How to create a ‘take a break’ culture

When nurses routinely skip breaks they put their health at risk, which can also affect the care they give their patients. Now some employers are promoting a culture change

When nurses routinely skip breaks they put their health at risk, affecting themselves and their patients. Now some employers are promoting a culture change

Breaks aren’t a luxury, they’re vital, says the RCN.
Picture: Charles Milligan

Taking a break at work is increasingly seen as a bonus rather than a necessity, with some nursing staff reporting going hours without a drink and even struggling to find time to go to the toilet.

‘We’re trying to send a very strong message that breaks aren’t a luxury, they’re vital,’ says RCN national officer Kim Sunley. ‘There’s a growing body of evidence that links the health and well-being of the nursing workforce with patient outcomes – which means it’s really important that organisations look after their staff, because it impacts on quality of care.’

In a 2017 RCN survey looking at safe staffing, which attracted more than 30,000 responses, 59% of respondents said they had been unable to take sufficient breaks on their last shift. The figure rose to 69% for those working in the community.

‘On a ward you may have a supportive manager who can check to see that everyone has had a break. But in the community it can be a bit out of sight, out of mind,’ says Ms Sunley.

Kim Sunley: ‘We’re so busy
caring for patients that we
forget about ourselves.’

Rest, rehydrate, refuel

The RCN’s report on the survey, Safe and Effective Staffing: Nursing Against the Odds, quotes one community nurse as saying: ‘We regularly miss breaks, go 14 hours without a drink – to the point where one of my colleagues has developed kidney stones.’

A practice nurse said: ‘I always go above and beyond for my patients – we all do as nurses – but that is to the detriment of myself: minimal breaks, not drinking enough fluids, holding on for the toilet.’

This spring the RCN launched its resource Rest, Rehydrate, Refuel as a spin-off from its Healthy Workforce, Healthy You campaign. It aims to encourage health and social care managers to make sure staff are taking breaks, are well-hydrated and have access to nutritional food, as well as to support staff to look after themselves and assert their right to have a break.

Missing breaks is unsustainable

Recognising the challenges of workforce shortages, the RCN says there may be times when staff miss their breaks, ‘but when this becomes a regular occurrence or is seen as the norm, it is unsustainable. If nursing staff are not enabled to self-care and have a poor working environment, they are more likely to become unwell, burn out or want to leave the job’. 

‘There is something about having permission to go on your break, so the manager’s role is very important and they can lead by example’

Kim Sunley, RCN national officer

A key issue for nursing staff is their wish to put patients’ needs before their own, says Ms Sunley. ‘We’re so busy caring for patients that we forget about ourselves. But we use the analogy of when you’re on an aircraft you’re told to put your own oxygen mask on first, before you help others with theirs – the same principle applies.’

Making time for lunch breaks and power naps

  • If taking a break has become a rarity where you work, speak to your colleagues and share your anxieties with them, says the RCN. ‘It’s easier to go to your manager as a group that is concerned about the situation in your workplace, rather than as one individual,’ advises Ms Sunley
  • Taking a break is especially vital for those working night shifts, says Guy’s and St Thomas’ NHS Foundation Trust in its campaign called HALT – Hungry, Angry, Late, Tired. It recommends eating well, keeping hydrated and taking a 15-20 minute ‘power nap’ during your break, if possible, making use of eye masks and ear plugs. ‘It improves your productivity and alertness,’ says Sarah Wilding, deputy chief nurse at the trust
  • Role modelling, leadership and visibility have been key to HALT’s success, Ms Wilding believes. ‘It’s important to have a culture where not taking a break is not accepted and is challenged,’ she says. ‘If you’re working alone, book time in your diary for lunch. Taking your break is as important as any other activity’

Poor staffing levels are adding to the difficulties. ‘It would be naive to think that wasn’t an issue, but you can also see organisations where things work quite differently depending on the ward,’ says Ms Sunley. ‘They face the same pressures on staffing but are still giving nursing staff their breaks. Where it’s become normal not to take a break, we need to turn the culture on its head.’

It’s important that the message comes from the top too, she believes, with managers being seen taking their break in their staff canteen. ‘There is something about having permission to go on your break, so the manager’s role is very important and they can lead by example,’ says Ms Sunley.

