You don't care how many hours you work, you're satisfied with your pay and you eat stress for breakfast. The bottom line is that you really like — or even love — your job, in spite of the pressure and the demanding schedule, and regardless of your tax bracket. That said, a few other factors in your professional life have the potential to seriously dampen your enthusiasm.

Those are just a few of the takeaways from this year's Outpatient Surgery salary survey. The good news? More than three-fourths of our readers say they're happy with what they do. That's as opposed to the less than 1 in 10 who feel the job is more frustrating than rewarding, or that in retrospect, they wish they'd chosen a different career path.

But there are issues to consider — ones that can bring people down, maybe the people you manage. Among the biggest is a lack of satisfying work-life balance. Here, your responses speak volumes. Among respondents who say they're satisfied with (or downright enthusiastic about) their work-life balance, 86% say they either like or love what they do for a living. But those who say their work-life balance is out of whack tell a different story. When work overwhelms any possibility of a satisfying outside life, only 47% say they "like or love" their job, and the tone can become one of desperation.

"I haven't had a vacation in 18 months," says the administrator of a Northeastern surgery center. "I am at my breaking point. It does no good to have 5 or 6 weeks of time off available if there is no time to take it." A charge nurse at a Texas hospital says she's caught in a never-ending cycle of misery: "I go home tired and hungry, never get an uninterrupted lunch break and lay awake at night with work issues still spinning in my head," she says. "Then I go to work tired, and it starts all over again."

ENJOYING THE RIDE Kris Sabo, RN, (with patient accounts rep Allison Stone, CBCS, CASC, and scheduler/receptionist Eva Ragsdale) finds time to pursue numerous outside interests with her husband, Tom, including camping and experimental light aircraft. "To have work-life balance, you have to make a commitment," she says.

'Make it happen'
Can you be in the healthcare trenches and still find the time and energy to enjoy your life away from work? Absolutely, says Kris Sabo, RN, executive director of the Pend Oreille (Idaho) Surgery Center. But, she adds, "to have work-life balance, you have to make a commitment. Nobody's going to offer to balance your work life for you. You have to make a conscious decision to do it, and then make it happen."

And it isn't always easy, she says.

"I struggled with this for a really long time," says Ms. Sabo. "I thought, I can't seem to get caught up and do everything that needs to get done. Finally, I listened to what I was saying and realized, No, there's no way you'll ever get everything finished, so quit that expectation. That's the first step. Then you just have to prioritize what you're going to be able to accomplish, and shut it off when it's time to go home."

DOGGEDLY DETERMINED Dianne O'Connell, RN, MBA, says her job is stressful, but "your family and your outside life are the most important things." She's an avid hiker and a "dog foster mother" in her spare time.

Dianne O'Connell, RN, MBA, director of surgical services at Frisbie Memorial Hospital in Rochester, N.H., agrees that it comes down to priorities. "Not to minimize my job at all, but really, your family and your outside life are the most important things," she says. "You can replace your job, you can never replace your family." For Ms. O'Connell, that means, among other things, no taking work home, and no checking email at home. The boundaries are sacrosanct.

"My job is a little more stressful than most," she acknowledges, "but it doesn't rule my life. I also have a great team of 4 clinical managers working for me. And my approach applies to them, too. I don't expect them to work overtime or work from home, and I try to drill the same thing into them: Leave work, leave your work problems at work and enjoy your outside life."

The right message
That last part can be key. As determined as you might be to achieve and maintain a satisfying work-life balance, having support from above, and/or providing the same support to others in your organization, is bound to help immeasurably.

"Senior leaders have to really say, 'This is important,' and they have to set limits and rules," says Beth Summerlin, MSN, BSN, RN, CNOR, manager of surgical services at Wellstar Windy Hill Hospital East Cobb Health Park in Marietta, Ga. "One of the practices my CNO has put into place is no emails, texts or phone calls after 6, unless it's my staff or team, which I don't mind. But during weekends, nights and holidays, there's no email traffic and no text messages."

Everything is driven from the top down, says Ms. Summerlin, so balance has to be a priority for upper management. "Don't take away people's days off or their holidays. And maintain adequate staffing," she says. "If you look at your [inadequate] staffing at the beginning of the month and say, 'Well, we'll just try to make due,' that's not going to send a message that you support them."

As administrator of the East Side Endoscopy & Pain Management Center in New York City, Helen Lowenwirth, MBA, CASC, arrives early and often stays late. But surrounded by some of the world's best restaurants, museums and theaters, she's determined to take full advantage of life in New York.

"I work 50 to 60 hours a week," she says, "but I'm not pulling my hair out, screaming about the long hours." The key, she agrees, is to set clear boundaries. "Other than some light reading, I never take work home. It's a rule I have for myself. I don't carry files home or log in at home. If there's work to be done, I come into the office."

She pops into the office roughly one Saturday a month, she says, to tie up loose ends and paperwork, but other than that, nights and weekends are free for her to enjoy what the city has to offer. "I enjoy the museums and the theater in New York, and I like to travel," she says, adding that the balance she's achieved is one of the reasons she loves her job.

