Analysis

Staying hydrated at work: how is your employer helping staff cope with long, hot shifts in PPE?

The pandemic has compounded long-standing problems of inadequate breaks and dehydration

With the pandemic compounding problems of inadequate breaks and unhealthy levels of dehydration, we hear from nurses about their experiences – and from employers who are trying to tackle the problem

  • A Nursing Standard survey found half of all respondents were unable to stay adequately hydrated at work
  • Lack of chances to take a break or drink is nothing new for nursing staff, but PPE has further limited opportunities, exacerbating health risks for staff
  • The initiatives easing the problem in some workplaces, plus how to raise the issue with your organisation

How much water did you drink on your last shift?

A lack of breaks and time to rehydrate

With the pandemic compounding problems of inadequate breaks and unhealthy levels of dehydration, we hear from nurses about their experiences – and from employers who are trying to tackle the problem

  • A Nursing Standard survey found half of all respondents were unable to stay adequately hydrated at work
  • Lack of chances to take a break or drink is nothing new for nursing staff, but PPE has further limited opportunities, exacerbating health risks for staff
  • The initiatives easing the problem in some workplaces, plus how to raise the issue with your organisation
Illustration showing a nurse removing a face mask and drinking water
Picture: iStock

How much water did you drink on your last shift?

A lack of breaks and time to rehydrate are long-standing issues in healthcare, but as staff face a second summer in personal protective equipment (PPE), nurses have shared how staying hydrated at work is more difficult than ever.

Here we look at nurses’ experiences in the pandemic and your rights regarding breaks, and highlight the innovative ways workplaces are helping staff stay hydrated and healthy.

Many nurses find it difficult to stay hydrated during long shifts

Earlier this year, Nursing Standard’s health and well-being survey asked if nursing staff were able to keep hydrated while wearing PPE. The responses were split, with 49.9% (706) of the 1,415 respondents saying they were able to drink enough and 50.1% (709) saying they were not.

20 minutes

The length of break that all UK workers are entitled to when working a shift of six hours or more

Source: The Working Time Regulations 1998

Respondents spoke of colleagues coping with urinary tract infections (UTIs), as well as how they are managing long-term conditions such as irritable bowel syndrome (IBS).

One nurse told the survey: ‘The only opportunities to drink are breakfast and lunch breaks if you get them. You also do not want to drink too much, because if you need the toilet there is no one to cover you.’

Others, however, have had a more positive experience, with one nurse working in a respiratory high dependency unit reporting they had ‘regular breaks’.

Another nurse said: ‘Can have as many drinks as we like when on duty. Our employer provides tea, coffee and cordial.’

But even where managers encourage staff to take time to rest and dehydrate, it isn’t always practical to do so.

Staff shortages and the need to wear PPE can prevent nurses taking time out

An intensive care nurse wrote: ‘We have supportive management who encouraged breaks, but we are often short-staffed, which makes it difficult to have mask breaks and get a drink even when it is encouraged.’

Leanne McCarthy: ‘In between breaks you would stay in your PPE – you did not drink; you didn’t go to the toilet’

Barts Health NHS Trust senior sister in critical care Leanne McCarthy recalls the challenges she faced during the first wave of the pandemic.

‘We were short on PPE and if you left the ward you had to take PPE off, throw it away and put a new set on when going back onto the ward. So, the plan was to have two, one-hour breaks a day and in between the breaks you would stay in your PPE. You did not drink; you didn’t go to the toilet. Once you were in, you were in.

‘Before the pandemic, when we were one nurse to one patient, there would be someone in the room who could cover your patient if you needed to run to the loo. But in the first wave, we had the responsibility of six patients,’ she says.

Poor hydration is having a negative impact on nurses’ health

Ms McCarthy believes that workload changes caused by the pandemic have contributed to her putting on about a stone and a half (10kg) over the past year.

37.8°C

The temperature on the UK’s hottest day of 2020, recorded at Heathrow Airport on 31 July

Source: Met Office

‘My exercise has dropped off,’ she says. ‘Before the pandemic, I could do 10,000-15,000 steps at work in a day. Being in PPE and not moving about as much, I might only do 4,000-5,000 steps.’

Ms McCarthy also describes how the lack of breaks and opportunities to drink have affected some of her colleagues.

She says one colleague was off sick for nearly a month with kidney stones – a condition where dehydration can be a risk factor – and a number have had UTIs.

She adds that although there is now enough PPE, the worry about wasting it by having to change into fresh protective wear is still at the forefront of nurses’ minds. Plus, taking regular breaks is still not easy in the working day.

‘You have to consider that the lack of opportunities to take lunch, water and toilet breaks have been in the nursing culture for many years.’

Breaks at work: what are my rights?

Under the Working Time Regulations 1998, UK workers are entitled to a minimum 20-minute break when working for six hours or more.

This break should:

  • Be uninterrupted
  • Be away from your workstation/working area
  • Take place during working time (so not right at the start or end of the working day)

Adapted from: My employer won’t allow me a comfort break during a shift: what are my legal rights?

Nurses have reported foregoing breaks to extend the use of PPE
Nurses have reported foregoing breaks to extend the use of PPE Picture: Alamy

Nurses in the community experience additional barriers

Community nurses who responded to our survey described different challenges to their colleagues working in hospitals.

