Rest breaks during a shift

You are entitled to a minimum break of 20 minutes when your daily working time is more than six hours. This should:

be uninterrupted

be away from your workstation

be during working time

not be taken at the start or end of the working day

not overlap with your daily rest.

The regulations are silent on whether a rest break is paid time, but we recommend that breaks should be paid.

Check your employment contract and/or policies to find out if you can leave your workplace during a break.

If you are unable to take your breaks due to unsustainable pressures on staffing please see the section above, regarding how to raise concerns.

What if I’m the only registered nurse?

If you are the only registered nurse and therefore in charge, you must stay on the premises during your shift. You should be paid for this. If you work in a care home, the registering authority will revoke the home’s registration if there is no qualified person on the premises.

As a nurse, you are bound by your NMC Code and owe a duty of care to your patients to ensure their safety and manage risk. You are professionally accountable for your acts and omissions and you must be able to justify your decisions.

If current working patterns or unsustainable pressures on staffing means that you cannot take your breaks (for example, where you are the only nurse), these working arrangements need to be reviewed. If you are in this position, contact us for further advice.

Daily rest breaks

You are entitled to a rest period of at least 11 consecutive hours in each 24-hour working period. This time may be taken over two calendar days.

Where this is not possible, you must be given ‘equivalent compensatory periods of rest’ or ‘appropriate protection’.

A 12-hour shift is legal. However, the regulations generally require that there should be a break of 11 consecutive hours between each 12-hour shift.

We believe that no shift should be longer than 12 hours, and that a 12-hour shift may not be appropriate for all nurses. Twelve-hour shifts should be considered in the context of both patient safety and the physical and psychological demands of shift work.

Weekly rest breaks

As a minimum, you are entitled to an uninterrupted rest period of at least 24 hours in each seven-day reference period. This is in addition to an 11-hour daily rest period.

Your employer can average the weekly reference period over 14 days. In a 14-day period, your employer should provide either two uninterrupted rest periods of not less than 24 hours, or one uninterrupted rest period of not less than 48 hours.

Where this is not possible, equivalent compensatory rest or appropriate protection must be given to you. On average, all workers should receive 90 hours rest per week. This does not include breaks during working time, which are additional.

If you work in the NHS, section 27.19 of the NHS Terms and Conditions of Service handbook states that all employees should receive an uninterrupted weekly rest period of 35 hours (including the eleven hours of daily rest) in each seven-day period for which they work for their employer. Where this is not possible, they should receive equivalent rest over a 14-day period, either as one 70-hour period or two 35-hour periods.

The persistently high premature mortality rate among people with mental health conditions should be a catalyst for change

Ensuring mental health nurses develop the right physical health competencies is an ethical imperative Picture: iStock

Concerns have been raised about the education of mental health nurses suggesting that it fails to prioritise mental health-specific skills and knowledge adequately.

Does this signal a long-term trend toward abolishing mental health nurse training at preregistration level?

Not quite. While it is true that some physical health competencies required by the Nursing and Midwifery Council (NMC) are seldom needed in mental health practice, this appears to be more a case of mismanagement than a deliberate effort to undermine the profession.

The issue stems largely from the NMC’s lack of engagement and understanding in determining which physical health skills should be prioritised for mental health nurses.

Training requirements need to align better with the realities of mental health nursing

Addressing this challenge requires proactive involvement from mental health nurse groups – including union members, academics and nurse leaders – who must work collaboratively with the NMC to ensure that future training requirements do align better with the realities of mental health nursing. Without such engagement, the risk of further misalignment and ineffective planning increases.

A far greater concern, however, is that focusing too much energy on the issue of learning a small number of unnecessary skills will divert mental health nurses from acquiring essential physical health promotion and treatment competencies needed to provide high-quality care.

High rates of premature mortality among people with mental health conditions

The persistently high rates of premature mortality among people with mental health conditions remain deeply concerning, and mental health services have long failed to address this issue effectively.

