Even as a consultant, I felt a (self-inflicted) pressure to work through my breaks. It didn’t feel good when I stopped for a break and everyone else was still working (especially if there were plenty of patients waiting to be seen).
Deep down, I knew all the reasons why I SHOULD have been taking breaks regularly and why it was important. I knew that not taking breaks wasn’t doing anyone any favours. It was not helping my colleagues; and it definitely was not helping the patients. And yet, I did often skip breaks.
Here’s a reminder of why we need to take breaks, and also some thoughts about what it is that holds us (or me) back from taking them…
Mental rest is key. Your brain needs a break; it’s as simple as that. Many a time, I’ve been in a situation where it was getting towards later in my shift and someone hands me another ECG to look at, and takes so much more mental capacity to look through it. This is the type of trigger that should help us recognise that it’s time to take a break. Slowing down makes clinically perform worse – for our team and also for our patients. We take longer to see them, and even take longer to get notes written. When we step outside to get fresh air and just have a breather (or even just to leave the confines of the department and think about something else) it makes all the difference. Have a mental recharge
Fluid intake is a great reason to take breaks. This is a huge problem in ED shifts. The problem has worsened since we are all wearing masks – it’s a lot less straightforward to drink some water. I have often gone to the toilet at the end of a shift and seen that horrible dark concentrated urine and realised that I have forgotten to drink for the entire shift.
It’s important to allow time for reflection. This allows you to see the bigger picture. It’s so easy to get caught up in seeing the next patient and then the next patient, or answering the next query, or doing the next review. You can get very bogged down in the minutiae of what’s going on with a particular part of a particular patient, rather than being able to take a broader overview. We need to be able to take that broader view, not just of the the department, but actually a broader outlook on that patient and their flow. Taking a break from picking up patient after patient allows you to have that time.
Show leadership. I can’t expect my juniors to take their breaks when I don’t take mine. It’s this balance between wanting your juniors to take their breaks first, but at the same time, taking your own breaks in order to show how it should be done. I do find it a challenge to get this balance right. We need to set an environment and a department where breaks are something that just happen. Even (especially) when it’s busy.
We know that breaks are important and it’s our job if we’re leading the shift, to make sure that breaks actually happens. If I know all these excellent reasons, why do I find that I still have shifts where I don’t take a break?
Reason 1. Guilt. I could see that patients were waiting to be seen – that might be on the board or, even worse, physically if I had to walk past them waiting. I really did feel guilty. I felt like all the patients were staring at me in the waiting room.
Reason 2. Something to prove to colleagues. Sometimes, I didn’t take breaks because I felt like I had something to prove to my colleagues. This is no bearing on my team who are all wonderful and I love them. It was 100% an internal issue. When I took a break, I felt I was somehow not as hardworking. I know how ridiculous that sounds given everything that we’ve already covered.
Reason 3 – there was never a good time. There was always something happening or about to happen. In reality, that is just the nature of ED – it’s a shift system and there’s always other people to help you with a task. We need to move on from feeling like we have to complete all our tasks before we can take a break. That’s what a handover is for.
Take time to reflect on the real reasons why you don’t take breaks or why you make them shorter than they should be. That’s how we’re going to start to change things.