WA Appellate Court says nurses cannot have 'break buddies' must use designated break nurse

  1. U.S. Circuit Court of Appeals says “NO” to break buddies at MultiCare | Washington State Nurses Association

    After years of battling in the courts over MultiCare's unsafe use of "break buddies" to cover for nurse rest breaks, the Washington State Nurses Association, together with our members at Tacoma General Hospital, won a big victory on July 23.

    The United States Ninth Circuit Court of Appeals issued an order rejecting MultiCare's attempt to overturn an arbitration award, which directed Tacoma General to stop using the break buddy system and to instead start using break relief nurses on every unit in the Hospital.
    We're dealing with this right now in Oregon as well. The board/bean counters won't approve increasing FTEs to hire "break relief" nurses, so every time a nurse goes on break, she's violating the department's staffing plan, which is in violation of the state law.
  2. Visit klone profile page

    About klone, MSN, RN Pro

    Joined: Apr '03; Posts: 13,098; Likes: 36,794

    28 Comments

  3. by   Scottishtape
    We do "break buddies" here in Florida. I'll have to look into this some more. I highly doubt they'll stop the practice, but here's hoping.
  4. by   cleback
    What's wrong with break buddies? And what's safer about using a designated break nurse? Should read, I suppose, but I'd think a designated nurse isn't a good solution either. What would that person do when not breaking the 6 nurses on the floor?
  5. by   klone
    Quote from cleback
    What's wrong with break buddies? And what's safer about using a designated break nurse? Should read, I suppose, but I'd think a designated nurse isn't a good solution either. What would that person do when not breaking the 6 nurses on the floor?
    What's wrong with break buddies is if your staffing plan says your ratio is 1:5, and you utilize the buddy system, then for 30 minutes while your buddy is at lunch (and 15 minutes x 3 for rest breaks) your ratio is 1:10 and you are in violation of your staffing plan.

    Between the legally required lunches and 15-minute rest breaks (x 3), a break nurse would have a full day. 6 nurses on the unit x 30 minutes each is 3 hours. Add 15 minutes x 3 breaks per shift x 6 nurses, that's an additional 4.5 hours. So basically, one nurse can spend 8 hours per 12-hour shift just breaking 6 other nurses.
  6. by   Davey Do
    Wow. I'm surprised. At Wrongway Regional Medical Center in beautiful downtown Eiffel Ill, they designate a staff member to do breaks on all 5 psych units during a particular shift. If staffing is short, the psych house supervisor breaks nurses.

    Wrongway isn't being consistent with its name for a change!
  7. by   Sour Lemon
    Quote from cleback
    What's wrong with break buddies? And what's safer about using a designated break nurse? Should read, I suppose, but I'd think a designated nurse isn't a good solution either. What would that person do when not breaking the 6 nurses on the floor?
    Some employers staff so that everyone is chronically behind on everything. Imagine you're already drowning with your own patients- then boom! You have double the number of patients. It's not fun and it's not safe.
    Some break nurses cover multiple units or help with admissions. There's always something to do.
  8. by   cleback
    Meh. I personally would just have a decent ratio to begin with, so breaks aren't am issue. I could just see being required to break 2 hrs into your shift because that's when the break nurse is available.

    I've also been sent to smaller units to break those nurses. I don't think it's necessarily safer.... you get into situations where you're covering for a specialty floor, like antepartum or peds, and I never felt very safe doing that, but having their own break nurse for a 5 bed unit wouldn't make fiscal sense either.
  9. by   klone
    Quote from cleback
    Meh. I personally would just have a decent ratio to begin with, so breaks aren't am issue..
    Okay, say your staffing plan says your ratio can't exceed 1:5. All nurses are given 1:3 or 1:4. On breaks, the break buddy is now 1:6 or 1:8, which still exceeds your staffing plan. So you're STILL in violation of your staffing laws.

    No, it's NOT safer. It's a ridiculously restrictive law which facilities are required to follow TO THE LETTER.
  10. by   Sour Lemon
    Quote from cleback
    Meh. I personally would just have a decent ratio to begin with, so breaks aren't am issue. I could just see being required to break 2 hrs into your shift because that's when the break nurse is available.

    I've also been sent to smaller units to break those nurses. I don't think it's necessarily safer.... you get into situations where you're covering for a specialty floor, like antepartum or peds, and I never felt very safe doing that, but having their own break nurse for a 5 bed unit wouldn't make fiscal sense either.
    No one should be covering a nurse in an unfamiliar specialty.
    My current employer staffs super-wonderful and a break buddy wouldn't stress me in the least, but my current employer is not typical from what I've experienced. I guess our individual opinions will be based on our individual experiences. I could easily agree with you if this job was all I'd ever known.
  11. by   klone
    That's the problem. >80% of the time, we staff on our unit such that having a break buddy is not a hardship or unsafe. Unfortunately, there are some hospitals and some departments that have unreasonable and unsafe ratios as the norm. It's these situations that this staffing law is meant to address. But, it's now law and needs to be addressed in black and white terms.

    The nurses in my unit all think this is ridiculous. I agree.
  12. by   kbrn2002
    Quote from cleback
    Meh. I personally would just have a decent ratio to begin with, so breaks aren't am issue. I could just see being required to break 2 hrs into your shift because that's when the break nurse is available.

    I've also been sent to smaller units to break those nurses. I don't think it's necessarily safer.... you get into situations where you're covering for a specialty floor, like antepartum or peds, and I never felt very safe doing that, but having their own break nurse for a 5 bed unit wouldn't make fiscal sense either.
    My thinking exactly. Sure a designated break nurse would have a full day between covering several nurses 15 minute and 30 minute breaks, but in order for one break nurse to cover all those breaks the nurses would have to start taking breaks within an hour of their shift starting. Now I can't speak for anybody else of course, but I would not be willing to take my first break an hour into my shift and if the break nurse covers other nurses in the same rotation the last break would then be about half way through the shift. Conversely I wouldn't want to be the last nurse in the break rotation and end up waiting for hours to get my first break and get stuck taking my last break almost at end of shift.
  13. by   DowntheRiver
    Quote from Scottishtape
    We do "break buddies" here in Florida. I'll have to look into this some more. I highly doubt they'll stop the practice, but here's hoping.
    Yeah, we have no staffing ratios in Florida so I wouldn't hold your breath on that one...
  14. by   HiddencatBSN
    Quote from klone
    What's wrong with break buddies is if your staffing plan says your ratio is 1:5, and you utilize the buddy system, then for 30 minutes while your buddy is at lunch (and 15 minutes x 3 for rest breaks) your ratio is 1:10 and you are in violation of your staffing plan.

    Between the legally required lunches and 15-minute rest breaks (x 3), a break nurse would have a full day. 6 nurses on the unit x 30 minutes each is 3 hours. Add 15 minutes x 3 breaks per shift x 6 nurses, that's an additional 4.5 hours. So basically, one nurse can spend 8 hours per 12-hour shift just breaking 6 other nurses.
    Also, in my experience, it often means that you do not take a break because there's too much going on with both assignments for one nurse to walk away for 30 minutes.

    Because of increased staffing and overlap during meal-ish times in the ED, it's never a huge issue to have a slot for a meal coverage nurse on the schedule. When we don't have a dedicated RN for breaks, we have 3 acute float/trauma RNs who can provide meal coverage provided there are no traumas or strokes.

close