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.

[JKL33]

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.

Not to be a jerk-type employee, but then why don't more RNs "go berserk" about being "required to keep our headset on" and, as someone mentioned earlier, being prohibited from running errands while on unpaid break?

I have successfully argued (respectfully, of course) that there are two choices:

1) Pay me and dictate what I do with my time

2) Don't pay me, and don't dictate what I do with my time

Those are the only two options. I do not work for free unless I'm voluntarily working for a good/charitable cause. But certainly not when someone else is running a business that is making money and just so happens to need what I'm selling in order to run it.

[jenniam]

When I lived in California (the land of unions and mandated patient ratios), I was hired as a break nurse. The position was 20 hours a week and I worked 2300-0300. I gave 30 minute lunch breaks (they'd give me a 5 minute report and hand me their phone) to the nurses and if there were more nurses than I had slots, the charge nurse, who did not take patients, would cover their lunches (she would take their phone).

A few of the nurses enjoyed signing up for an extra break nurse shift or two per week as it was only 4 hours and they could go into that overtime money.

A very different story where I am now, unfortunately.

[adventure_rn, MSN, NP]

This strikes me as one of those policies that seems great for nurses, but in practice will probably make things much harder at the bedside.

Most nurses try to strategically plan their break to take place at a time when there's a lull in patient care (i.e. assessments are done, meds are given, everyone has toileted). Logistically, if only one person can take a break or have lunch at a time (since there's only one 'break nurse'), that means that people's breaks and lunches will probably get pushed back, and will probably fall at times that are less convenient for patient care. When someone breaks me, I only give them a 5-minute report (as opposed to the half hour report I give at handoff); in the ICU setting, I don't want my 'buddy' or break nurse taking over my meds, assessments, family communication, etc. It seems like if you have your mandated lunch break at a certain scheduled time, patient care could suffer (either because someone who doesn't really know the patient is doing the care, or because the nurse waits to provide the care until after lunch).

In addition, since every person's break and lunch depends on the person before them getting back to free up the 'break person,' I think the schedule would fall behind as the day goes on. I'd be annoyed if I'd planned my nursing care around having lunch at a certain scheduled time, and then got delayed by half an hour while I sat on my hands waiting for the break nurse; consequently, I'd be half an hour late for all of my cares when I got back.

I personally don't care what time I go to lunch, but I know that there are some nurses who would be extremely temperamental if they were hungry, had finished up their patient care, and had time to go eat, but weren't allowed without handing off to the break nurse because it is now illegal. This is especially true when several people order delivery food to the unit; in this scenario, they'd have to take turns eating it one at a time (which would equal some very hangry nurses).

I am all about support/resource nurses who are available to step in and break you if you need it, or who are able to jump in and help with your assignment if your 'lunch buddy' gets tied up. However, my guess is that this policy will probably lead to more missed lunches and missed breaks.

Honestly, I think the best solution would be to make sure that assignments are appropriate in the first place (the main underlying issue), and have a resource person available as needed (rather than being mandated to cover breaks). I've always worked places with decent ratios and a resource nurse to help out, and I've never had an issue with covering assignments for breaks.

As a sidebar, I think that it would be kind of sad in the break room if only one person could eat lunch at a time (assuming that there's only one 'break nurse'). Chatting with coworkers mid-day can be therapeutic and revitalizing, and you can't do that if you're all alone.

[klone, MSN, RN]

This strikes me as one of those policies that seems great for nurses, but in practice will probably make things much harder at the bedside.

Honestly, I think the best solution would be to make sure that assignments are appropriate in the first place (the main underlying issue), and have a resource person available as needed (rather than being mandated to cover breaks). I've always worked places with decent ratios and a resource nurse to help out, and I've never had an issue with covering assignments for breaks..

That sounds so sensible!! You should run for Congress. Seriously - I so wish the state health authorities that are tasked with making sure hospitals are in compliance with these black-and-white laws had even a smidge of the common sense that this post demonstrates.

[kalycat, BSN, RN]

This is a very interesting discussion. I don't work for MultiCare, but this may be applicable in my region. When I used to work the floor, we had "break buddies" at night with no resource nurse, and it could be an utter nightmare. Even on stepdown where we only took 3-4 patients, these were post open heart, post arrest, VADs and transplants. It was totally possible that more than one patient would crump at a time. Also, if you were partnered with someone who took a very long break, went late in the shift, etc, it could be truly awful for workflow.

Now I'm CVICU full time and we have a free charge as well as at least one, and often two depending on census, resource nurses. If you are in a one to one assignment because you have a device patent, fresh open, or arrest, usually the resource nurse breaks you. I personally like to stay nearby and keep my phone. I feel that I get breaks during my shift and that my down time is adequate - I'm just more comfortable maintaining the primary role for my patients. (If that makes sense).

Our acuity varies wildly but is typically quite high - I don't take an uninterrupted hour break. (Which some night staff do). My work flow just doesn't support that - I prefer small breaks when my patient's status allows. Not trying to be a martyr but I definitely am a control freak! I take 30 minutes and eat, recharge, was some laps, and then head back. I don't expect that everyone would do this. I just think it would be weird to be told I would have to leave for a full hour (how things are done at night) and at a specific time.

I agree with the others who have stated that implementation of this may be a train wreck. Thanks for posting this, Klone!