I’m reading the book WHEN: The Scientific Secrets of Perfect Timing by Daniel H. Pink. This book describes how we all have a typical circadian pattern. We are either larks, owls, or third birds. Most of us are third birds. Chapter 2 describes a nightmare of a hospital and then notes that all these horrific data points happen across the country in the afternoon. He noted that internists are 26% more likely to order antibiotics, nurses are 10% less likely to wash their hands, and patients are 3 times more likely to have an error in anesthesia. Poorer care occurs when we are tired and without a break, it’s the worst around 3-4 pm.
Thoughts on how to Improve our Patients’ Outcomes
- He encourages “Vigilance Breaks” which we know in the OR as Time Outs. When I was in acute care, I remember pausing after I received my report from the night shift before starting my morning cares and thinking, “ok, what’s my plan, what might happen, is my emergency equipment ready?” Our emergency supply checklist was evaluated at the beginning of every shift and charted. Should ICU nurses take an extra “vigilance break” at 1 pm to again ask all those same questions?
- For those of us that are not in high acuity areas, “restorative breaks” are equally important. A restorative break is a technology-free moment without working on any tasks. Ideally, you would take a 15-minute stroll but even a 3 minute moment outside with some deep breaths could be beneficial.
- Take a lunch break! As a bedside nurse, I often skipped taking a lunch. I would look at the clock and realize it was 4 pm and I hadn’t eaten, drank or peed during my shift. At the time, that was almost an expected part of the job. Now as a clinic nurse, I often eat at my desk while making phone calls and finishing my charts. I do not socialize or take a break from my patient obligations two-thirds of the time. The key to a healthy lunch break is to be completely detached from the work you were doing and to socialize. If your lunch break includes scrolling through social media, your brain will be equally or more fatigued then if you haven’t taken a break at all.
- Take a nap. If only this was a real option for nurses. The author found a huge benefit for those that took 200 mg of caffeine followed by a 10-20 minute nap had improved performance and cognitive ability. I do remember a charge nurse who would do this and she powered night shift like a hero. Eventually, someone “tattled” and her ability to close her eyes on her lunch break was taken away. I can’t recall how long after that she went to days but I’m sure that had a little something to do with the transition. If you really think about it, why isn’t there a nap room for night nurses to use on their lunch break? I rarely ate when I worked nights because I always felt sick. If I could have taken a 20-minute nap after giving a report to a colleague to watch my patients maybe I would have lasted longer. One of the biggest issues in health care is having only young, new grads working nights, could a simple cot improve outcomes and staff longevity?
- Micro-Breaks are also important, wandering to the water fountain to refill your water bottle counts. When power charting every 20 minutes look away from your screen across the room for 20 seconds.
I have read the importance of taking a 10 minute walk outside to improve the quality of your work life in the past but I’ve never followed through. I didn’t want to appear lazy or unengaged. However, with data in hand, I short burst to the courtyard will decrease my chance of making a medical error and improve my hand hygiene, I can now walk proudly to the nearest exit.
What changes will you make to improve your patient outcomes?
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