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

[klone]

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.

[HiddencatBSN, BSN]

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.

[ClaraRedheart, BSN, RN]

Ummm...No. This is ridiculous. I usually set myself up to take my break at the same time every day. Right before I hand my patients off, I check with each of them to see if they need ANYTHING! I also make sure there are no medications due within 30 minutes and know those due within an hour so I can tackle that when I get back. I do what it takes to not set my break buddy with a mess . 90% of the time, they don't even have to answer a call. Same with those that I relieve for lunch. I would rather break when I am comfortable that my patients don't have major issues that don't need taking care of, not when a break nurse is available to relieve me as one of 8 of the nurses on the floor. She doesn't know my patients or their needs, and if she's relieving a new nurse every 30-40 minutes, it's impossible to keep up. This is a ridiculously stupid idea to implement on a med-surg floor.

[Nurse Beth, MSN]

Having a break nurse prevents the nurse from being "on call" during her break.

Which by definition, makes it not a break.

[gemmi999]

My workplace currently uses a breaker nurse. It is helpful but at the same time the Charge RN views the breaker as an extra set of hands and will routinely pull them from breaking to assist with critical patient's that come into the ER. I couldn't imagine having to do a breaker buddy in our ER, it's

[cleback]

Having a break nurse prevents the nurse from being "on call" during her break.

Which by definition, makes it not a break.

I don't agree that this is always the case. When I worked in a specialty area, a medsurg nurse would come and "break" me. However, because the break nurse was often unfamiliar with the specialty, I would stay on the unit on case something happened. I don't think these new provisions take into account these situations. I maintain that it would be safer to have a decent ratio to start with so that someone on your floor, who is presumably familiar with the patient population, can cover your break. That would also prevent a nurse from being "on call" during break.

[klone, MSN, RN]

If you are staying on the unit "in case something happens" then by legal definition, you are on call and not on break. Unfortunately (fortunately?) hospitals have to follow the letters of the law.

Even with good ratios, having a break buddy and doubling up your assignment for 30 minutes would still go against most facilities' staffing plans, which is in violation of state law, in those states that have these laws in place.

It's not financially feasible to only assign every nurse HALF a patient assignment so that they can watch each other's patients for 30 minutes without being in violation of law.

[Creamsoda, ASN, RN]

Having a break nurse prevents the nurse from being "on call" during her break.

Which by definition, makes it not a break.

Ive always wondered about this. When I eventually might get a break, its always interupted. And I know if something happens, i have to go back. Its not like I can go run errands on my break.

[elephantlover, BSN, RN]

I work as a CNA. The RNs on my unit take a few minutes when they can. Managment wants us to use break buddies, but this simply is not practical for our workflow. I cannot think of a safe alternative. In theory like the concept of having a resource nurse take over for breaks--however I see many issues with this being applied into practice.

At a minimum, I believe nurses and assistive personal should be compensated for their breaks because they are "on call." I rarely have the opportunity to take an uninterrupted full 30-minute break. I NEVER get to take my paid 15 minute breaks.

Lawmakers and nurses need to work together to find a safe solution.

[159Nursesrule, ADN, BSN, CNA, EMT-B]

We only get a 30 minute lunch break and are required to keep our headset on. When someone goes on break we cover for each other so yes we will have 10 patients no one ever says anything about it. But don't take a lunch and get fractional overtime and they go berserk.

[lrobinson5]

So for people using break buddies is there not a charge nurse on the floor to relieve nurses for breaks? Or is it not common for them to do break relief?

[akulahawkRN, ADN, RN, EMT-P]

We only get a 30 minute lunch break and are required to keep our headset on. When someone goes on break we cover for each other so yes we will have 10 patients no one ever says anything about it. But don't take a lunch and get fractional overtime and they go berserk.

Since you're required to keep your headset on, that means you're not likely being completely relieved of all work duties while on break. That means you're actually not taking a break from a payroll perspective. That means your lunch break must be compensated as "time worked." You should take a close look at the FLSA work orders (Federal Law) and see if your facility is violating those orders. Your state may also have its own work rules too, so check those. If you're under a union contract, that can supercede (to a degree) the work rules so look there as well.

Where I work, we're required to be given a 10 minute break every 4 hours, a 30 minute meal break every 6 hours (but before 6 hours and 1 minute), and if we're on a 12 hour shift, employees can agree to waive the 2nd meal break. Where I work, we actually get 15 minute breaks and a 30 minute lunch. Most of us (to my knowledge) have agreed to waive the 2nd 30 minute meal break.

We also try to have sufficient break nurses in the department to provide all nurses their timely breaks. I'm an ED RN so our census can vary wildly. When the census slows down and have "excess" staff vs occupied beds, we assign those nurses to do breaks. That's a variation of "break buddy" nurses but if doing so would cause a nurse to go over-ratio, we can't do it. So... when that happens, we must be paid for missing breaks (1 hour regardless of "paid" breaks missed) and missing our meal breaks. When that happens, we also incur incremental overtime...

Missing breaks can be quite expensive. Think of it like this: if you have 10 nurses and no breaker nurses, that means the employer has to pay each nurse an extra 3 hours (equivalent) for missing those meals breaks with incremental OT (at a DT rate). So over a 12 hour shift, those 10 nurses normally are budgeted for 120 hours but miss all the breaks and now it's equivalent to 150 hours (equivalent of 30 hours over budget). With one breaker, all the nurses get their 30 minute meal and therefore also don't get incremental overtime. That saves 20 hours. If you have a 12 hour breaker nurse, you've got 18 hours "cushion" before exceeding the 150 hours. At that point, all the nurses could still miss all their "paid" breaks and you're still under by 8 hours... Or you could have the breaker continue doing breaks and you improve that even though some nurses will still miss a break and therefore get their 1 hour.

Oh, and I forgot to mention that this is under the rules in the state where I work, miss one or miss all "paid" breaks, it's still only one hour paid extra to you. Same goes for meal breaks. Yes, they're treated separately.

[akulahawkRN, ADN, RN, EMT-P]

So for people using break buddies is there not a charge nurse on the floor to relieve nurses for breaks? Or is it not common for them to do break relief?

Where I work (in an ER), we usually have staff nurses assigned to doing just breaks. The charge nurse rarely will do break relief as their duties generally preclude being able to take on a full assignment, even for a short time. When census gets low enough, we do use a variant of the break-buddy system, but that's only when/if doing so won't put someone over-ratio.