‘True holistic care recognises that mental and physical health are inseparable. There is no health without both’

As the largest professional group in these services, nurses have a critical role to play.

Ensuring that mental health nurses develop the right physical health competencies is not merely a matter of education policy – it is an ethical imperative.

True holistic care recognises that mental and physical health are inseparable. There is no health without both.

Generally, the law imposes a duty of care on a health care practitioner in situations where it is ‘reasonably foreseeable’ that the practitioner might cause harm to patients through their actions or omissions. This is the case regardless of whether that practitioner is a nurse, midwife, nursing associate, health care assistant or assistant practitioner. It exists when the practitioner has assumed some sort of responsibility for the patient’s care. This can be basic personal care or a complex procedure.

To discharge the legal duty of care, health care practitioners must act in accordance with the relevant standard of care. This is generally assessed as the standard to be expected of an ‘ordinarily competent practitioner’ performing that particular task or role. Failure to discharge the duty to this standard may be regarded as negligence.

When harm has come to a patient, the law examines who has a duty of care to that patient – and whether there was negligence – in order to attribute responsibility/liability for that harm.

A newly qualified nurse would be expected to deliver safe care in the same way as a more experienced nurse when performing the same task. The standards to be expected are not generally affected by any personal attributes, such as level of experience.

One of the most important roles a nurse takes on is the role of advocate and that includes for other nurses.

It is no secret that since the Covid-19 pandemic in 2020, healthcare on a global scale has faced immense challenges with providing mental health care and support.

“It is unfair to expect emergency nurses to feel confident and skilled in this area, with no additional specified training support”

These scarcities have been felt on national and regional levels, with emergency departments (EDs) facing overwhelming volumes of acute mental health presentations daily.

While the World Health Organization declared a global mental health crisis in 2021, sadly four years later there is no sign of it letting up.

In my experience working in mental health and addictions as a community crisis nurse, this declaration of urgency could not be more accurate.

With colleagues often feeling a sense of overwhelming helplessness when faced with ongoing nursing shortages and increased workload. During my time in this role, collaboration with the emergency department staff was key.

In such a diverse and complex environment, the emergency department sees every type of patient diagnosis. However, the knowledge gap is believed to be felt widely by emergency nurses.

As often they are the first point of contact for mental health patients in the healthcare system and yet, receive very little, if any, additional training.

In my recent work for my master’s degree, I learned that most ED nurses do feel unprepared and uneasy caring for these patients.

This is not a direct reflection of the nurses themselves, but of a lack of educational support and resources offered to them by their employer. As we must not forget, psychiatry is a specialty field.

And daily, acute mental health patients are seeking support and treatment in emergency departments across the globe, as many are without community support networks.

As nurses, we all have a duty to uphold and provide a level of patient care that is competent and caring no matter the issue, and mental health patients in the emergency department are no different.

However, it is unfair to expect emergency nurses to feel confident and skilled in this area, with no additional specified training support.

It is essential that we conduct more research in developing educational tools to aid our emergency nurses in triaging, caring and managing these complex presentations.

The alternative is further cuts to an already dwindling nursing front-line, caused by burnout and a lack of support.

I believe further research and investment in this area would help nurses feel more capable to support complex mental health patients on a daily basis, confidently.

In turn, helping to ease workplace frustration and fatigue when faced with acute mental health patients.

Abigail Weavers is a recent master’s of advanced nursing graduate, University of Edinburgh, and Americas Regional Hub chair, Challengers’ Committee, Nursing Now Challenge

In the first part of this special investigation, The PUNCH uncovered the appalling state of infrastructure at primary healthcare centres across Ebonyi State—facilities stripped of drugs, electricity, water, and even basic medical tools. But beyond the crumbling buildings lie a deeper, deadlier crisis: an overwhelming shortage of trained health professionals and an alarming dependence on unqualified personnel, reports EDWARD NNACHI, in this final part of the report

From hinterland villages to semi-urban settlements, this second part of the series reveals how thousands of residents are left at the mercy of auxiliary workers, poorly trained aides, and in some cases, individuals with no medical background at all.

