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Nurses Say They Need A Break; Why Leadership Should Listen

Rebecca Hendren, for HealthLeaders Media, September 14, 2010

1. Promote taking a break as the right thing to do for patient safety. The Washington State case found it was the hospital's responsibility to ensure nurses were receiving breaks, not the individual nurses. Leaders must step in. Ask nurse managers to pay attention to this issue and check whether staff are getting breaks. Support nurse managers to make the culture change when needed.

2. Educate nurses on the importance of breaks: Host a lunch and learn seminar on the importance of rest and the danger that fatigued nurses pose to patients. Provide strategies for busy units on how to ensure nurses are able to take breaks.

3. Implement fatigue countermeasures: It can be as simple as talking about breaks to change the culture of martyrdom too many nurses feel they must work under. Small investments can pay big dividends, particularly if you bring extra help. Consider having per diem or float pool nurses who work during meal periods. I've written before about creative scheduling for older nurses and those who want non-traditional hours. You'd be surprised at the number of people who would love to work two hours rather than a full shift. A hospital in California developed an SOS?save our staff—program to do just this. They have nurses who work 3- to 4-hours to cover lunch breaks. If a unit is stretched thin that day, they can ask the SOS nurses whether they want to stay longer.

Another option is to bring in nursing students. The hospital pays students to answer call bells or check dressings. It gives the students experience on the unit, which they want, and removes some of the burden from the RNs.

When budgets are stretched thin, it may appear the wrong time to focus on this issue. A little extra effort, however, can pay dividends in staff satisfaction and patient safety. And it just might stop those nurses ending up on the local evening news.


Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits www.StrategiesForNurseManagers.com and manages The Leaders' Lounge blog for nurse managers. Email her at rhendren@hcpro.com.
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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