Take a Break! Stressing the Importance of Meal Breaks

As chair of the Retention Council at Cleveland Clinic Hillcrest Hospital, Marie Novak, BSN, RN, CMSRN, recognized a problem in the spring of 2016. Nurses on several units were not taking – or were unable to take – their meal breaks during shifts. “The biggest problem it was causing was nurse fatigue,” says Novak, a clinical nurse in the Neurological Institute at Hillcrest Hospital.

Novak shared her concerns at a Retention Council meeting in June 2016. With buy-in from Chief Nursing Officer Susan L. Collier, DNP, RN, NEA-BC, the committee initiated an A3 project with Cleveland Clinic’s Continuous Improvement Department to explore the root causes for missed meal breaks and brainstorm possible solutions.

Looking for root causes

During the A3 project, the council unearthed a few primary reasons why nurses were skipping meal breaks, including the following:

• Concern for patient coverage – Nurses wanted to ensure a process was in place to assign accountability for who responded to their patients while they were off the unit for their lunch break
• Time management issues – “A lot of new nurses, in particular, had issues with time management,” says Novak. “They weren’t sure how to incorporate breaks into their shifts.” By the time some of the nurses finished their tasks, it was an hour or so from the end of their shifts so they simply skipped their meal breaks.
• Staffing shortages – Some nurses did not feel comfortable leaving the unit for their breaks when their staffing resources were decreased

Implementing solutions

Based on the findings, the council implemented a few solutions. The main one was creating a procedure for assistant nurse managers (ANMs) and charge nurses to assign and track meal breaks. The procedure was trialed on a medical/surgical unit prior to roll-out to the entire hospital.

Nursing units already utilize an assignment tool that lists all the beds on the unit, the acuity level of patients and nurse assignments by patient. Novak added a new column to the tool for meal breaks. ANMs and charge nurses write down the assigned meal break time for each nurse, then check off when the nurse returns from break. Novak presented the tool during nurse manager huddles, reinforcing the importance of breaks to combat nurse fatigue and improve staff morale.

“The tool made people more aware of taking a meal break,” she says. “It showed, ‘If Michelle is going out at 11:30 a.m., then I can go at noon.’ It also encouraged people to help each other out.”

Helping one another out is a second component to the solution. Each nurse is assigned a buddy on the unit. They tell one another when they are going on a meal break and cover each other’s patients. If a nurse is unavailable to answer a call, it is sent to the assigned buddy.

A third solution is related Cleveland Clinic’s time reporting system. The Human Resources Department updated the system to include an attestation at end-of-shift clock out that the employee had an uninterrupted meal break.

Tracking the project’s success

After trialing the new procedures on the medical-surgical unit, Novak sent a brief survey to nurses on the unit asking if the solutions – in particular the new assignment system – made them more likely to take a meal break. Eighty-one percent of nurses on the units confirmed it did.

When all the units adopted the new procedures, Hillcrest Hospital launched a campaign promoting the importance of meal breaks, sharing the message during staff meetings and with flyers and emails. Novak confirms that the A3 project around meal breaks has made a difference: More nurses are taking meal breaks, and nurse fatigue has decreased.