With doctors and nurses migrating en masse, and the state lagging far behind global standards in healthcare staffing, the lives of Ebonyi’s most vulnerable citizens hang precariously in the balance —often with no one qualified to save them.

Aside from absence of drugs, water, electricity, medical equipment, and other basic infrastructure at primary healthcare centers in Ebonyi State, other factors threatening the survival and sustenance of medical facilities across the state are shortage of doctors and nurses.

Investigations revealed the development not only exposes the lives of the poor natives seeking medical services in the hinterlands to danger, but also leave them to the whims and caprices of unskilled healthcare practitioners or quacks.

The PUNCH reports that one major determinant of the healthcare services in every society is quality and quantity of healthcare givers. This is why personnel form the minimum standard requirements for PHCs globally.

Further inquiries by our Correspondent observed Ebonyi State was yet to meet the global standard for doctors-patients’ ratio. Owing to incessant migration of doctors from Nigeria to other countries for better conditions of service, records have shown that doctors-patients’ ratio is presently four to every 10,000 patients against the World Health Organization’s standard of 1:600.

This decline in the number of doctors and nurses available for patients’ treatment in the state has contributed significantly to the poor primary healthcare delivery. Consequently, many patients have resorted to self-medication and patronage of quacks which often increases their health challenges.

One of the directors at the Primary Healthcare Development Agency in Ivo Local Government Area of the state, who spoke on condition of anonymity, opined that the major challenge in the area was lack of human resources, adding that the nurses/midwives were employed on adhoc basis which does not deepen their passion for their job.

“This development is quite unfortunate in a state where shortage of health personnel has proven to be one major obstacle to public healthcare delivery.”

Corroborating the Ivo LGA healthcare agency director, Mrs Sylvia Ndidiamaka, the Officer-in-Charge at the Afikpo Road Health Center, Ndiokoro village, Ishiagu community in the same council area, said she managed the health center alone with the assistance of an auxiliary nurse. Admitting she only had basic healthcare certificate as qualification, Ndidiamaka revealed they hardly contained severe medical cases at the facility.

“We do not have doctors or nurse at this facility. Infact, this is why we hardly treat anyone here. We can’t attempt to treat patients we can’t handle their health matters. We do this just to avoid people dying from what we can’t tell,” she said.

“We need doctors and nurses here because patients find it difficult leaving here when we tell them we can’t handle their cases. For me, I’m just a holder of basic healthcare certificate and we are always afraid handling cases that are beyond us,” she added.

From the Abina Health Post, Ndufu Amagu community; to Elugwu Ettam Primary Health Center, Ettam community; Amuda Health Post, Igbudu 1 Ward; Obeagu Health Center, Enyibichiri community; and the Ndiechi MDGs Health Center, Ekpaomaka community, all in the Ikwo Local Government Area of Ebonyi State, our Correspondent observed absence of trained healthcare personnel in the facilities. The precarious situation leaves natives of the communities with the only option of traveling several miles from the hinterlands to Abakaliki (capital of the state) in search of medical services.

Still at the Abina Health Post, an untrained healthcare worker, Mr Oke Cornelius, said he was in charge of the facility, adding the last time he received any form of basic medical training was in 2017.

According to him, the health center neither had a doctor nor a nurse, saying administration of healthcare services at the facilities was both frustrating and challenging. He called on the authorities to intervene.

He said, “Here, we have no doctor or nurse, and I don’t know whether the OIC is even a Community Health Extension Worker (CHEW) or not. The truth is that there is need for the government to send doctors and nurses to PHCs in the wards across the state so that patients and those of us taking care of them will not suffer much.

“It’s not fair that we don’t have anything here like water and light here, yet we still don’t have doctors and nurses. It’s worrisome.”

