Introduction

Nurses skipping breaks and mealtime is a means of disaster for the nurse, the patients, and the institution. A nurse’s energy and stamina are not limitless even though some of us assume it is. Periodic rest and meal breaks are essential to function at our highest level — both physically and mentally. Working 12-hour shifts, which push nurses to their limits as it is, makes these breaks even more critical 1. Many nurses work 12-hour shifts and workloads have not been decreased or additional breaks added. Although many industries have adopted extended shifts very little information is available regarding the timing, duration, and frequency of breaks required when employees work longer shifts 2. Available data from other industries have suggested that periodic breaks may improve short time performances and fatigue 3. In a study, critical care nurses working beyond 12.5 hours had a significantly increased probability of making an error or near miss 4.

It has increasingly become the responsibility of employers to provide preventative wellness programs to counter increasing costs and loss of productivity in the interest of the organization's bottom line 5. Such benefits like meal breaks, and booster breaks not only increase the motivation and physical well-being of existing employees, but those benefits also become a differentiating factor to attract qualified new employees and retention of old employees and on the other hand patient safety. A recent study among workers from companies in various sectors showed that a higher frequency of rest breaks is associated with less work‐related fatigue and distress 6. Previous studies have mentioned the effect of work breaks on employee performance, but the present study aimed to elicit the association between demographics and the nurse’s challenges over their break time.

Materials & Methods

Results

The survey forms were distributed to 400 nurses out of which 378 nurses participated with a response rate of 94.5%. Nurse demographics for the overall sample were not similar across the 2 departments as shown in Table 1. The mean age was 33 years, and the average experience of nurses was 6 years with 97.7% females. Out of 378 respondents, 289 (76.5%) were undergraduates and 69 (18.3%) diploma holders in nursing.

The values in bold Italic represent ED nurses and the light ones for CCD nurses in Table 2. Overall, 39.4% of the nurses got the opportunity to have a meal during their duty sometimes, and 43.7% of the nurses expressed that they never felt relieved from patient responsibilities during their break time. 42.9% felt their workload was increased due to their coworker’s absenteeism. 37% of the nurses had always sacrificed their break to fulfill the patient care responsibilities assigned to them. 51% of the nurses never planned their break time at the beginning of their shift. 42.1% of the nurses always skipped their breaks due to their work load even if they scheduled their break at the beginning of the shift. 37% of the nurses sometimes had health problems because of missing breaks and meals during duty.

The nurses with scores above 3 for all items in the tool were considered with challenges and the percentage of staff is shown in Figure 1. There were 201(53%) nurses, 116 from ED with a Median (IQR) score 5(3-7) & 85 from CCD with a Median (IQR) score 5(2.5-7) had administrative challenges, 303(80%) staffs, 178 from ED with median 5(2-7) score & 125 from CCD with median 5(3-8) score had Patient related challenges and 190(50%) nurses, 117 from ED with median 2(1-4) score & 73 in CCD with median 2(2-4) score had Staff related challenges.

Discussion

Our staff (43.7%) said their break time was interrupted due to a call from their reliever or physician sometimes which was like Rogers, et. al (2004) 2 study where 43% of nurses reported having the time for a break or eat a meal but not being relieved of patient care responsibilities. 33.1% of the nurses felt that their units did not have a restorative break environment.

In the present study, 57.1% of nurses in the age group of 20-30 with experience 3-6 years and 42.9% of nurses from the age group of 30-40 with experience < 3 years said they never got the opportunity to sit down for a meal during duty in CCD. A large survey (N = 13,515) conducted by the ANA (2009) found that 35% of the nurses reported taking a meal break rarely or never. Similarly, Nejati et al. (2016) 12 observed that 11% of nurses reported taking no breaks during their shifts.

In Taylor’s model, nurses take collective “booster breaks” for 10 to 15 minutes and can include restorative activities such as healthy snacks and mindfulness exercises (e.g., yoga, tai chi, meditation), 13. Taylor has argued that this change fosters nurses’ physical and psychological well-being by providing a regular reprieve from the ongoing stress of the work environment. But only 63.6% of our nurses between the age group 20-30 with < 3 years’ experience ‘sometimes’ had break except meal time.

Nurses reported having a break or meal period free of patient care responsibilities less than half of the shifts they worked (2,429/5,211 shifts), 2 76.9% (n=51) of the nurses in CCD among 20-30 years with < 3 years’ experience says they ‘sometimes’ feel relieved from patient responsibilities even if they get a break. The leaders must understand that there is a great impact on employee satisfaction with their rest & break times between their duties can adversely affect the quality of patient care. The drawback of work breaks is that their implementation is highly dependent on the type of work being carried out (i.e. not all work settings allow for a flexible arrangement of work and breaks). Additionally, the employer and employee both need to accept the changes required by the work‐break pattern: (1) the employer providing extra time for breaks, and (2) the employee accepting a longer presence at work to cover more break time but the same amount of work time 14.

All nurses have an opportunity to investigate their patient’s acuity level and plan for their break time every day. But our study explores 51.3 % of nurses in ED & CCD never schedule (plan) their break at the beginning of their duty and 46.8% of the nurses wait for their friends (colleagues) to join them for a break which shows that employee’s acceptance in planning break schedule is still not clear. As per Article 101, 15. ‘Working hours and rest periods during the day shall be scheduled so that no worker shall work for more than five consecutive hours without a break of no less than thirty minutes each time during the total working hours for rest, prayer and meals, provided that a worker shall not remain at the workplace for more than eleven hours a day’ our staff in this study adopt to the same instructions as above. When comparing, Nurses in CCD on 12 hours of duty experienced more significant challenges than ED Nurses on 8 hours of duty in having meals and restorative breaks (P=0.048).

For 80% of ED nurses with 40–50 years of experience and 45.5% of nurses with 30–40 years of experience and 6–10 years of experience, the workload "always" prevented them from taking breaks, and this violates Article 102 ¹⁵ , which states that "the periods designated for rest, prayers, and meals shall not be included in the actual working hours." The employee will not be under the employer's control during these times. The employee will not be obliged by the employer to stay at work during these productive breaks.

The Towers Watson survey 5 found that the companies that are most successful at encouraging employee wellness, invest more in health and productivity than organizations with less-effective programs. Improvements in the restorative break time may significantly improve nurse satisfaction and stress reduction, potentially leading to improved care for their patients.

Conclusion

37% of the nurses sometimes had health problems because of missing breaks and meals during duty. This might affect their work schedule which might further burden their colleagues. We observed that staff-related challenges were more compared to Administration and Patient related challenges. Sorting out staff-related challenges will help create a good impact among staff about their meal break & restorative breaks. Scheduling the break time at the beginning of duty will help the nurses to have their break time.