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September 28, 2016

How Harborview Medical Center made time for nurses' breaks—and how it paid off

Daily Briefing

Editor's note: This popular story from the Daily Briefing's archives was republished on Jan. 22, 2020.

Nurses often can't find a spare moment in their shifts to take a break, but Harborview Medical Center in Seattle found a way to give its nurses some much-needed rest—leading to better nurse retention and improved patient outcomes.

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No break, big problem

Skipping breaks can be dangerous, both for nurses and patients.

Compared to other professionals, nurses have high rates of on-the-job fatigue, injuries, and burnout. A lack of rest can exacerbate those problems, and overworked, tired nurses are more likely to cause patient harm, Paige Minemyer writes for FierceHealthcare.

Vanessa Patricelli, an orthopedic nurse at Harborview, writes in a STAT News opinion piece that "the solution may appear obvious: Just take a break." But she notes that's easier said than done.

In many cases, hospitals lack adequate staff to cover for nurses who take breaks. And some RNs delay or skip breaks out of concern for patients. "We tend to put our patients' needs first before we sit down, go to the bathroom, or grab a bite to eat," Patricelli writes.

According to Patricelli, a nurse working a 12-hour shift should take at least three 15-minute breaks and have one uninterrupted meal. While many hospitals set a policy to provide those breaks, "the reality of patient demands and short-staffed units means we are lucky to get five minutes to ourselves," Patricelli writes.

How Harborview found time for breaks

Patricelli details how she and her nurse colleagues at Harborview set out to solve "this unsustainable nursing norm."

They surveyed nurses at the hospital and found that, on average, each nurse missed two meals and 10 breaks over a two-week period. Spurred by the data, they worked with their management team to develop a pilot project to address the problem.

Under the six-month pilot, the hospital added four full-time nurses to two of its acute care units, which allowed relief nurses to cover patients while staff nurses took breaks.

After just a few months, nurses on those units reported increased satisfaction and retention. Patient outcomes also improved, with a documented decline in falls and medication errors compared with nursing units using the traditional "buddy system" to cover patients during breaks.

Now, the relief nurses are part of the units' regular rotations.

"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," Patricelli writes. "The future of nursing depends on it" (Patricelli, "First Opinion," STAT News, 9/23; Minemyer, FierceHealthcare, 9/23).

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