Safety Culture & Virtue 6: Lunch Breaks

How much do you trust your coworkers to watch your patients during lunch?

During a lunch break, bedside staff are able to realize if something is troubling them and provides a chance to decompress, pray, think about their patients objectively, and consider circumstances that they had not consciously identified yet could become problematic. 

Indeed, rest from the demands of clinical work is absolutely essential to evidence-based healthcare. During breaks, staff not only physically refuel, but they have an opportunity to reflect or escape, to weep or laugh, to debrief from the day’s assignment. That’s why today’s assessment item is whether team members willingly cover each other’s lunch breaks.

For one thing, it displays a profound amount of trust to leave your patients in the hands of another caregiver. All nurses, for example, are incredibly possessive about “their” patients, and it is not an easy thing to hand them off to another nurse if you think that nurse may not be trustworthy, may not really watch them, or may not intervene if warning signs arise. That’s why it is a sign of a virtuous safety culture when that handoff does occur, because it means that staff trust each other.

The ability to trust each other and work together is so valuable in a variety of circumstances. I’ve seen my professional colleagues return from their brief lunch break with a fresh perspective or an awareness of how a seemingly insignificant factor is a critical sign that can guide treatment. Further, providing a federally mandated lunch break is a simple test for compliance with rules and guidelines. If those rules are brushed off as an inconvenience, how many other rules are disregarded? And since it’s a federal labor law, it’s clearly not just a luxury or a preference, but a necessary intervention to preserve safety and a healthy workforce.

Another issue is that when rest is withheld, it is a sign that the team does not work together, that there is a lack of trust and compassion. Obviously, the suffering of one employee does not benefit the team, so the root cause is always dysfunctional. This trend can rapidly lead to burnout and poor retention. But when someone volunteers to cover a lunch break, it is a basic sign of compliance with regulations and respect for coworkers.

So what are the other reasons why lunch breaks don’t happen? Retaliation by a clique is another possibility because it is a simple way to punish outsiders. I have seen travel nurses left on their own during lunch breaks because the full-time staff felt that their pay was unequal. Other times, whistleblowers were snubbed when it was time for a lunch break. But it’s not just the target who suffers in these circumstances; it’s their patients as well. These are social realities that are not easy to identify, but if you see cold behavior and missed lunch breaks it becomes much easier to label.

Another reason why people can be hesitant to cover lunch breaks is when they feel personally overloaded and unable to manage any increase in capacity. If staff already feels stressed about their own load, they won’t want to be responsible for even more because it could become a safety issue of its own.

In some ways, this item is more difficult to solve because it can depend on the root cause, but I have also noticed that a variety of causes can be ameliorated by a good team. On a practical side, some managers try to randomly audit whether everyone has taken their break and enforce it by authority, and others have assigned “break buddies” so that there is a clear chain of responsibility.

 Lunch breaks are a critical reflection of virtuous culture because they are a relatively easy to way to measure if staff are acting as a team. If your team isn’t covering for each others’ lunch breaks, you can bet that patients are paying the price for it.