Disclosures: Shahan reports no relevant financial disclosures.
August 10, 2020
5 min read
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Work-life balance for APPs who are parents in the era of COVID-19

Disclosures: Shahan reports no relevant financial disclosures.
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Achieving a “work-life balance” can seem an elusive dream.

In my 11 years as a physician assistant (PA) and more than 9 years as a mother, I have found that my best efforts can sometimes lead to feeling like a failure as a mom, as a wife or as a PA.

When I reflect on my time as a new PA, I recognize the responsibility I felt for my very complicated, often very ill patients with hematologic malignancies. My hours spent reading and worrying at work outweighed my hours at home for some time.

Jaime Shahan, PA-C
Jaime Shahan

After the birth of our first child, in a moment of overwhelmed desperation, I reached out to my mother, who gave me some simple but profound advice. She said, “Jaime, just do your best. Give 100% when you are at work. When you go home, give 100% with your kids. And when they go to sleep, give 100% to your marriage. That’s all you can do.”

Looking at that advice in a practical way, the balance we seek can be improved, and more consistently achieved, through healthy boundaries around work life and home life.

‘COVID-19 turned the world on its head’

Prior to COVID-19, my life consisted of a very delicate juggling act of responsibilities.

I woke at early hours to feed a baby (our fourth child), take my older two children to school and the younger children to daycare, and then speed through a terrible commute.

I saw patients all day, struggling to complete documentation and review all clinical messages, reports and results. Then I rushed home to catch the end of [insert child/sports team activity] and manage dinner, bath time and bedtime routines. Add to this list of responsibilities many months of too-personal-to-recount lactation struggles.

Just as I felt I could manage this delicate balance, COVID-19 turned the world on its head.

I struggled with sleep, anxious that I would be the source of infection for my aging, diabetic parents or my young children.

I worried about my patients, amid warnings that the mortality rate among patients undergoing stem cell transplant would be much higher. One of my beloved patients died of complications of the novel coronavirus in April, and in May, another.

The persistent media coverage of bad news has been overwhelming on my mental and emotional well-being. I also faced more laundry to clean, surfaces to sanitize and taking an extra shower before I touched my children.

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‘Ever-connected’

COVID-19 shoved the health care world forcefully into the future with telemedicine. Now, the clinic workflow has been adjusted to include virtual visits — for which timing is much less forgiving — with patients sitting expectantly in virtual “waiting rooms.”

Moreover, the boundaries between home and work life blurred. Now my four children, my husband, my child care provider, my patients and I are all under one roof, at least technologically at times.

One day during a telehealth visit, my 4-year-old daughter, Presley, innocently walked into my office. Thankfully, my sweet patient was graceful and forgiving. I was reminded that despite the lines of professionalism drawn in the sand, we are human first. We are APPs, but we are also mothers, fathers, children to aging parents, spouses and siblings. Many of our patients understand this.

With remote work and digital meetings, there has been real temptation to stay ever-connected.

However, I have found more success on days when I’ve logged off after my “clinic” is over. To develop stronger boundaries, I disconnected my work email from my cell phone. Taking away the pop-up notification has helped to create balance and maintain mental presence with my family.

Tips from other parents

I have admired how many colleagues manage their time while being great providers and parents.

Teresa Herlevi, MPAS, PA-C, is a physician assistant at Huntsman Cancer Institute at University of Utah and the mother of three children. She said the biggest help in maintaining her work-life balance has been working 4 10-hour days. That leaves her with one weekday “to do the mom stuff,” like volunteer at her kids’ school or take them on a fun outing.

She relates that with her eldest child, “we always focus on having that one weekday together to make her favorite meal for dinner or curl her hair for school.”

Working a similar schedule has helped to balance the demands of a difficult job with my personal and family needs. Presley has also patterned her life after my work schedule, asking every night, “After wake-up time, is it a stay-home day?” I use this weekday at home not only to spend time with my children, but also to schedule appointments, such as well-child checkups and dental visits, and do housework.

My supervising physician, Madhuri Vusirikala, MD, also is a mother of two. I have wondered how she could be so brilliantly aware of all that is going on with each of our patients as the director of our allogeneic stem cell transplantation program and also find time to be such a great mother and spouse. She has supported me many times when a child is sick and encouraged me to take care of my family in times of need.

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One nurse in the clinic, Paul Skinner, BSN, RN, BMTCN, is training to become a nurse practitioner. As the father of two girls, he shared that part of his success with his busy clinic workload is to “work as time-efficiently as possible while at work, in order to minimize the need to do anything from home.” He also recommends using available vacation days to take a much-needed break.

Caroline Pearson, NP, MSN, RN, said she tries to spend as much time outside with her children as she can. She also takes care of herself while her children nap, so she feels more refreshed when they wake up. I, too, find that when I do things for myself that I enjoy, like playing the piano, taking a walk or reading a book, I feel more capacity to care for both my children and my patients.

Delegating

Part of the work-life balance is delegating appropriate tasks and realizing it is OK not to be able to do everything.

The beauty of working in teams is that we can each fulfill our own responsibilities and trust and rely on each other. My supervising physician, our team’s two fantastic transplant nurses and I have worked out a system where we all practice to the top of our scope.

There are additional things we can do at home to make things easier and help achieve more balance. We can order groceries for pick-up or delivery, which also minimizes COVID-19 community exposure. We can meal-prep on our weekends or off-days.

When sports and extracurricular activities resume, we can choose sports teams with children of our friends, or make friends with the parents on the team. This can help in the rare instances when we need assistance getting a child to or from practice. We can also have our children help with dishes and laundry and use their “pay” to teach them about money management.

Silver linings

Despite the persistent challenge of COVID-19, I have noticed some silver linings. There are generally shorter commute times, with fewer cars on the road and more employers noting the possibility and success of remote work. With the cancellation of team sports, there has been more quality and quantity time with our children (although sometimes requiring more patience).

As APPs caring for immunocompromised patients with cancer, my hope is that we can center our lives on family, those we love and the things that matter most. Whether the schedule be chaotic or quiet, we can utilize the things that work for us, tweak the things that are within our control, prioritize the important things and do our best. As my mother said, “that’s all you can do.”

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Let us turn our focus to more everlasting things and look for the good in others. As we do, we can have more peace and feel more whole. With boundaries, the balance and fulfillment we work toward can become more of a reality.

For more information:

Jaime Shahan, PA-C, is a physician assistant in the Bone Marrow Transplant and Hematologic Malignancies Clinic at UT Southwestern, focusing primarily on acute leukemia, myelodysplastic syndrome and allogeneic stem cell transplantation, as well as graft-versus-host disease. She can be reached at jaime.shahan@utsouthwestern.edu.