CRONA Newsletter, November 8, 2019

Meal and Rest Breaks*

A Summary of Key Points About Breaks

It was recently brought to CRONA’s attention that there are issues with Nurses on your unit not getting all of their legally mandated breaks. Your break time is important. The hospital must provide you all of your breaks, and the unit must remain within ratio when you are on your break. For a 12-hour shift Nurse, that means you must be able to take three paid 15-minute uninterrupted rest breaks and one unpaid 30-minute uninterrupted meal break during each shift.

This article summarizes the key rules to remember regarding breaks, your responsibilities, and why it matters that we all take our breaks – for ourselves, our co-workers, and our patients. Please contact CRONA if you have questions.

THREE RULES TO REMEMBER REGARDING BREAKS

  1. The Hospital Must Provide You All Your Rest and Meal Breaks on Each Shift.
  • The Hospital must provide you a reasonable opportunity to take each of your breaks.
  • For a 12-hour shift Nurse, this means three paid 15-minute rest breaks and one unpaid 30-minute meal break during each shift.
  • For the full duration of each break, you must be relieved of all duties and the Hospital must relinquish all control of your activities.
  • If you go on a break and are asked to return early or asked to do any work while on break, that break does not count as a break. You must be provided time for a full uninterrupted break.
  • The Hospital must not impede or discourage you from taking any of your breaks.
  1. The Unit Must Remain within the Required Nurse-to-Patient Ratios When Any Nurse Is on Break.
  • The unit must remain in ratio at all times, including when a Nurse is on break. A Nurse on break does not count in the ratio.
  • As a general matter, meeting the Title 22 ratio requirements means that each Nurse’s patient assignment must not be over ratio by both number of patients and patient acuity.
  • If a Nurse “covers” a break for another Nurse, the covering Nurse is responsible for every patient in the assignment, and this combined assignment must be within ratio by both total number of patients and patient acuity. The Nurse who covers your break is responsible for all patient care until you return from break.
  1. If You Are Not Provided Opportunities to Take All Your Breaks, You Are Entitled to Missed Meal/Missed Break Penalty Pay.
  • If you are not provided all of your 15-minute uninterrupted rest breaks, you are entitled to a “missed break” penalty of one hour of pay. The penalty is one hour of pay for each day with a missed break, regardless of how many breaks you missed that day.
  • If you are not provided your unpaid 30-minute uninterrupted meal break, you are entitled to a “missed meal” penalty of one hour of pay.
  • Missed meal penalty pay and missed rest break penalty pay are separate. If you miss both a 15-minute rest break and your 30-minute meal break on the same day, you are entitled to two (2) hours of penalty pay.
  • If you go on a break and are asked to return early or asked to do any work while on break, that does not count as a break. You must be provided all your required breaks without interruption, or you are entitled to missed break or missed meal pay.

WHAT ALL NURSES SHOULD DO TO PROTECT YOUR BREAKS

  1. Take Your Breaks, and Claim Missed Meal/Break Penalties When Breaks Are Not Provided:
  • When you are offered a break, take it – unless doing so would compromise patient care or violate staffing ratios.
  • Do not do work while on your break.
  • If you do not receive all of your breaks, make sure to claim the missed meal/break penalty.
  • “See Something, Say Something” – file an ADO (Assignment Despite Objection) form if your unit is too short-staffed to provide breaks.
  1. Account For All Missed Meals and Missed Breaks in API (SHC) or KRONOS (LPCH):
  • If you do not clock out for an unpaid meal break during your shift, API will automatically add a missed meal penalty. For LPCH, check the appropriate “missed break” or “missed meal” on the daily staffing sheet.
  • If you do not receive a 15-minute rest break, you will have to add the code to API. Under your last clocking for the day, add the Special Code “MBPR” to request the penalty pay. It is a good idea to include an explanation in the “requested reason” text box so your manager is aware of what happened.
  1. Protect Against Improperly Modified Timecards:
  • Your manager should not modify your time card to add a clocking for a missed meal break you did not receive. Please notify CRONA immediately if this happens so we can follow up.
  • Some Nurses take a screenshot of their clockings on days they have missed a break, so they can compare their entries to their final time card. This is a good idea.
  • If your time card was modified by your manager and is no longer accurate, do not sign off on your time card at the end of the pay period. Instead, send your manager an email to report the inaccuracies as soon as you notice them. You can copy CRONA on the email.
  1. What Resource Nurses Can Do to Help Nurses Get Their Breaks:
  • Ask a manager about getting a Float Pool nurse, contact the Nursing Supervisor, or ask management for other assistance to help cover breaks.
  • Encourage Nurses who missed breaks to add the missed meal/missed break penalty to API.
  • “See Something, Say Something” – file an ADO (Assignment Despite Objection) form if not all Nurses get their breaks. Document on the form why Nurses could not get their breaks, what you did to get help, who you told, and what was the result.
  • If you feel you are being harassed/intimidated by your manager when you report a missed meal or break, please notify CRONA.

