For many of us outside nursing, taking a break in the workday—to grab a bite, go for a walk, or catch up with a coworker—is a practiced habit. It’s something we take for granted. Not so for nurses.
Our VP of Nursing recalls the predicament he faced on most shifts: He was unable to take an uninterrupted break, but there was also no permissible place to drink water at the nurses’ station. It’s ironic that those entrusted to keep the rest of us comfortable, rested, and fed aren’t afforded the same courtesy—especially in a field where nurse fatigue and patient safety are so closely linked.
Long shifts in nursing are standard practice. What’s not so common is the routine of taking a short break to unplug and recharge during those long workdays. In fact, research shows that the more hours a nurse works in a shift, the less likely he or she may be to escape call lights or other patient needs. In one study:
“… nearly 40 percent of nurses surveyed worked shifts longer than 12 hours, but the long workdays were not associated with an ability to enjoy a rest period. In fact, the numbers went down. Forty-nine percent of nurses working shifts of 8.5 or fewer hours were able to escape patient-care duties during a break, compared with 46.7 percent working shifts of 12.5 hours or more. And the percentage of breaks free of patient-care duties decreased to 30 percent when nurses worked 20 or more consecutive hours.”
Statistics like this aren’t too surprising, given the character of those drawn to nursing in the first place. Nurses tend to prioritize others’ needs. Vanessa Patricelli, an orthopedics nurse at Harborview Medical Center in Seattle, says, “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.”
There’s also a stigma that surrounds taking a break. Coworkers may frown on it, creating peer pressure to dissuade the habit. And many employers still expect nurses to keep working during lunch breaks that they’re not paid for, as evidenced by the string of lawsuits filed against such practices. Higher patient acuity and an increasing shortage of nurses are contributing to this hamster-wheel pace as well.
Still, there’s ample research showing how important it is to give the brain and body some downtime. John P. Trougakos, an assistant management professor at the University of Toronto Scarborough and the Rotman School of Management, explains,
“Mental concentration is similar to a muscle. It becomes fatigued after sustained use and needs a rest period before it can recover, he explains — much as a weight lifter needs rest before doing a second round of repetitions at the gym.”
Studies show that when nurses log long hours without breaks, they’re also more prone to injuries, which take a financial toll on the facility as well:
“Adverse schedules such as workdays longer than 13 hours, weekend work, working without breaks, returning to work on days off, on-call work, and overtime have all been found to relate significantly to the incidence of musculoskeletal injury in nurses. These same schedule characteristics have also been found to be significantly related to the incidence of needlestick injuries among nurses.”
Industries outside health care have been quicker to adopt measures to address fatigue in shift workers. Measures taken to support airline crews could provide inspiration to facility leaders when it comes to nursing, including limiting time on duty, mandating opportunities for sleep, and using controlled rest periods. Ultimately, as the saying goes, “what’s good for the goose is good for the gander.” In other words, when nurses are rested and rejuvenated, patients in their care benefit, as do facility leaders looking to maximize reimbursements.
Here are some ways nurse managers can help their staff get some much-needed relief:
- Adapt staffing levels: Much of the time, nurses don’t take breaks because they don’t have anyone to cover for them. Balancing nurse-to-patient ratios with budget demands is a challenge to say the least, particularly in non-Magnet facilities. Giving nurses the relief they need, though, will improve retention and patient care, factors that ultimately bode well for the bottom line too. And technology solutions can help you quickly summon on call staff members and fill open shifts with more targeted requests that available staff are more likely to pick up, helping you maintain appropriate staffing levels with the staff you do have.
- Structure breaks: Setting up the work environment to permit and encourage downtime is key. Ensuring you have the proper staffing levels in place is critical (#1), but making a commitment to changing the work environment is just as important. A group of nurses at Harborview Medical Center in Seattle did just that recently. The results of their pilot program to add four full-time nurses to two acute-care units–which allowed two relief nurses to cover the patient care assignments of staff nurses while they took real, uninterrupted breaks–included increased nurse satisfaction, a sharp decline in patient falls and medication errors, and dramatically improved nurse retention rates. The results were so significant that the relief nurses became part of the units’ regular staffing plan.
