How Holidays Affect Healthcare Workers: ER Surges and Pay

Predictable surge: Cooking, decorating, travel, alcohol, and indoor gatherings bring more patients to ERs between Thanksgiving and early January.
Cooking fires: An average of 1,600 home cooking fires happen on Thanksgiving, more than 3 times the daily average.
Census splits by unit: Elective procedures slow in late December, while ERs and ICUs often fill with injuries and respiratory illness.
Holiday pay isn’t federally required: For staff clinicians, it depends on facility policy or a union contract.
Holiday work can be a choice: PRN work lets clinicians earn on high-demand dates or protects the holidays that matter most.

For healthcare workers, the holidays bring turkey fryer burns, ladder falls, and the start of flu season, often while coworkers are out on paid time off (PTO). Emergency rooms (ERs) and intensive care units (ICUs) fill as some units see low census, the emotional load rises, and so do the chances to earn more.

If you’re a registered nurse (RN), licensed practical or vocational nurse (LPN/LVN), or certified nursing assistant (CNA), you’ve probably clocked in on a holiday while everyone else clocked out. Here’s what spikes, when it spikes, and where nurses feel it, plus how holiday pay works and how to choose which holidays you work.

Why hospitals get busier during the holidays

The holiday surge is predictable. Cooking, decorating, travel, alcohol, crowded gatherings, and delayed care all bring more patients through the doors between Thanksgiving and early January.

Holiday injuries that fill the ER

Most holiday injuries trace back to a handful of seasonal activities:

Thanksgiving cooking burns and fires

Cooking causes nearly half of all reported home fires, and Thanksgiving is the peak day for home cooking fires.

According to the U.S. Consumer Product Safety Commission (CPSC), there is an average of 1,600 home cooking fires on Turkey Day alone—more than 3 times the daily average.
According to State Farm, nearly 60% of cooking fires involve frying equipment, and nearly 70% happen between 5 and 8 p.m.

Ladder falls and decorating injuries

The CPSC estimates that about 160 decorating-related injuries occur a day during the holiday season, and more than 40% involve falls. From November 2021 through January 2022 (latest data available), about 14,800 people were treated in emergency departments (EDs) for decorating injuries.

Toy injuries in children

EDs treated an estimated 145,500 toy-related injuries in children 12 and younger in 2022, and 11 toy-related deaths were reported, mostly from choking on small parts, balls, or balloons.

Non-motorized scooters caused about 1 in 5 toy injuries in children 14 and younger. Choosing age-appropriate gifts and keeping small parts away from children under 3 are 2 of the simplest ways families can prevent these ER visits.

Alcohol-related crashes

According to the National Highway Traffic Safety Administration (NHTSA), in 2023 (the latest data available):

12,429 people died in crashes involving an alcohol-impaired driver, 30% of all U.S. traffic deaths, or 1 every 42 minutes.
Alcohol impairment among drivers in fatal crashes was 3 times higher at night than during the day and nearly double on weekends (28% vs. 15%).

Holiday parties, late nights, and long weekends stack the crash risks.

Flu season and holiday gatherings

U.S. flu activity can peak between December and February. Holiday travel and indoor gatherings fall in the same weeks, when respiratory syncytial virus (RSV) and COVID-19 also circulate. The pressure tends to land on:

ERs: Higher volumes of respiratory complaints and dehydration
ICUs: Older adults and patients with chronic conditions who develop complications
Pediatrics: Infants and young children with RSV
Long-term care: Residents exposed during family visits

The busiest holiday days in the ER

Patterns vary by region and facility, but these dates tend to produce the most predictable spikes.