WHY BREAKS MATTER

We Nurses are caretakers, and sometimes it is difficult to advocate for ourselves, or to see how advocating for ourselves is also advocating for other Nurses. When Nurses pass on taking breaks because the unit is busy, because they feel badly about burdening other Nurses with work while they are on break, or any of the other reasons Nurses give for giving up their breaks, it impacts every Nurse on the unit. When we give up our breaks, we contribute to a culture where that is expected, and it pressures everyone to do the same. When the work culture is bad like this, a Nurse who does advocate for herself and takes all her breaks can wrongly be seen by others as a troublemaker, or entitled. Please don’t let this be your unit’s work culture.

When Nurses get their breaks, we have the opportunity to rest, eat, and hopefully relax. Morale is better, we feel better, and we take better care of our patients and each other. When we practice advocacy and insist on our breaks, but have to take penalty pay because there isn’t sufficient staff to provide breaks, that helps communicate to the hospital that we are short-staffed and need to increase our staffing numbers and/or hire more staff. As long as we accept being short-staffed and overworked by giving up our breaks or not claiming missed break/meal penalty pay, that short-staffing and overworking will continue.

SAFE STAFFING*

Protect Your Patients, Protect Your Coworkers, Protect Yourself

Staffing levels in the hospital setting are mandated by law. If you’ve never heard of things like Title 22 (check out ratio language starting on page 41) or California Health and Safety Code (check out staffing by acuity in Section 1276.4 (b)), this is something good to learn as part of your professional nursing practice. These laws and regulations set not just maximum nurse-to-patient staffing ratios; they also specify that staffing be done according to patient acuity.

Safe Staffing Is Ratios AND Acuity

Your patient assignment may meet the letter of the law by number of patients, but if your patients are high acuity your assignment may in violation of safe staffing laws. Every unit should have a way to measure patient acuity. Learn how acuity is measured on your unit so you’ll know when your assignment is not in compliance.

 

What Do I Do If My Assignment Isn’t In Ratio?

  1. Notify your Resource Nurse as soon as you know your assignment is out of ratio/acuity. Real-time action is essential.If your RSN does not take any action, follow the chain of command and notify the manager on duty (in house or on call), then continue to Nursing Supervisor if needed. If your RSN has already done everything possible – call Staffing for help, notify the manager, and help is not available and the manager does not come in to help? You can’t refuse the assignment but you can document the situation by completing an ADO.
  2. Write an ADO – Assignment Despite Objection. This form is on the CRONA website. The ADO form should be completed as soon as possible – if not during your shift then right after. Send to CRONA via email or fax when complete. Make sure to document who you informed, when you informed them, and response you received. Tell your RSN that you plan to complete an ADO. This should be done calmly and politely; it is not a confrontation and is not meant to get anyone “in trouble”. The purpose is to bring attention to problems at a higher level so they can be solved.
  3. Expect to discuss the situation with a manager. When a nurse writes an ADO, it is reviewed by the Nurse Practice committee. That’s a joint CRONA-Department of Nursing committee and includes the CRONA President and Associate CNO. Your manager is required to gather information and present it to the committee along with recommendations for improvement. Your manager should speak to you as part of that process. It should not be intimidating or punitive – let CRONA know immediately if that happens. If a manager says, “This wasn’t appropriate for an ADO” that manager is WRONG. Managers don’t get to make that decision, only Nurse Practice committee does. We will not say an ADO is wrong, because every AD O is a learning opportunity.

 

Change Can Happen If We “See Something, Say Something”

As an example of change, several years ago there was no such thing as a Float Pool at Stanford. Units had been running short-staffed, especially during winter flu season. Nurses in the med-surg (now AAU) units started writing ADOs. It wasn’t a huge number from any one unit, but it was all over the hospital and increasing. Nurses reported they were unable to get people to come in for overtime because they were already burned out from working too much overtime. In response to the ADOs and the situation they brought to the attention of senior Nursing and CRONA leadership, the Float Pool was created and then expended when it proved a success. When you See Something, Say Something, you can make a difference.

 

CRONA Elections 2019

Voting takes just a couple minutes – less time than you spend in the cafeteria line. If you did not receive an electronic ballot link in your email today and have not voted, let us know immediately so Ballot and Elections Committee can get the link to you today.

Nurses on the Ballot and Elections Committee have been working hard behind the scenes to make this election a success. Please show your appreciation for their hard work by taking the time to vote today. Special thanks to current Ballot and Elections Chair Vanessa Brewer (LPCH, Intermediate Care Nursery) and former Ballot and Elections Chair Annamarie Varo (SHC, Operating Room) for their hard work this year, especially trying to make a ballot with all the imminent changes for Stanford nurses with the upcoming new hospital.

What About Elections Results?

That’s all being conducted by Ballot and Elections Committee. They will certify results, which will then be announced via a special election results newsletter.

 

 

* Information in this article is current as of the date of publication of this newsletter. For most current information, please refer to most current version of state and federal laws and the CRONA contract.

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