Does a member of your staff frequently leave to buy lunch, and not count the travel time against allotted break minutes? Does your PACU nurse make a phone call or brew a pot of coffee and say she didn't start her break until after she completed those tasks? Or does your pre-op administrator not leave her post until 15 minutes after she is relieved, therefore eliminating the break time for someone else? Problems arise when employees are away for too long or refuse to break when asked. You need to recognize those abuses, correct the behavior and teach your staff to fend for themselves when it comes to finding the time for timeouts.

Schedules, slackers and smokers
I assume most managers and charge nurses place a high priority on giving their staff breaks throughout the day. The reality I encounter at many surgery centers, however, is that my assumption is wrong. I had to change the culture of the work environment in several facilities where I worked to create routine breaks and equitable lunch relief.

Two 15-minute breaks per shift and a 30-minute window for lunch is the norm in a typical surgery center employee handbook, and I think most mangers will agree those respites are necessary for strong staff morale. But most managers will also agree that what works well on paper is often difficult to implement in the world of ambulatory surgery.

Scheduling breaks to match the unpredictability of the surgical schedule is an art form at best, and a near impossible task at worst. The number of cases to prepare for in a surgery center fluctuates from day to day and from hour to hour. What a full complement of nurses can handle in the morning may overload the same group in the afternoon, tying up the extra person who usually floats from area to area to relieve the staff.

Differences in the expectations of staff and management also present challenges to creating an effective break schedule. Managers expect an employee to take a 15-minute break; an employee, depending on her work habits, mindset and attitudes, may stretch her break to 20 minutes or 30 minutes. Managers expect staff to take breaks as soon as someone comes to relieve them; staff may wait around to finish charting or to take breaks with friends.

Employees who smoke are often consistent abusers of break protocol, giving mangers a unique set of problems to work around. Instead of taking a breather in the staff lounge, smokers head outside for a few quick drags that usually exceed the 15-minute allotment. In a large facility - especially in a hospital setting - the smoking area may be far from the clinical setting, causing cigarette breaks to last even longer. The smokers I have dealt with also take more than the two allotted breaks per shift, don't like to take breaks alone and will coordinate their cigarette fixes with other smokers in the facility.

Tracking the tardy
So what's the big deal if a nurse takes five extra minutes to finish her coffee or needs to smoke a cigarette every two hours? The employees who don't abuse break privileges might tolerate those actions for a while, but the negative feelings they have toward their co-workers will eventually be exacerbated if their own breaks are compromised because of a nurse who doesn't play by the rules.

Managers and clinical coordinators are not policemen. We'd all like to think that our employees are adult professionals who'll follow facility protocols and be considerate of their peers. But as we all know, that isn't always the case. You need to implement a measuring tool if break abuse is a problem in your facility.

Don't ignore break abuses once you've identified a problem employee. Call her into your office and have the facts of the questionable behavior present to back up your position. Use your tracking sheets or notes regarding dates and times of long breaks you noticed; an employee will have a tough time arguing against documented proof. Then offer them guidance and tools they need to correct their behavior. Some employees abuse break times because of a poor attitude or work habit, but many more simply don't know how to manage their day. I once suggested an employee read Ken Blanchard's The One Minute Manager because she needed help with organization and time-management skills.

Have your staff take ownership in the break-scheduling process, and teach them the skills of relieving each other instead of waiting for the direction of a manager. I have no sympathy for the often-repeated complaint, "I couldn't take a break because no one came to relieve me." Your staff needs to recognize lulls in the surgical schedule, and take breaks during those times. I guarantee you any nurse can look at a facility's schedule at the beginning of the day and pick out a couple times that would work for breaks - if you demanded she do so. Also insist employees take breaks and lunches when they are scheduled, or they forfeit their opportunity to relax.

Rest for the weary
Breaks and lunches provide time away from stressful situations. Staff can rest for a couple minutes, make phone calls or read the paper. In the midst of a busy day of surgery, down time will re-energize and refocus the most harried nurse. But a few minutes lost because of a long lunch by one person can ruin the break schedule for the entire staff. You must be observant and deal with abuses quickly and effectively to keep your staff's morale and performance high.