Using a few of Dr. Rucinsky’s techniques as a guide in fighting compassion fatigue, start by saying “No” to stepping out of the exam room to answer that non-emergency client call, and reduce your stress by empowering your team to handle any issues that arise.

There are steps you can take to change things – and that might even include seeking professional help. We all know what’s good for us. Dr. Rucinsky touches upon the usual such as regular exercise (taking a brisk walk during your lunch hour), making healthy food choices (brown bagging it instead of heading for fast food), surrounding yourself with positive people (the vet tech who’s always willing to jump in and help wherever needed), for example.

If you start from within, you can consciously change your attitude — and that’s a good first step to a better outlook on life that will ultimately help you combat compassion fatigue.

Since 1972, the U.S. economy has suffered through six major recessions.  Through the previous five the overall gross domestic product (GDP) shrank while the veterinary profession grew.  The current sixth recession is once again proving to be kind to our profession.  According to Fritz Wood CPA, CFP and noted veterinary accountant, eighty percent of small animal veterinary practices are continuing to grow despite the current economic climate.

The Pet care industry (of which veterinary medicine makes up the lion’s share) accounted for $23 billion in 2008.  This is projected to grow to $34 billion by 2013.  Currently the second fastest growing segment of consumer spending is Pet care (second only to consumer electronics).

The Bureau of Labor Statistics reports Certified Veterinary Technician as the second fastest growing profession and Veterinarian as the ninth fastest growing profession.  New graduate veterinarians and technicians continue to entertain multiple job offers.

Veterinarians continue to be ranked as one of the most admired professions. In fact, Money Magazine (November 2009) just listed veterinarian as one of the top 25 “Best Jobs” in America. Veterinarians were ranked as an “A” in benefiting society and scored near the top of all careers in job security, personal satisfaction and future growth.

And it just keeps getting better!  The bond between Pets and families continues to grow stronger.  Technology is allowing us to do things we couldn’t even imagine a generation ago, and a huge number of Pets remain in need of quality veterinary care.

The economy will rise and fall, recessions will come and go, but the bond between Pets and families continues to grow, and the need for great veterinary care is stronger than ever.  There has never been a better time to be a veterinary professional!