When I started my nursing career nine years ago, I was confident that my nursing education prepared me with the fundamentals of the profession — anatomy and physiology, pharmacology, clinical skills, and more. What I wasn’t prepared for was that some of the basic aspects of health that we ensure for our patients, like nutrition, rest, and removal from constant stressors, aren’t necessarily guaranteed for nurses.
In a national online collaborative forum with my fellow nurses about the future of the nursing workforce, many themes emerged. One that I took to heart is that nurses need undisturbed break time on each shift to balance the emotional and physical demands required to provide high-quality care to patients and to keep more front-line nurses at the bedside.
The solution may appear obvious: Just take a break. But nurses can’t do that if staffing isn’t adequate to meet patient care needs. It’s well-documented that patient care suffers when units are short-staffed, leading to more adverse but avoidable events such as medication errors, infections, and even death. Nurses are more likely to experience fatigue, burnout, and injuries on the job. Harder to measure, but just as much a factor, is the low morale and job dissatisfaction that results when there aren’t enough nurses to adequately cover a unit.
Solving the problem of missed breaks starts with getting nurses who are immediately responsible for their patients’ care to admit they aren’t able to take them. That’s not easy, especially when managers and supervisors respond by challenging time management skills and saying, “Everybody else takes a break; why can’t you?”
Actually, everybody else isn’t taking breaks — they just aren’t admitting it.
Ideally, nurses scheduled for 12-hour shifts should get a minimum of three 15-minute breaks and one uninterrupted meal period. Many hospital policies offer this as a guideline. But the reality of patient demands and short-staffed units means we are lucky to get five minutes to ourselves. We tend to put our patients’ needs first before we sit down, go to the bathroom, or grab a bite to eat. At the end of the day, we’re exhausted with the added weight of knowing we face the same challenges tomorrow.
My nurse coworkers at Harborview Medical Center in Seattle joined me in solving this unsustainable nursing norm. We surveyed our colleagues to learn about break time. On average, over a two-week period every nurse had missed at least two meals and 10 of their 15-minute breaks — time that could have offered quiet space to cope with the demands of caring for severely injured or ill patients, a visit to the restroom, or a warm meal instead of a crumbled energy bar.
We shared our findings with our management team and together created a six-month pilot project to add four full-time nurses to two acute-care units. Every day, two relief nurses cover the patient care assignments of staff nurses while they take their breaks. Really take them. We finally got the time to eat and recharge, even go outside for a few minutes, because we trusted that these seasoned nurses would respond to our patients just as we would.
After just a few months, nurses on those two units reported increased satisfaction with the new break system. Just as important, we saw better patient outcomes — there was a sharp decline in patient falls and medication errors compared to the units that continued the old system where nurses use a “buddy system” to cover each other’s patients during breaks. The pilot project was so successful that relief nurses have become part of our unit’s regular staffing plan.
An additional bonus: Nurse retention rates in those units improved dramatically.
Our pilot project was successful because we were able to work together with our hospital administrators to find a commonsense solution to a chronic problem. Hospital administrators and staff nurses shared the same commitment to support the safety and well-being of nursing professionals, just as we would expect for our own patients. We need to consider similar collaborative approaches that keep nurses at the bedside and nursing as a career choice that we want for our daughters and sons to pursue. The future of nursing depends on it.
Vanessa Patricelli is an orthopedics nurse at Harborview Medical Center in Seattle and a member of SEIU Healthcare 1199NW.
When we (nurses in ER) spoke at a meeting about having security in the E R 24/7 administration offered only a Friday or Saturday night. Shortly afterwards we got the 24/7. That is the culture change we need. The change agents to work with administration . Thank you for your info. Please go to http://www.stophealthcare violence.org
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