Safety Culture & Virtue 6: Lunch Breaks (7 mins)

How much do you trust your coworkers to watch your patients during lunch?

This question is an often overlooked key indicator of safety culture. Nurses are possessive of "their" patients and this episode explores reasons and symptoms of lunch breaks that are not covered.

Key Points:

-Critical debriefing

-Trusting your team

-What makes a "good" team?

Transcript

Lunch Breaks

A nurse was asked to care for a attempted murderer, and two beds away perpetrator’s victim fought for life. They were siblings, which made visitation hours particularly difficult for their relatives. The victim’s room was full of staff delivering emergency interventions, but the murderer spent the entire hospital stay staring at the victim’s room as though willing death to come and finish their work.

For the nurse, it was profoundly draining to figure out how to be therapeutic. The expression of hate on the attempted killer’s face was utterly unnerving, and the few words spoken were rude and terse. When it was time for lunch breaks, the charge nurse stepped in to say she would personally watch the patient so that the nurse could take a break. This was an important and necessary intervention because it wouldn’t be wise to ask the victim’s nurse to also care for the murderer as the family could be upset. The other nurses had heavy cases and amidst this political and logistical staffing nightmare: the charge nurse was the best choice. Without the charge nurse stepping in and prioritizing a lunch break for an emotionally exhausted nurse, therapeutic care would not be possible. 

In my own experience, it was during my lunch break that I realized if something was troubling me about my patients and had a chance to decompress, pray, think about my patients objectively, and consider circumstances that I had not consciously identified but could become problematic. 

Indeed, rest from the demands of clinical work is absolutely essential to evidence-based healthcare. During breaks, staff not only physically refuel, but they have an opportunity to reflect or escape, to weep or laugh, to debrief from the day’s assignment. That’s why today’s assessment item is whether team members willingly cover each other’s lunch breaks.

For one thing, it displays a profound amount of trust to leave your patients in the hands of another caregiver. All nurses, for example, are incredibly possessive about “their” patients, and it is not an easy thing to hand them off to another nurse if you think that nurse may not be trustworthy, may not really watch them, or may not intervene if warning signs arise. That’s why it is a sign of a virtuous safety culture when that handoff does occur, because it means that staff trust each other.

The ability to trust each other and work together is so valuable in a variety of circumstances. I’ve seen my professional colleagues return from their brief lunch break with a fresh perspective or an awareness of how a seemingly insignificant factor is a critical sign that can guide treatment. Further, providing a federally mandated lunch break is a simple test for compliance with rules and guidelines. If those rules are brushed off as an inconvenience, how many other rules are disregarded? And since it’s a federal labor law, it’s clearly not just a luxury or a preference, but a necessary intervention to preserve safety and a healthy workforce.

Another issue is that when rest is withheld, it is a sign that the team does not work together, that there is a lack of trust and compassion. Obviously, the suffering of one employee does not benefit the team, so the root cause is always dysfunctional. This trend can rapidly lead to burnout and poor retention. But when someone volunteers to cover a lunch break, it is a basic sign of compliance with regulations and respect for coworkers.

So what are the other reasons why lunch breaks don’t happen? Retaliation by a clique is another possibility because it is a simple way to punish outsiders. I have seen travel nurses left on their own during lunch breaks because the full-time staff felt that their pay was unequal. Other times, whistleblowers were snubbed when it was time for a lunch break. But it’s not just the target who suffers in these circumstances; it’s their patients as well. These are social realities that are not easy to identify, but if you see cold behavior and missed lunch breaks it becomes much easier to label.

Another reason why people can be hesitant to cover lunch breaks is when they feel personally overloaded and unable to manage any increase in capacity. If staff already feels stressed about their own load, they won’t want to be responsible for even more because it could become a safety issue of its own.

In some ways, this item is more difficult to solve because it can depend on the root cause, but I have also noticed that a variety of causes can be ameliorated by a good team. On a practical side, some managers try to randomly audit whether everyone has taken their break and enforce it by authority, and others have assigned “break buddies” so that there is a clear chain of responsibility. But one of the best ways to build a team where the workforce is fractured, is to serve together for a charitable cause. One of the other assessment items deals more directly with the subject of charitable work, so I will save the details for a later episode, but suffice it to say that the closest teams I have worked on were the ones that collected funds, food, and donations for a shared purpose. Nothing knit us together like service because it made us feel like we were a “good” team – not just coworkers, but virtuous people working together for an important, common purpose. It reminded us why we entered the healthcare field and drew us together in respectful and trusting collegiality. Teams are happy to work together and cover for each other.

 Lunch breaks are a critical reflection of virtuous culture because they are an easy to way to measure if all of your staff are acting as a team. If your team isn’t covering for each others’ lunch breaks, you can bet patients are paying the price for it.