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Nurses Say They Need A Break; Why Leadership Should Listen

Rebecca Hendren, for HealthLeaders Media, September 14, 2010

There has been a spate of news articles in the last few months about nurse protests and threats of strikes. A frayed work environment lies at the heart of many of these confrontations, with a workforce that feels it is stretched too thin. Nurses are speaking up about overwork and short staffing and the effect they feel it has on patient care.

Nurses at a Veterans Administration hospital in Augusta, GA, last week planned a protest claiming 16-hour workdays that they said threatened patient care. Facing a budget deficit of several million dollars, the VA nurses association said the hospital was forced to slow hiring and extend nurses workdays.

The Washington State Nurses Association successfully sued two healthcare organizations over missed rest breaks. The rulings affirmed the employers' responsibility to provide uninterrupted rest breaks.

These incidents, and others, are surprising during a weak economy, when jobs are scarce—particularly for new grads—and employers in all professions find many people are simply grateful to have a job.

The complaints are even more surprising given the culture of nursing. Rarely having time for rest and meal breaks is part of the nursing folklore. New graduate initiation practically stipulates that a requirement of successful floor nurses is a gargantuan bladder.

This culture is entrenched. A 2004 study published in the Journal of Nursing Administration revealed that hospital staff nurses were completely free of patient care responsibilities during a break or meal period less than half the shifts they worked. In 10% of their shifts, nurses reported having no opportunity to sit down for a break or meal period. The rest of the time, nurses said they had time for a break, but no one was available to take over patient care.

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2 comments on "Nurses Say They Need A Break; Why Leadership Should Listen"


Greg Mercer, MSN (2/10/2012 at 7:12 PM)
This important issue is one of so many examples of the impact of conflicts of interest on every aspect of health care today. That it requires litigation for Nursing staff to ensure brief breaks of any sort is a surprise to many people, but certainly not Nurses. Who else could believe that professional care providers have routinely been routinely denied a short break to eat lunch or dinner, even in frequent 12 or 16 hour shifts? The Harvard-affiliated Partners system recently experienced such successful litigation, as another example. No other professional or other employee group, to my knowledge, suffered such abuse. Such suits result from a common practice: many managers have routinely insisted that all nurses have time to eat, ignoring obvious and frequent evidence otherwise, thus improving their staffing budgets. Even after successful litigation, training and policy may consist of rule sets such as: 1) You must take breaks, although no action will be taken to ensure this is possible in a way consistent with professional obligations to your patients, 2) You must document your time worked accurately, including breaks, 3) You must document extra time worked, and document missed breaks as such, 4) You must not skip a break or work extra time until you have contacted your supervisor and obtained prior approval. Add these rules up logically: when you lack time for a break, nevertheless you must find your supervisor, whether available or not, and take time to find them and discuss the situation, before you can receive accurate compensation. If such efforts and the distraction and time involved degrade patient care, you remain entirely responsible. The onus thus remains entirely on you, as it was prior to litigation. With such a Catch-22 scenario, HR departments may continue to permit managers to avoid ensuring breaks, while formally agreeing the opposite. Such is the power of a conflict of interest, highly regulated in many areas of American life, health care being a prominent exception. Here, conflicts at many levels have become so common as to considered customary and unavoidable, while a major source of the waste and inefficiency Americans can no longer afford.

Deb Andelt (9/15/2010 at 4:31 PM)
We human beings can't give what we don't have. Nurses, or anyone, can't extend care and compassion unless they are "filled" themselves. A new study reveals the the need to change the paradigm from caring for others first to primarily caring for self first. Being in a state of personal well-being, healed on all levels, is the only way to be present to be of service for others. The report: "5 Dimensions of Self-Caring that Heal Healthcare" provides organizations a roadmap to curate their "beingness," the experience, with self-caring as the keystone of the stategy. This goes beyond breaks. While that is certainly important, the impact of the 5th Dimension -the business model- may be the most important transformation an organizattion can undertake. Report is available at www.experienceinmotion.net