- Promote communication: Encourage your nurses to ask for help. Instead of feeling like they need to carry a burgeoning load on their own, they should feel supported. By helping them delegate during especially hectic times, they’ll have more room to recharge.
- Set up a nap room: NASA studies on sleep-deprived military pilots and astronauts found that a 40-minute power nap improved performance by 34 percent and alertness by 100%. In another study that looked at napping on breaks during night shifts, “10 out of 13 critical care nurses who napped regularly during breaks reported several benefits to napping, including improved energy, mood and decision-making, and vigilance.” We know it won’t be easy to convince senior management to allow sleeping on a shift. But suggesting a pilot program like the nurses at Harborview Medical Center–who gathered data about breaks among colleagues and shared it with their managers, which led to the groups collaborating on the pilot program–could be the most effective way to establish compelling enough preliminary results for a broader rollout.
Are you and your staff taking breaks? If no, why not? And if you are, we’d love to hear how you’re making it work. Share in the comments below.
This article was republished with permission from SCRUBS Magazine.
I currently work for a hospital that does not give breaks. No effort is made to give breaks. I have endured it for the past eight years but can no longer put up with this. I know there are labor laws that are being ignored and I don’t understand why nurses don’t matter to anyone as far as how they are treated. I worked in a factory before I became a nurse. After 35 years of nursing I often wish I was still a simple factory worker where I was given breaks and treated with respect.
I worked in the OR for 37 yrs. Management kept just enough staff to run the rooms. No one extra to help or give breaks/lunch. Because of no breaks, no lunch, mandatory OT and on call everyone was burned out and everyday we had call offs that mostly were mental health days just because people were too tired to work causing low moral. All this could have been avoided by adding 1 nurse and 1 tech. I was lucky and could retire at age 57 not because I really wanted to but because I felt I could no longer keep up and give it my best and all I could see in the future was more of the same. Being unionized was no help either.
Office types of people in hospitals (and other occupations) always take their breaks, take lunches, and get to sit down. These are the types of people who make the decisions on how the facilities function. They are clueless what nurses put up with. I’ve worked in most fields and some of the laziest are ICu nurses.I don’t care who doesn’t want to hear it. Does anyone here think that office types who “run everything” would put up with no breaks, no lunches, and hardly sitting down?
I used to work on an car assembly line. Since the assembly line can’t stop – they would have people that would take your spot while you took your break. Similar idea to the hospital in Washington. Surprised it’s taken this long to implement a similar idea that’s been in manufacturing for a long time.
Where I work no nurses take breaks. Recently phlebotomy duties have been added to our already full plates! Now we are being told that we have to manage our time better and clock out on time! I have been nursing over 35 years, and for the first time I’m beginning to hate it! And the only break I am asking for is a chance to see during my 12.5 hour shift!
It amazes me to think that this problem persist. Imagine this interview, “We are so happy to have you come and work for our company, let me tell you a little bit about your duties. You will work a 12 hour shift , but you will probably work 13 because all documenting must be completed before leaving. I hope you brought some crackers or something because you will not get a break for eating because your patients will be in your care during the entire shift. Please let the secretary when you have to go to the bathroom so we will know why you are not answering your phone. Once again, we are so happy you are joining our team.” Can you believe it? Yet we do this everyday we go to work. Someone needs to change this culture. I am convinced we must and that we can for ourselves and for the nurses that will follow. What we have is an industry taking advantage of people who want to nurture and take care of others. Let’s change this.
I am an administrator now and sit in my office alone for hours on end, focused on my task at hand. I find getting up and going to speak to others, share a laugh, talk to a patient or their family, does so much for my focus. I can actually get back on task with more vigor. Also staring at a computer and papers all day is so tiring to the eyes, the above people are much easier on the eyes!
A 20 or 30 minute power nap always did it for me! Gets you through the shift.
I am presently on a long term care contract as a travel nurse. I work 17 hour shift, typically seven days a week. I could not tell you the last time I had a break. I wish there were a way to rectify this, but in my 13 years of nursing, it is more common to skip your break than it is to take it.