Monday morning. Six new referrals on my desk. I go to the wards and find two more. The doctors want these patients discharged home this week. They need the beds. I make a face and sigh 'Just what I need. Do I really have to see them?' A few more questions and we decide one does not need an OT assessment. I am relieved - just another referral form to file. I stop a moment. These 'referrals' are people made in God's image, and I am here to serve God. Instead I have a complaining spirit and stress levels are rising.

Overworked and underpaid?

Technological advances mean more can be done. More hospital treatment means a greater demand for therapists for assessment, equipment provision and rehabilitation following treatment [1]. New OT services are developing and the demand is there, but as yet there are few staff in post to meet this.

There is also the 'recruitment and retention crisis' [2] for all health professions which adds to workload. All this results in waiting lists, and in the case of OT in a hospital ward setting, prioritisation decisions and some patients going without [3]. This in turn causes stress for professionals [4] facing heavy workloads and difficult decisions. A vicious circle is set up: 'Waiting list pressures . . were of major concern to therapists with regard to . . their retention within employment' in a recent survey [5] .

I previously worked in community paediatrics, which has particularly long waiting lists for OT [6]. I took phone calls from parents who were sometimes irate, wanting to know when their child would be seen. Perhaps one of us should see them, to stop the endless phone calls? Perhaps with one assessment and some advice one child would be off the waiting list. However, would it be just to see these children sooner because their parents are vocal? Philippa Hickie has pointed out 'those parents who have children with great needs are not always the ones who can or do speak up' [7].

There are increasing concerns about litigation. My record-keeping needs to 'cover my own back'. It is difficult to have right motives in this environment, but we must avoid conforming to the world and instead be 'transformed by the renewing of (our) minds' [8].

There are biblical principles to guide us in our decisions at work and David Cook has recently written about them [9]. He advocates a framework which is dynamic, holistic, person-based, inspired by God's Holy Spirit, and not individualistic.

Christian concepts

1. We have department standards and professional codes of conduct. Where right, we need to work to these. We submit to authorities, under God [10, 11] .
2. We serve God at work, as in all aspects of our lives [12]. Even when no-one else will know what we have done or omitted to do, God sees. We are answerable above all to him.
3. Our decisions should show we are working towards loving God with all our beings and loving our neighbour as ourselves [13].
4. As we prioritise, we need to remember each patient is made in the image of God [14]. They are people, not bed numbers, diagnoses, or referral forms. They are all equal, although they may not equally need our service. We are 'servants of all' [15], so we serve our patients. This means listening to them, as Jesus did with Bartimaeus [16].
5. Our responses under pressure, with the help of the Holy Spirit, should show 'love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control' [17].
6. We are witnesses to the gospel, even at work [18]. As we act in a Christian way, even under pressure, people will notice and God will be glorified [19].

Pressure pointers:

God is in control:

we may not be, but we are 'working under God . . as he remains in overall control of his creation' [20].

God understands:

Jesus knew what it was to have many people needing his help at once [21].

Praying helps:

commit the situation to God 22 , and ask for the wisdom he has promised to give [23].

God loves you:

and nothing can separate you from that love [24]. He has planned your work, even the tasks you need to do today, especially for you to do [25,26]. He knows all that is being asked of you and will not ask more than you can do with his Spirit's help.

Take breaks:

if you have a choice, do not work more hours than is good for you, and take breaks - Jesus took time out and encouraged his disciples to do so too [27].