Staff shortages, combined with the need to care for patients holistically amidst the growing requirements of record keeping and technology, places ever higher demands on nurses. More and more often one hears nurses say that there isn’t time to take breaks during their shift. You are not doing yourself or your patients any favors by working hours on end without a taking a break to restore your physical and mental resources.
Why breaks are vital
Would you expect peak performance from an athlete who competes in one event and then, without a break, in another? Everyone brings a limited amount of physical, mental and emotional resources to the workplace and as we put in an intense effort, these resources become depleted. Breaks during the working day allow our resources to be restored, increasing both personal well-being and productivity.
Research in the field of occupational psychology has shown that job performance is affected when we become physically and mentally fatigued. It leads to a slower pace of work, decreased the ability to make decisions, and a lower level of creative thinking. This obviously leads to a greater chance of errors. In the case of nursing, it puts the safety of our patients at serious, possibly lethal, risk. Fatigue also reduces emotional control which can set back how we communicate with patients and colleagues.
“Fatigue also reduces emotional control which can set back how we communicate with patients and colleagues.”
Furthermore, high levels of stress and fatigue can cause loss of motivation, low morale, resentment, and even ill health and burn-out. Eventually, this can result in increased absenteeism and staff turnover.
In any job, adequate restorative breaks are essential. This applies even more in nursing which is physically, mentally as well as emotionally demanding and where patients’ well-being is at stake. Research has shown that proper breaks allow for restoration, with reduced levels of stress and a greater feeling of well-being.
In a study conducted by Cornell University, it was found that computer data capturers who were alerted to take short rest breaks during the day made 13% fewer errors than those who were not alerted, while there was no reduction in the total number of keystrokes. While a similarly measured study would not be possible for nursing tasks, it does demonstrate that breaks reduce errors without affecting productivity.
What is a restorative break?
Personal resources can only be recovered, and emotional well-being improved if you engage in activities during your break that you enjoy and prefer. Doing other chores during a break does not allow for restoration. You need to switch off from demands and do something that does not require personal effort. One person might enjoy socializing with colleagues while another would prefer to be quiet and alone, maybe with a book or taking a walk in nature. You must also not forget to refuel your body with the necessary hydration and fuel.
A restorative break, therefore, requires that nurses should be able to get away from the unit during their lunch break, preferably to a comfortable restroom. They should not need to be concerned about their patients or be on call.
“A restorative break, therefore, requires that nurses should be able to get away from the unit…”
During a shift, the one lunch break of 20-30 minutes required by law in most countries is probably not enough. This is particularly the case of the 12-hour shifts which many nurses are working today. Research has shown the value of regular shorter breaks and even mini-breaks of a few minutes, during the day.
You can usually sense when you need a short break – you feel stressed out, your head is spinning, and you aren’t thinking clearly anymore. This is when the likelihood of errors or the odds of losing your cool are greater. Take a couple of minutes to get it together – sit down or stretch and take some focused deep breaths. An excellent one-minute mindfulness exercise to use is the Quick Coherence® Technique advocated by the Institute of Heart Math.
Providing for breaks
One study found that nurses took a break or ate a meal free of patient care responsibilities in only 47% of their shifts over a period of one month. Given the discussion above, this is obviously not good either for the well-being of the nurse or safe patient care.
There are various reasons why nurses do not take breaks. The causes most often mentioned are work pressure or that there is no-one to take over responsibility for the patients when the nurse takes a break. While this is true in many cases, there is also often a culture of martyrdom, where nurses expect and are expected to deny their own needs for the sake of their work. This is understandable given that caring for others is the primary motivation for people to choose the nursing profession.
“…there is also often a culture of martyrdom, where nurses expect and are expected to deny their own needs for the sake of their work.”
Management and nurses, amongst each other, should promote a culture in which breaks are valued and encouraged as necessary for staff well-being and patient safety. Staff coverage should make it possible for nurses to take breaks. Creative strategies can be employed to achieve this, for example having floating or relief staff to take care of patients while their primary nurse takes a break. One hospital very successfully employed part-time nurses, such as older nurses or young mothers, to work a 3-4 hour shift to relieve nurses over the lunch period.
Take care of yourself
The well-known saying that you have to care for yourself before you can care for others comes to mind about breaks during work. Neither you nor your patients will benefit if you wear yourself down. Excessive stress and fatigue could even lead to a breaking point causing you to leave the profession.
If you find yourself in a position where the workload and staffing are such that it is impossible to take a break this is a legitimate professional concern because it can affect your well-being, increase errors and place patients at risk. This calls for raising the issue with management, workplace representatives or your nursing organization.