RECIPE FOR HAPPINESS Becky Applebee, RN, ASC, is determined to enjoy life outside work, now that her schedule allows. She and her husband, Michael, are into "elaborate cooking," as well as traveling and gardening.

Counting blessings
Perspective can be key, too. Becky Applebee, RN, the director of Eye Care of Maine ASC in Waterville, Maine, vividly remembers what life without balance was like. "For 35 years I worked in a hospital OR," she says. "It was a great job, and it wasn't weekends and evenings. But for all those years I also was on call at least once a week and one weekend a month." There were days, she says, when she'd get home at 9 p.m., get called back in from midnight to 3 a.m., and then have to get up early and go back into work.

Being able to leave work at 5 p.m. every day and know that the day is done feels almost too good to be true, she says. Not that her current job isn't demanding. She still puts in long hours, but she's made work-life balance a priority, as she adjusts to her newly found freedom. "It's still hard at times to believe," she says. "Sometimes the first thought in my head if someone suggests something for the weekend is, That sounds like fun, but am I on call? I hope I'm not on call."

She isn't. And she's making it a point to enjoy her leisure time. "I go home after work and still think about work-related things, but it's not like physically being at work," she says. "I don't have computer access from home, and there's a definite line drawn between work and what I do at home."

Other factors
As noted, despite the challenges, most Outpatient Surgery readers are largely unaffected by the stress that's inherent in their jobs, and by the long hours they put in. Enthusiasm runs high, provided they believe they're fairly compensated for what they do (which most do). How high? More than 80% of ASC readers say they either love or like their jobs, and 73% of hospital readers say the same.

But in addition to work-life balance, a few other recurring themes drag down those who are less enthusiastic. For starters, feedback and recognition matter. OR managers want feedback as to how well they're doing their jobs, and when they don't get it, morale suffers.

"I only hear about my performance once a year, at my annual evaluation," says a Mountain States clinical manager. "There's never even a 'good job' in between, even though our ASC has amazing patient satisfaction scores and employee engagement scores in the 75th percentile." A Midwestern administrator tells us, "I have no performance evaluation, no thanks and no recognition."

Fortunately, the majority of readers say the feedback, support and recognition they get is at least adequate. But again, the job-satisfaction numbers take a huge hit for those who feel as if they're doing their jobs in a vacuum, or who only hear about the bad stuff. Those who get little or no recognition are also likely to feel less secure, and ultimately less happy. In contrast, those who don't worry about losing their jobs tend to be much happier with their jobs.

Only human
It's clear that healthcare providers are a tough and inspired bunch. They have to be. But they're also human. In addition to needing quality time away from work, they thrive on recognition and appreciation. "Employees who report receiving recognition and praise within the last 7 days show increased productivity, get higher scores from customers, and have better safety records," says consultant and author Tom Rath. "They're just more engaged at work."

That's a message that resonates with Patrick Rehm, R.T. (R), administrator of the Center for Specialty Surgery in Austin, Texas. "I fully believe that staff are happy when they feel they are treated with respect," says Mr. Rehm. "Complimenting staff goes a very long way and should be done weekly, if not daily." OSM

BONUS PAYMENT
How Big's Your Bonus Check?

BONUS BEHAVIOR Patient satisfaction matters, and "it doesn't cost anything to be nice," says Tammy Andrews, CASC.

The vast majority of ASC administrators who responded to our survey say their salaries stayed about the same or rose only slightly in 2016, but it appears to have been a good year for bonuses on the surgery center side. Of 348 ASC survey respondents, 59 say they earned bonuses of at least $10,000, and more than one-third of those cashed bonus checks of $25,000 or more.

The top criteria for such hefty rewards? Not surprisingly, facility profits, case volume and other financial benchmarks. Tammy Andrews, CASC, administrator of the Carolina Coast Surgery Center in Murrells Inlet, S.C., says patient and physician satisfaction scores are also key considerations where she works. And her center is in the top 1% in the country in patient satisfaction. "We look at ourselves as a boutique operation, compared to a hospital," she says. "We try to go the extra mile and really take the time for our patients."

That involves some minor spending that could raise costs — like picking up soup from a local restaurant and bringing it back for total joint patients — but "we look at it as the cost of making sure we accomplish the goals we've set in our culture," she says. "And a lot of the things we do don't cost anything. It doesn't cost anything to be nice. It doesn't cost anything to be thoughtful and kind."

Meanwhile, an Ohio administrator says her criteria for bonuses aren't explicitly spelled out. But she knows what matters most when her physician-owners get together at the end of the year. Her bonus, she says, stems from "the fact that the center runs seamlessly, and the physicians don't have to get involved in issues and problems with staffing and day-to-day operations." That's her job, and she does it well.

"They're very happy with that," she says. "If they weren't pleased with the direction of the facility and my performance, they wouldn't be inclined to give me a bonus."

— Jim Burger