‘It’s not easy to find toilets and therefore I’m not drinking much,’ one explained.

Another said: ‘I work in the community and only wear PPE during visits. I carry water with me at all times.’

‘The lack of opportunities to take lunch, water and toilet breaks have been in the nursing culture for many years’

Leanne McCarthy, Barts Health NHS Trust senior sister in critical care

Community nurse Kelly Joyce, who is based in Nottinghamshire, told Nursing Standard that she tries to drink water in between patient visits.

‘It is always a challenge finding a toilet when working in the community, regardless of COVID. I think we get very good at training our bladders,’ she says. ‘But I try and take advantage of what I’ve got available to me. That would be a care home I am visiting, our base or public facilities.’

Ms Joyce knows from personal experience how important it is to stay hydrated: ‘One time when I was on shift and didn’t drink enough water, I thought I was going to faint. I told myself I would never put myself in that position again, so I make the effort to drink throughout the day.’

Hydration stations show a commitment to keep staff healthy

NHS Forth Valley was in the process of rolling out a scheme to encourage staff to drink more water when the pandemic hit.

Hydration stations – trays placed in accessible areas of wards where staff can access labelled water to avoid cross-infection – were being introduced across Forth Valley Royal Hospital.

NHS Forth Valley staff at a hydration station
NHS Forth Valley staff at a hydration station, a simple measure that helps staff avoid fatigue and maintain concentration during a long shift

The initiative was spearheaded by intensive care nurse and RCN steward Hilary Nelson, who won the backing of the health board’s senior management. When the pandemic began, she wanted to make sure that staff were still being encouraged to stay hydrated, especially while wearing personal protective equipment (PPE).

‘We were hearing that people were exceptionally dehydrated. They were worried to drink water because of infection control risks,’ says Ms Nelson.

Hilary Nelson
Hilary Nelson: ‘We are committed to this, with or without COVID’

Ms Nelson worked with the infection control team to ensure the hydration stations were safe and could be kept on the wards throughout the crisis. A member of staff is responsible for cleaning the station and ensuring all water bottles are taken home at the end of a shift.

Rehydration wards off fatigue

The initiative has since been extended across the health board to clinical and non-clinical areas.

‘Staff would often only drink water on their breaks,’ says Ms Nelson. ‘But now because they can see their water bottle on the hydration station, they are more likely to drink and refill.

‘They have reported that they are not going home with sore heads, their concentration and their fatigue levels have improved, and they have noticed a massive improvement in their health.’

‘Our organisation is committed to this,’ she says. ‘If COVID didn’t exist tomorrow, our commitment to hydration and well-being would still be in place.’

In her role as RCN steward, Ms Nelson says she made it clear to the trust that the hydration stations are not a substitute for staff having scheduled breaks.

Dehydration is not a new problem for nursing staff

Inadequate hydration at work was an issue for nurses long before the COVID-19 pandemic. A 2020 study commissioned by the Nursing and Midwifery Council said nurses and midwives were risking their health because they felt unable to take breaks and hydrate. It also warned that fatigue and dehydration could result in impaired decision-making by registrants.

According to guidance from the British Dietetic Association, adults should aim to drink 1.5-2 litres of fluid every day.

The RCN’s former national officer Kim Sunley says PPE and the wider pandemic should not be a reason for staff to feel unable to have a drink or toilet break.

1.5-2 litres a day

Recommended daily fluid allowance for adults

Source: British Dietetic Association

‘Under health and safety legislation, employers have a duty to ensure that staff can easily access drinking water and have the time to take the breaks to which they are entitled,’ she says.

‘They should also recognise that some staff may require more breaks due to underlying health issues, or when pregnant or experiencing the menopause.’

She advises nurses who are experiencing difficulties in being able to access drinking water or take toilet breaks should escalate concerns with their RCN representative or discuss with their manager.

One such nurse is Sheffield Teaching Hospitals NHS Foundation Trust digital senior charge nurse Joan Laplana.

Mr Laplana, who works in intensive care, lives with IBS, a condition he says he did not disclose to his manager or colleagues before the pandemic.

Joan Laplana Picture: Neil O’Connor

‘For me the pandemic has been one of the most challenging things to manage my IBS because I normally take for granted that I can go to the toilet any time,’ he says. ‘I told my manager that I had IBS and she was supportive and said there was no problem if I needed to go to the toilet, I could just have more PPE.’

He says while his colleagues have been supportive, he felt guilt over needing to use further PPE supplies after taking a break. ‘You would see in the news that other colleagues didn’t have access to PPE and it makes you feel very guilty.’

Helping staff stay cool and hydrated: employers’ obligations

The Health and Safety Executive position on the issue is clear.

A spokesperson told Nursing Standard that every organisation, no matter its size or type, should have a COVID-19 risk assessment tailored to the workplace that is regularly reviewed – and that includes considering how workers can stay cool and well hydrated while wearing PPE.

How we conducted the survey

  • We asked nurses to share information about their health and well-being at work
  • The questions were asked using online tool Survey Monkey and the survey ran from 17-28 February 2021
  • It was promoted via email to registered users of RCNi.com, in our online news section and on social media
  • We received 1,415 responses and the initial findings were analysed by Nursing Standard staff


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