The story was the same at the Elugwu Ettam PHC. No fewer than 28000 patients visit the facility yearly, findings revealed.

Speaking about the decrepit condition of the health center, the Officer-in-Charge (OIC), Mrs Nworie Confidence, said the health center only had doctors which usually visit it from the Ananda Marga Universal Relief Team (AMURT). She said the situation has simply limited them to rendering either immunization or other sundry medical services to natives of the area.

According to Mrs Nworie, “It’s only me and my colleague that are here. There’s no doctor and there’s no nurse here.”

She called on the relevant authorities to intervene, adding the facility was doing its best to assuage the health challenges of residents of the community.

At the Amuda Health Post, the Chief Cemetery Keeper (CCK), Mrs Nwoba Regina, lamented the harrowing experience managing the facility alone with her boss, Mrs Nwoba, a community Health Worker (CHO). According to her, over 29 patients from the area were referred to other hospitals in the city because they could not handle their cases last year.

“We referred many patients from this place to other hospitals in town last year, about 29 of them. So, this is what we keep doing. How can we treat people for illnesses we can not handle? It’s not just here alone, it’s like that in most health centers in the state except those ones regarded as , “Selected.” Most PHCs including this very place, don’t have doctors and nurses,” she lamented.

The Community Health Extension Worker at the Ndiechi MDGs Health Center, Mr Nkoko Joseph, narrated the crisis-like experience running the facility without a doctor or a nurse, and called on the relevant authorities to intervene.

The Officer-in-Charge at the Obeagu Primary Healthcare Center, Enyibichiri community, in the Ikwo LGA, Mrs Philomena Nweke, painted an ugly picture of the clinic, which also hadn’t any doctor nor nurse, adding the facility catered for the medical needs of over 14000 patients from over 12 villages yearly.

Continuing the investigation, our correspondent got to the Odeligbo Healthcare Center, Amainyima community; and the Onuafiaukwa Heath Post, Eka Awoke community both in the Ikwo council area. His findings showed that clinics were left in the hands of untrained healthcare workers, who inadvertently were saddled with the responsibility of saving the lives of the people.

At the Achacha Health Center, Ndieta village, Igbeagu community, in the Izzi Local Government Area of the state, it was discovered the facility was managed by a farmer who neither pronounced an injection ampoule nor weight scale correctly. The ‘healthcare’ worker, Mrs Sunday, who described herself as the OIC, said the facility was not suitable for any human being on admission medically, adding she was only there to administer drugs to children battling fever or malaria.

Her husband, Mr Sunday Nwankporo said, “This place is just here for the sake of it. Nothing is happening here and we don’t even admit people. My wife and I manage here and there’s no doctor or nurse. So since this place is not selected, we are not bothered. It’s a worrisome environment to work in.”

The same story pervaded the air when this newspaper got to the Iboko Staff Clinic, Mgbalukwu community, still in the Izzi council area, Governor Francis Nwifuru’s hometown.

At the facility, a 23-year-old Community Health Extension Worker, Efia Micheal and an auxiliary nurse, Rita Odoh were available for inquiries. Both manage the clinic, which caters for the healthcare needs of over 24000 natives from 12 villages, annually. Findings revealed neither a doctor nor a nurse was attached to the facility. The two adhoc healthcare workers decried the absence of qualified manpower at the clinic, saying they did referrals day in day out from the clinic.

The experience was not different when our Correspondent got to the Amaezu Health MDG Health Center, Amaezu community; Umuhuali MDGs Health Center, Umuhuali community; Eguhuo Health Center, Ezzagu community; Ndiaguachi, Ezilo community; Ogboguma Health Center, Azuinyaba community; Abonyi-Okpoto Health Center, Okpoto community; and the Ezekaugo Health Center, Ntezi community in the Ishieu Local Government Area of Ebonyi State.

The facilities were manned by auxiliary healthcare workers who were on adhoc engagements with the state government.