Hungry, angry, late, tired

With plans to repeat the survey in the future, the RCN is keen to see a reduction in the number of staff who say they are unable to take sufficient breaks. ‘If the culture doesn’t change, more nurses will become unwell and stressed,’ says Ms Sunley. ‘We need to look after the staff we have.’

Sarah Wilding: ‘We all need
to take responsibility.’

One organisation that is taking the issue seriously is Guy’s and St Thomas’ NHS Foundation Trust. In March 2017 it launched a campaign called Hungry, Angry, Late, Tired (HALT) to make staff aware that taking enough breaks helps them to provide the highest standards of patient care.

‘The context is a recognition that our staff are struggling,’ says the trust’s deputy chief nurse, Sarah Wilding. ‘They’re not having breaks, while the case mix of patients is becoming more complex, so more physically and mentally draining, and there can be burnout.

‘It also came out of our staff survey, recognising that staff weren’t going home on time. We wanted to see how we could improve their well-being.’

Now the issue is brought up during staff ‘huddles’ that take place regularly in clinical areas, with managers checking to see whether staff have been able to take their breaks.

Breaking bad habits

‘But possibly the biggest impact is that people are going home on time much more often, with anecdotal feedback that staff are leaving together,’ says Ms Wilding. ‘Our staff survey also shows a reduction in staff working over their hours.’

‘It’s breaking bad habits – for example eating while you’re emailing, rather than going out and getting some fresh air’

Sarah Wilding, deputy chief nurse at Guy’s and St Thomas’ NHS Foundation Trust

Among the current challenges is to try to establish the ‘take a break’ culture in smaller groups and for some individual and lone practitioners.

‘It’s breaking bad habits – for example eating while you’re emailing, rather than going out and getting some fresh air,’ says Ms Wilding. ‘Initially there were questions about the practicalities of how we could make this work. But it’s forced discussions to happen. And it’s a constant cycle of reinforcement. We all need to take responsibility.’

‘We schedule breaks, just like we schedule medications’

Nurse ward manager Dennis Paquiz says making certain that his 37 staff take their breaks has brought positive benefits for both them and patients.

Dennis Paquiz: ‘If you go for your
break on time you’ll perform better.’

‘It was really hit and miss before,’ admits Mr Paquiz, who manages a 35-bed inpatient haematology ward at Guy’s and St Thomas’ NHS Foundation Trust.

‘It’s a very busy ward and sometimes we sacrificed ourselves to be on top of the game. Staff would rather look after the patients than go for their break. But they couldn’t sustain that over an 11-and-a-half-hour shift. When the trust first implemented this initiative I said to myself that we need to change.’

Second nature

Today staff plan their breaks from the beginning of their shift, with times written up on the board so patients are also aware. ‘It’s an open discussion during a ward meeting,’ says Mr Paquiz, who has managed the ward for the past ten years.

‘From first thing, they need to know exactly when they are going on their breaks. It’s been in place now for more than a year and it’s become second nature.’

Having discussed different options, the team has settled on a 30-minute break, followed by a 45-minute one. But initially it was difficult to persuade some staff that scheduling breaks was a good idea, says Mr Paquiz.

‘My approach is simple,’ he says. ‘I asked them to think about how we manage to give patients their antibiotics or painkillers on time – and of course it’s prescribed on their drugs chart. I then said, I’m prescribing that you take your break on time. You can only give what you have, and you need to look after yourself.’

He also reminded staff of the dangers of being hungry or tired. ‘If you’re hungry, you’ll have mood swings and your attitude could be picked up by your patient.’

‘You’re also more prone to make mistakes. But if you go for your break on time, you’re keeping your patient safe because you’ll perform better – your brain is working at 100%, rather than 50%. If you emphasise that patients are at risk, staff become more aware of what you’re trying to do. When they realised this, things began to change.’

‘It’s made a real difference to the team’

It’s crucial too that managers take a lead, setting a good example, he says. ‘It’s like building a big structure. If managers are supporting this, then others will follow. Staff see me taking my break – it’s visible.’

‘It’s an ongoing campaign too, because of course nurses come and go. From the management point of view, it’s about reinforcing it. And it’s not just about breaks – it’s also going home on time and not staying late.’

Now everyone is happier, he says. ‘You can see the impact and it’s made a real difference to the team.’

Lynne Pearce is a freelance health journalist