January 25, 2017

Q&A With Nurse B: Off The Clock And Still On The Unit!

Q&A With Nurse B: Off The Clock And Still On The Unit!

Boynton_profilePic.jpgBeth Boynton, RN, MS specializes in communication, collaboration, and workplace culture. She offers advice on how to navigate common conflicts in nursing and healthcare with an eye towards shared accountability and co-creative solutions.

If you’d like to have a conflict or situation considered for this column please submit to



Dear Beth,

I’m a staff RN at a long-term care facility and I love my job. Our facility was cited by a state accreditation organization for an issue involving nurses not taking lunch or dinner breaks. Many of us don’t have time and find it easier to simply skip the break rather than try to leave the unit for a meal.

As a result, HR has created a new policy that requires us to punch out for one meal break each shift. Since we’re also pressured to get all of our work done without any overtime, there’s a lot of resentment on the part of many staff members, and some nurses are punching out to meet the policy but still not taking the break. I don’t like being forced to take a break or lying about it, yet I don’t see any other options. Can you help?


Off The Clock And Still On The Unit!


Dear Off the Clock,

Thank you for a super example of nursing staff and administration being divided about something while an underlying issue gets lost or distorted. The mandatory “punch-out” policy may be a good faith effort to address a labor requirement, support your work, and ensure patient safety; however, as you can attest, attempting to control it seems to be increasing resistance, contributing to a power struggle and the creation of a new problem.

I can understand your feelings of resentment about being forced to take a break or thinking that you have to lie about not taking one; after all, nurses are professionals and should be able to determine this for themselves. However, I can also hear HR saying, “Meal breaks are an important patient safety strategy. We sent out emails to nurse managers who repeatedly informed staff about the importance of taking meal breaks, and it was the last straw when we got a warning from the Department of Labor.” I would also understand their feelings of frustration.

Another issue to consider is the potential liability and labor issues centered around working while you’re punched out (and which a labor attorney would be better suited to address).

In this situation, some staff and management behaviors are creating a power struggle that runs the risk of burying important issues. If everyone is willing to consider their own part in the situation, there is hope for finding what is known as “The Third Door” (a new solution based upon understanding and respecting staff, patient, and organizational needs).

Consider the following:

What would happen if staff nurses and HR professionals spent some time reflecting on these questions?

Staff reflections:

How does this policy impact the nurses on the unit?
What would we nurses need in order to actually take breaks?
What questions can we ask HR that would help us to understand their position?
What could I personally do to make breaks more feasible, and what stands in the way of my even considering taking a meal break?

HR reflections:

What is the impact on HR or the unit when nurses don’t take regular breaks?
How might HR or the unit support nurses in their efforts to increase compliance with the break requirement?
What questions might HR ask nurses in order to gain a better understanding of their perspective?
What could we in HR do to help, and what limits do we have?

The answers to these questions will help both sides show ownership of a part of the problem, a willingness to help solve it, and a curiosity about each other’s position. This in and of itself is not the solution, but it does contribute to an environment of respect, openness, and collaboration. This will allow you and your organization to get at the underlying problem(s), which may include workload, time management, staffing, trust, and delegation skills.

Progressive healthcare organizations will listen if they recognize the value of collaboration, improved nurse retention, quality, and safety. Meanwhile, nurses who take pride in their professionalism can practice assertiveness while speaking up about their needs and demonstrating collaborative respect for organizational issues.

Who knows, perhaps you’ll develop new part-time “Break Nurse” or “Float Nurse Assistant” positions, obtain training on assertiveness and delegation, pilot a new scheduling model, or even collaborate with the cafeteria staff to minimize waiting times at meal breaks. As respectful dialogues unfold with active listening and individual ownership, there are many possibilities and potential solutions to this dilemma.

I hope this was helpful for you. Good luck, and thanks for submitting your scenario.


Next Up: We Used to Work Together But Now I’m Her Boss!

Beth Boynton, RN, MS specializes in communication, collaboration, and workplace culture.  She is a Medical Improv Practitioner and author of Confident Voices (CreateSpace 2009) and Successful Nurse Communication (F.A. Davis 2015).  Her third book,  Medical Improv: A New Way to Improve Communication is scheduled for release in 2017.


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