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.

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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.

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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.

  • I plan to share this article with our CNO. Working in Risk Management over the past 10 years, I would love to see our excellent nursing staff feel “OK” with taking their well-deserved breaks.

  • After 28 years from LPN in a Nursing home to ICU BSN, I want to find something else to do with my hard working, intelligent, caring life. The first 25 years I loved every position in nursing. The past 3 years healthcare systems have changed the focus to scrape every dollar away from the ” hands and feet” of ” care”. It is no longer Healthcare. It is now Medical business. I know I have great experience and I still have a heart to give great care to every single patient. I am not burned out on taking care of patients. I’m sick of the model we now are forced to be slaves to. Nurses can’t have a voice in what we do or staffing. We are mandated by someone looking at numbers who is not at the bedside. I’m looking for another career.

  • A sign outside our Physicians’ Dining Room reads as follows:
    “The physicians’ dining room is a ‘Safe Haven’ for our medical staff. Out of respect for your colleagues, please refrain from bringing guests (PA’s, residents, medical students, nurses, staff, etc.) into the Dining Room.”
    It reminds me of a sign I occasional saw on lawns when I was stationed in Norfolk, VA some 30 years ago. It read, and I’m paraphrasing, “Dogs and Sailors: Keep Off the Grass”.
    Nurses don’t get a break because they don’t demand it, and hospital administration sees us as little more than interchangeable parts in a machine.

  • After I graduated as an RN, on my first job I never had a breaktime. Lunchtime, I ate in my car and read my Time magazine. It was the only humane way I could get completely away; I was not abusing the time either; I just NEEDED that time away. I was criticized for that, being told I Must stay in the building in case there was an emergency!
    I was steps away from the hospital door.
    It is SO much worse now! In Good Samaritan Hosp, on LI, NY, while visiting a friend, I couldn’t avoid noticing that nurses RAN down the halls, and were hard to catch for anything; things were chaotic. Maybe they are different now, but 2 years ago, I could not help noting my relative-patient there Never got a bed bath any day I’d been there. She had blood down her legs, caked from yesterday that I took care of. I was and am heartsick. And, it was not the nurses’ faults; they were kind but waaaay too busy.

  • I work 12 hr nights in the ICU and I can tell you I rarely get to take a break. I eat breakfast bars when I’m charting and have an illegal mug of water near me to drink something. I’ve often said if I were a prisoner in a jail I’d have more basic human rights. I’ve had UTIs because I didn’t even have two minutes to run to the bathroom and pee. I’m 52 and in for the long haul, but I’m exhausted more often than not. No wonder the younger nurses are all flocking back to school to become NPs. Working in a hospital is like working in an unsafe coal mine.

  • Profit and PATIENT welfare over NURSES’ welfare. Only RNs and residents would put up with this, and residents eventually become attendants. Nurses eventually burn out.

  • I agree with other commenters here in that profit has been placed above the welfare of both patients and caregivers in our medical system.

    As a teen, I briefly worked as an OJT Respiratory Therapist. I worked 12 hour shifts at $4.25 per hour. (Yeah, it really was that long ago.) Staffing was so short, that I was routinely forced to work another half; sometimes even another full shift. I recall that now and shudder to think of a teenager in her 23rd hour doling out medical treatments. Fortunately for everyone, I was offered $5.25 to work in a fast-food restaurant that was open only from 11 am until 9 pm. I jumped at the chance for higher pay and more humane hours.

    Could I have worked into a better position had I stayed with the hospital? Maybe, but looking at relatives who went into and stayed in the medical field, I doubt it. I have relatives who have worked in the medical field as Nurse’s Aids, LPNs, and RNs for as long as 20 years. They earn a bit more than they did when they started. Otherwise, their work conditions are as abysmal as ever.

    They work 12 hour shifts and are routinely asked to work overtime. They rarely get to eat at all much less get the cute little 15 minute breaks referenced in the article. The mention of “breaks” in a hospital sends them into a fit of bitter laughter.

    They worry aloud about making a mistake; about truly harming a patient someday. Though nurses, they run on junk food from the vending machine, coffee, cigarettes, energy drinks, energy shots, and over the counter caffeine pills. Staying alert is their primary goal, again, because they worry so much about a fatigue induced mistake.

    Whether nurses working a 12 hour shift should get regular 15 minute breaks is an absurd question. We should ask why nurses are allowed to work more than 7 hours a day or more than 35 hours a week unless they are paid time and half?

    A hard rule requiring time and half, if the day exceeds 7 hours or the week exceeds 35 hours, applied to all hospital caregivers including both nurses and doctors; would slash medical malpractice. It would put a huge dent in addictive disorders among medical providers especially among those young enough that they have not yet developed such disorders. It would allow personal time so that familial relationships among care providers are strengthened and protected. It would lower our unemployment rate due to the additional staff required. That additional staff would boost our economy. Patients would be safer. Staff would be healthier. Everyone, except perhaps corporate investors in a for-profit medical scheme, would be better off.

  • Many years ago when I was in nursing school, we were imbued with the philosophy of sacrifice for our patients (“Hold the Nightengale lamp high!”). In fact, I and others actually used to wear menstrual pads because it was frequently difficult to take time to go to the bathroom. Then, as now, we were chronically short staffed but for a different reason. Then, patients stayed in hospital considerably longer than today and treatment modalities were not s effective, so there were simply more patients requiring close nursing care, and we were expected to put our patients first. Now, it is more a question of economics where the hospital corporations want to increase their bottom line. The simplest way to do that, of course, is to hire fewer R.N.s. The problem will not change until we get money out of health care. We must institute Medicare for all.

  • Great article on our earthly Angels. As an aside even in combat we recognize the need for sleep and breaks to minimize “friendly fire” incidents and judgement errors. After 2 combat tours I’m currently on home hospice and my days go smoother thanks to wonderful nurses and my wife. Thanks for all you do ! JB

  • Wonderful article. My wife is a nurse (and one hell of a nurse, too), but I have two big concerns about her and her health: back problems and burnout (caused mainly by understaffing). Both of these are fixable issues, and both issues need to be addressed at a systemic level.

    We are already starting to see a nursing “shortage” as older nurses start to retire, and that trend is only going to be exacerbated by the physical and mental damage nurses are subjected to because “that’s just how nursing is.” That’s how it has been, but that doesn’t make it right – and the sooner we can get nurses, nurse leaders, and hospital administrators speaking frankly and openly about those problems, the sooner we can start to extend the workforce and save some backs and minds.

    • How did those extra nurses factor into the shift? Were they floating nurses or did they have their own assignments? I’d like more details on that. It makes sense that if you have more staff you would have fewer patients to nurses, and nurses would have more time to complete care and take an appropriate lunch. Were they extra on the shift, or just new positions being added to the units? People are doing that everywhere. It seems we are just changing the definition of adequate staffing to a literal term, instead of what is most profitable. Still, when we are “fully staffed”…which hardly ever happens, we definitely do not get 3 fifteen min breaks on top of a lunch. Productivity is a killer man.

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