Reclaiming meals and breaks in Bend

As a seasoned registered nurse, Susin Stoeckel said that for most of her career lunches and rest breaks were simply not a part of her regular routine.

“It was part of being a nurse – you don’t pee and you don’t eat,” she said. “Now, that culture has changed.”

Nursing teams at St. Charles Bend in the ortho/neuro and surgical services units have spent the past two years developing a process that ensures every nurse gets two breaks and a lunch period during their 12-hour shift.

“Oregon has had a nurse staffing law for the past 10 to 12 years,” said Debbie Robinson, chief nursing officer for St. Charles Bend. “Starting in 2017, the law underwent a huge revision that said you have to maintain a consistent level of nursing care when nurses go on breaks and lunches.”

It seems simple, but in reality takes a whole lot of coordination, additional nurses and – more than anything – trust.  

“Nurses can be protective and not want to let go of their patients,” Stoeckel said, explaining that often nurses would choose to skip a break rather than hand off a patient to a colleague.

Initially, St. Charles made an investment of $6 million to add more nursing staff to the floors. But even though the teams had more people, they weren’t originally allocated correctly to solve the problem.

Rebecca Berry, vice president of Human Resources, said she clearly remembers reaching out to the Value Improvement Practice team for help. The group brings in Lean methodologies and tools to help frontline caregivers solve problems in ways that make the most sense to them.

At the beginning of their two-year journey, the group working on the problem admitted that although they had already tried to achieve consistency in meals and breaks for nurses, many were still being missed.

In fact, the team found that in the first week of evaluation 58 breaks were missed, as well as three lunches. At times, charge nurses would spend hours of every shift covering for breaks, which meant they couldn’t get other important work completed.

To achieve success, the group decided to completely change the staffing model. A new position called the resource nurse was created. The person in this role covers breaks and lunches for other nurses and does not carry a separate patient assignment. Instead of leaving break times up to the individual, now when nurses start their shifts they receive their patient assignments and their designated break and lunch times.

“We found that we needed buy-in from the staff to participate and take their break when assigned, otherwise the lunch nurse would always be behind,” said Kate Kulin, a nurse on ortho/neuro who was part of the team. “Minimizing verbal hand-offs was key. If they get behind by one to two minutes with each transition, they are behind 45 minutes at the end of the day.”

After working out the kinks in the system, the team reduced missed breaks from 58 in a week down to seven and missed lunches from three to zero. They continue to work to make improvements to the new process and are spreading their learning to nursing units throughout the Bend hospital.

St. Charles has also become a resource for other hospitals throughout the state looking to implement similar improvements, which not only align with state nurse staffing law, but also lead to improved patient experience and care by ensuring nurses are properly rested and ready to get back to work.

“I never miss a break. It is flawless,” Stoeckel said. “It’s refreshing. I look forward to my 9:30 a.m. break and my 12:30 p.m. lunch. I know when I come back I’m going to be a better nurse.”