When	What spikes	Where nurses feel it
Wednesday before Thanksgiving	Travel crashes and alcohol-related injuries on one of the busiest drinking nights of the year, often called Blackout Wednesday	ER, trauma
Thanksgiving Day	Cooking burns and fires on the peak day for home cooking fires, kitchen cuts	ER, burn units
Late November through early January	Ladder and roof falls while decorating, candle and tree fires	ER, orthopedics
Christmas Eve and Christmas Day	Toy injuries in children, decorating falls, and respiratory illness	ER, medical-surgical, pediatrics
New Year's Eve and New Year's Day	Alcohol-impaired crashes, intoxication	ER, trauma, ICU
Late December through February	Flu, RSV, and COVID-19 peaks	ER, ICU, pediatrics, long-term care

Holiday staffing and census changes

Do hospitals have fewer patients during the holidays? Some units do, while others get busier, so the answer depends on where you work:

Lower census in some units: Elective procedures slow in late December, so surgical and some medical-surgical units may see low census and canceled shifts.
Higher acuity in others: ERs and ICUs often fill at the same time with injuries, cardiac events, and respiratory illness.
Long-term care: Family visits increase, which comforts residents but can raise the risk of outbreaks after gatherings.
Staffing pressure: PTO requests cluster around the same dates, so many facilities use a holiday rotation schedule to divide coverage, and call outs can still leave gaps.

For staff clinicians, the dates you protect are usually decided before the schedule posts. Planning holiday PTO early and knowing your unit's request deadlines gives you the best chance of getting the days you want.

Holiday stress for nurses and CNAs

The holiday effect is the rise in stress many people feel between Thanksgiving and New Year's. In a 2023 American Psychological Association (APA) survey, 89% of respondents said something about the season stressed them, from money to missing loved ones.

For nurses and CNAs, that stress adds to the everyday challenges of healthcare work, such as short staffing and heavy patient loads. Missing family dinners, school performances, and traditions is also part of it.

Another part is caring for terminally ill patients during weeks meant for celebration. Being with a family on Christmas morning as they say goodbye can stay with a clinician long after the shift ends. Grief after a patient's death is a normal response, and clinicians cope with death and dying in different ways, from debriefing with coworkers to personal rituals.

If holiday stress or grief starts to affect your sleep, health, or daily life, we encourage you to reach out to your employee assistance program (EAP), a licensed mental health professional, or your primary care provider.

Do nurses get holiday pay?

It depends on how you work. Federal law doesn't require private employers to pay extra for holiday work, since the U.S. Department of Labor treats holiday pay as a matter of agreement between employer and employee. For staff clinicians, it comes from facility policy or a union contract.

Where facilities offer holiday pay, common practices include:

Premium rate: Many facilities pay time and a half, or sometimes double time, for hours worked on a recognized holiday.
Recognized holidays: These usually include Thanksgiving, Christmas, and New Year’s Day, and some facilities add Christmas Eve or the day after Thanksgiving.
Holiday window: Some facilities define a holiday as a 24-hour period that doesn’t line up with the calendar day. This affects how much of a night shift earns holiday pay.

Independent contractors picking up per diem shifts don't receive employer holiday pay. However, facilities often post higher rates for hard-to-fill holiday shifts, and clinicians can see the rate before they commit.

Choosing which holidays you work

Working a holiday can be a deliberate choice rather than a fallback plan. Many clinicians decide which dates matter most to them first, then build the rest of the season around those:

Earn on high-demand dates: The Wednesday before Thanksgiving, Christmas Eve, and New Year's Eve are often hard for facilities to cover. On the Nursa platform, facilities post open shifts with the rate, unit, and shift time listed, so you can compare holiday dates before requesting one.
Protect the holidays that matter most: Picking up single shifts lets you work Thanksgiving and keep Christmas, or the reverse. PRN nurses usually set their own availability, so the holiday calendar becomes something you plan rather than something assigned.
Cover a stretch with shift blocks: Some facilities post blocks of shifts across the holidays, which gives you steady hours at a single facility and a chance to get to know the team.
Step back from holiday work: Some nursing jobs don't require working on holidays, which can suit clinicians who want those dates protected every year. You can also apply for full-time and part-time roles that facilities post on Nursa and weigh each facility's holiday policy before you apply.

Per diem nursing shifts this holiday season

Holiday weeks bring more patients, more pressure, and more emotion to many units, and nurses and CNAs carry much of it. We see you, and we thank you for the care you give while others celebrate.

Work the holidays you choose and keep the ones you want. Sign up with Nursa to pick up shifts that fit your season.

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