The ugly trend in Ebonyi State is coming less than a month after the Coordinating Minister of Health and Social Welfare, Prof Muhammad Pate, declared that over 16,000 Nigerian doctors have left the country in the last five to seven years to seek greener pastures in other countries.

Pate said the doctor-to-population ratio is now 3.9 per 10,000 in the country, while the estimated cost of training one doctor exceeds $21,000.

This was as he lamented that nurses and midwives who left have also reduced the number of healthcare workers in the country.

The minister disclosed this at the seventh annual capacity building workshop of the Association of Medical Councils of Africa in Abuja, tagged, “Integrated healthcare regulation and leadership in building resilient health systems.”

The Commissioner for Health in the state, Dr Moses Ekuma and the Executive Secretary of Ebonyi State Health Insurance Agency (EBSHIA), Dr Divine Igwe, did not respond to inquiries made by The PUNCH on this matter.

Both were yet to respond to messages sent to their mobiles by our Correspondent, before filing this report on Wednesday.

However, the Executive Secretary of Ebonyi State Primary Healthcare Development Agency, Dr Emeka Ovuoba, said Governor Francis Nwifuru was doing everything within his powers to revitalize the primary healthcare centers in the state.

According to him, the governor’s effort in this direction could be seen in his recent directive to recruit doctors for deployment to the health facilities in the state.

He said, “The Governor, Rt. Hon. Francis Ogbonna Nwifuru, has made healthcare a priority. That’s why we now have a system where structures, equipment, and manpower are being simultaneously improved. Already, we’ve started by revitalizing general hospitals. Many of them were empty shells — good buildings, but nothing inside.

“Today, they are fully functional, with ambulances and medical staff. Now, the governor’s focus has shifted to the primary healthcare level. He has approved recruitment. Each PHC now has at least two skilled birth attendants. The plan is to scale up to a minimum of six staff per center, especially in high-volume locations — nurses, midwives, doctors, and support staff. That’s how serious this government is.”

In 2023, Governor Francis Nwifuru approved the recruitment of 39 medical doctors and 156 other health workers for the 13 General Hospitals in the state.

This came against the backdrop of widespread manpower shortage in the General Hospitals, in Ebonyi State.

A statement signed by the governor’s Chief Press Secretary, Dr. Monday Uzor, then, announced the recruitment.

According to the statement, “In fulfilment of his promise to reposition the health sector, the Governor of Ebonyi, His Excellency, Rt. Hon. Francis Ogbonna Nwifuru, has approved the immediate recruitment of medical personnel for the 13 General Hospitals in the state as follows:

“Thirty-nine medical doctors; 39 nurses; 39 laboratory scientists; 39 pharmacists; and 39 health attendants.

“To this end, His Excellency the Governor has directed the Head of Service, and Chairman, Civil Service Commission to urgently commence the process of recruiting suitably qualified medical personnel to fill the existing vacancies.”

Also, Nwifuru last month, announced a new salary package of N500,000 for newly employed medical doctors working in primary healthcare facilities across the state.

He made the announcement during the flag-off of the health activation initiative, in Abakaliki, which signaled the commencement of the Drug Revolving Fund and the distribution of medical equipment to general hospitals.

According to the governor, his administration has invested over N10bn in upgrading health infrastructure, procuring medical equipment, and strengthening the healthcare workforce.

To bridge the human resource gap in the sector, Nwifuru again reaffirmed the state government recruited 195 healthcare professionals, including doctors, nurses, pharmacists, and laboratory scientists, who have been deployed to general hospitals to enhance service delivery.

He said, “This event is not just a ceremony—it is a declaration of our administration’s commitment to revitalizing the healthcare system of our dear state. It is a testament to our resolve to deliver on the health pillar of our People’s Charter of Needs.

“For some time now, the health sector in Ebonyi has suffered from insufficient funding, inadequate personnel, and a lack of basic equipment. This narrative must change, and it must change now.”