Breaking Bread in the Breakroom

DontStealMyPenRN

The term "breaking bread" is often synonymous with the act of sharing a meal in a social environment. Throughout our lives, meaningful relationships are cultivated after breaking bread for the first time. First dates often begin with sharing a meal. Holidays are spent consuming seasonal fare with family, friends, and co-workers. Special occasions such as weddings, baptisms and bar mitzvahs often involve consuming a meal. These food-centric occasions often foster something that is a hallmark of the nursing profession: a human connection.

Nurses are notorious for their meal-sharing abilities. In my facility, the night-shift nurses in particular are well known for their ability to host a mean potluck. Collective meals not only serve as a means to share delicious food and recipes, but also as a manner in which we freely communicate with one another without the constraints of the bedside. A question such as "How did you make this?" or comment like "Your cake was really good! Did you make it from scratch?" has often proved to be a catalyst for future conversation.

The discussion of work and non-work related topics within the confines of the breakroom has helped me become more comfortable around my colleagues; making it easier to confide in them when I encounter challenging situations. These nurses know my fears, my strengths, and my weaknesses. I don't hesitate approaching them when I am plagued with uncertainty; their feedback has been essential to my growth as a nurse. My relationship with them is reciprocal and founded on a mutual appreciation for one another. I see my co-workers as human beings, not just "nurses." They are people with emotions, experiences and a story to tell.

If it's so simple to establish connections with one another, then why is there such a persistent problem with nurse-physician relationships? Why does a large disconnect still exist, and why is communication still identified as a root cause of hospital error? The superficial resolution to this problem is to mandate professional and respectful communication in the workplace, but anyone who is employed in the healthcare field will tell you that ineffective communication is an all-too-familiar offense. Interpersonal behaviors can be difficult to monitor and even more challenging to describe objectively. Healthcare environments still remain very hierarchical, stressful and complex places to work. Variable skill mixes and personalities often co-exist and can lead to unscrupulous behaviors when in conflict with one another. Problematic behavior, often described in conjunction with a culture of bullying and lateral violence, has been well-documented as a critical issue within the literature. It remains an ongoing challenge faced by healthcare professionals across all disciplines.

I'll never forget the night when my co-workers threw me an unofficial wedding shower at 2 am. The food was plentiful and the company was excellent. This act of appreciation reminded me why I had stayed in the same position for the past five years. While enjoying the breakroom festivities, I welcomed one of the new ICU fellows into the breakroom and encouraged him to partake in the celebration. While making small talk, I mentioned where my now-husband and I planned to go on our honeymoon. I learned that he had vacationed on the same Caribbean island many times before, and he gave me some excellent restaurant recommendations. I learned that he used to live in Germany and travels there often to visit relatives. He beamed with pride when he described his six-month-old daughter; the first child born to him and his wife. We continued on to exchange pleasantries and learned more about each other's personal and professional lives.

Several nights after this encounter, I worked with the same physician while he inserted a chest tube into a patient with a pneumothorax. It was a particularly stressful situation due to many extraneous variables (angry family members, missing supplies, etc.) that were beyond our control. I could tell that this physician was nervous. It was his first year out of residency and his first time practicing at this particular medical center. He didn't know where the equipment was located, was new to the facility's policies, and hadn't yet established rapport with unit staff. When he was preparing his sterile field prior to inserting the chest tube, he dropped the gloves on the floor. His face turned twenty shades of red as he froze, staring at the contaminated gloves. Before he had the chance to look up again, I had retrieved the spare set of gloves that were sitting outside of the room (I always keep a spare set nearby during sterile procedures). The remainder of the insertion ensued without incident.

After this incident, I reflected on how I could have reacted. If I were a different person, I could have rolled my eyes at him. I could have chastised him and made him feel like an incompetent physician; potentially influencing his performance throughout the rest of the procedure and causing unintentional harm to the patient. An unprofessional remark from my end could have created a barrier to effective communication between us. Fortunately, I did none of these things. The physician was very gracious for my assistance after the patient was taken care of. Later that night, I overheard some of my nursing colleagues whispering around the unit; "Can you believe he dropped his sterile gloves? Get it together man!" I quickly interjected, "He's human. He makes mistakes just like we do." Silence ensued as I walked in the other direction.

I'd like to think that the physician and I would have worked well as a team regardless of whether or not we had engaged in that initial conversation. In a perfect world, all of our healthcare colleagues would make an effort to see one other as human beings with emotions, fears, and imperfections. Unfortunately, this humanistic approach to collaboration is commonly overlooked in situations where a person's life is at stake. Add in conflicting personality types and you have a recipe for teamwork that exudes discord. Our patients are at the mercy of the healthcare team working well together. When this doesn't occur, quality patient care can be difficult to provide. I often fantasize of a workplace where everyone works in harmony; where all disciplines come together to achieve a common goal and show respect for each other's role in making it happen. My vision may be a bit farfetched, but perhaps it's worth a try to establish a connection with the people we work with under the pretense of something like free food in the breakroom. It is, after all, the most appetizing team-building exercise.

annabanana2 · Mar 28, 2017

Man, while I obviously never put in chest tubes, I drop sterile things all the time. It's why whenever I know I'll need sterile gloves I always bring two pairs. At least! It's hard to imagine my colleagues telling me to get it together for dropping something. What an innocuous little mistake.

Ruby Vee, BSN · Mar 29, 2017

We have fabulous relationships with most of the physicians and surgeons where I work. I'm pretty sure it's due to the fact that when we plan a holiday potluck or our typical Sunday night "breakfast in the break room", we look to see who is on call that night and extend the invitation to them to participate. When we order pizza, we make sure to include the on call docs and when we plan to go out for drinks after work we invite them. Usually they cannot go out after work, but we've extended the invitation. There are a few single providers who don't cook and are reticent to take part without contributing, and usually they're asked if they'll bring the soda or paper plates and plastic silverware. Some of the attendings order take-out and share it with us once or twice a year and one attending sprang for a champagne brunch (for those going off shift) in the wake of a pretty significant patient victory.

There are a few providers with whom we (collectively) have had bad experiences, and invariably it's been someone who has declined to share a meal with us. I'm pretty sure there's a correlation there.

DontStealMyPenRN · Mar 30, 2017

My thoughts exactly! Ironically, the nurses that were whispering about this particular physician were fairly new to the nursing profession. In my opinion, their behavior was completely unwarranted and childish. I sincerely hope that if and when they make a mistake in their career, someone is there to support them instead of making fun of them. In retrospect, I think they were trying to compensate for their lack of experience by putting someone else down.

Penelope_Pitstop, BSN, RN · Mar 30, 2017

At first glance, I read this as "Breaking BAD in the Breakroom" and boy would that have been a different article!

Breaking Bread in the Breakroom

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