Volume 5 | Issue 10 | Through November 29, 2011

Nurse to Colleagues: You Deserve a Break Today

By Tyler Smith
Clinical nurse Sarah Stalder sits at a table in a small break room on the hospitals 11th oor Oncology/Blood and Marrow Transplant Unit and does something that would have seemed far-fetched just six months ago. She uses a fork to spear a piece of lettuce from a salad in a Tupperware container without a phone sitting next to her or in her pocket. She can thank a pilot program she herself launched for the scene. Its one that is still played out only infrequently in the hospitals inpatient units. Many nurses, in fact, wouldnt think of grabbing even a hasty meal break without the phones that keep them connected to their patients. The biggest resistance is they dont want to give up control of their phones and of their patients, Stalder says.
Nurses on the 11th oor of the AIP now heed the words on signs in break rooms.

In fact, she admits, for most of her seven-and-a-half years as a nurse, she didnt want to take phone-free breaks either. She didnt plan for them and was reluctant to bother a colleague to cover for her when, well into a 12-hour shift, shed suddenly realize that she hadnt eaten anything or even paused for a break. I did it only occasionally up until now, she says of handing over her phone to enjoy a meal not punctuated by urgent rings. The culture wasnt conducive to it, and I felt guilty asking somebody to cover for me. Give me a break. But in 2010, Stalder, a member of the Staff Nurse Council, volunteered to take the lead in piloting a plan for regular, phone-free breaks on her unit. The rst effort failed miserably, she says, and when she broached the subject again last April, she still found many of her fellow nurses resistant to the idea.

Still, she pushed forward, creating a model program that includes scheduled 45-minute breaks for both nurses and certied nursing assistants (CNAs) in break rooms that are now No Phone or Hakuna Matata (no worries, the Swahili phrase made famous in The Lion King) zones. Six months after the second try, the pilot is a success: 92 percent of nurses on the Oncology Unit report being able to sit down for a meal break, free of patient care. On the BMT side, the percentage is a more modest, but still impressive, 69 percent. More importantly, nurses have bought into the idea that taking a break is good for them and for their patients, Stalder says. After about two months, they realized they could trust their coworkers and give up control of their patients, she explains. They say they feel better and happier, that they relish getting a break and getting off the oor. Its helped staff morale.
Continued

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Volume 5 | Issue 10 | Through November 29, 2011 | Page 2

Problem without a solution. In developing and implementing the policy, Stalder waded into a long-running, controversial issue. Thirty-eight percent of UCH nurses in the 2009 annual nursing survey reported they could not sit down for a meal without being free of responsibilities for patient care. At least one unit 12 West Medicine implemented, with some success, a system that allowed nurses to buddy up and cover patients for one another while each took meal breaks (Insider, May 26, 2010). Nursing leadership strongly supported the idea of untethering nurses from their phones for at least short periods of time.

a new plan. It designated 45-minute lunch breaks between 12:30 and 2 p.m. for nurses and CNAs on the day shift. The night charge nurse assigned lunch buddies for the day shift, so people could think early on about the break time that would work best for them. The goal is to go within the time you choose, Stalder says. Some things you cant anticipate, but the big thing is to plan ahead, just like if you have a meeting you have to attend. The plan also had the support of the units nurse manager, Jennifer Zwink, RN, and a team of other staff nurses, who encouraged some of their dubious colleagues to follow the break schedule. Early on, nurses put up lots of resistance, Stalder admits. People would tell us, Im having a busy day, I cant give up my phone, or I dont want to inconvenience anyone, she says. But she and Zwink met the objections with their own determination. They patrolled the break rooms, keeping an eye out for phones. We were strict about implementing the phone-free zones, Stalder relates. People would try to smuggle their phones in and hide them. Change of heart. The objections broke down as nurses discovered they could trust the system. They now brief their buddies with mini reports before they go on break and know they can call or talk to the charge nurse to ask for backup if their buddy is busy, Stalder says. Where she once received emails from nurses angry about the plan, she now gets occasional messages thanking her for implementing the change. People now enjoy not having the phone ringing and having silence instead, she says. I enjoy seeing my coworkers take breaks and seeing their satisfaction. Its validating when they tell me now that they love it. The idea could spread. Magnet Program Director Danielle Schloffman, RN, MSN, says seven other units are now working on their own meal-break plans. Stalder has talked directly with a staff nurse representative from one, 6 East Medicine Subspecialties. Every oor is different, Stalder says. But when you show your coworkers that you are actually advocating for them and that you care about them and their mental health, its proven that people are willing to change.

Sarah Stalder (left) with nurses (from left) Annsley Bufngton, Nicole Martinez and Aline Schulte, enjoying a phone-free break.

The commonsense idea is that nurses working 12-hour shifts on typically busy inpatient units need break times to relax and recharge. In a Jan. 2009 article in the American Journal of Nursing, a director of a unit at Massachusetts General Hospital that instituted hour-long, off-unit meal breaks described nurses who were less fatigued, managed their time more efciently and enjoyed closer relationships with their colleagues. Still, the idea fell at when Stalder rst tried it in 2010 on the 11th oor as it had on most inpatient units. The problem wasnt only staff resistance although that was certainly there, she says. It was a lack of consistency in sticking to the plan. Nurses were supposed to sign up with lunch buddies to cover their patients while they were on break, but too often they didnt give up their phones or simply skipped their time off altogether. Taking another shot. The second time around, Stalder solicited feedback from the unit about what had and hadnt worked and devised