I clocked out at the end of my shift, pressing my badge against the timekeeping system. When it asked me to verify that I had taken a 30-minute lunch break, I hesitated, my finger hovering over the screen before confirming that I had.

In truth, I hadn’t. Between staffing shortages, meetings and patient caseloads, my clinical responsibilities as a neonatal therapist left little room for uninterrupted breaks. While the hospital administration touts mandatory lunch breaks as necessary for self-care, it is often easier to falsely verify taking an unpaid break than to try to explain why my work environment made this unrealistic.

Requiring employees to take lunch breaks, it turns out, is not the same as creating an environment that supports doing so. Placing responsibility for taking unpaid breaks on employees without considering the work environment will lead to healthcare workers working through breaks without appropriate compensation.

The issue, not unsurprisingly, has led to litigation. An Oct. 6 article by the firm Law360 reported that an employee of Salida Hospital District in Colorado is seeking class action status for a lawsuit alleging that workers are subject to automatic pay deductions for 30-minute breaks they are allegedly often required to work through. Just one week later, Bloomberg Law reported that a Colorado federal district court allowed a lawsuit against Craig Hospital to proceed for its alleged failure to compensate employees for missed breaks.

The Fair Labor Standards Act states that employers generally don’t have to provide compensation for meal breaks lasting 30 minutes or more as long as nonexempt employees are completely relieved of duty. The U.S. Department of Labor’s healthcare-specific guidelines further state that employers using automatic 30-minute deductions are responsible for ensuring that employees receive their full uninterrupted break. In healthcare, where clinical responsibilities seem to have their own magnetic field, employees can be pulled back to patient care despite their best efforts to take a break.

The symptoms of institutional dysfunction merely strengthen that magnetic pull. Even in states that legally require breaks for healthcare providers, the gap between a recorded break and actually receiving one persists.

In Washington state, for example, most hospitals are required to submit quarterly reports on meal and rest break compliance. In April through June 2025, it was reported that all 45 reporting hospital facilities achieved the state-mandated 80% threshold, and 43 topped 90% compliance. But a 2025 Washington State Nurses Association member survey told a different story. It found that only 19% of the 266 respondents reported they were consistently relieved of patient duties during breaks.

One possible explanation for this discrepancy is reminiscent of my own experience: 76% of respondents reported they missed breaks without documenting them as missed. Insufficient staffing, concern over retaliation from management and hesitancy to burden coworkers are among the reasons listed for this underreporting.

While some lawsuits remain pending, recent settlements and federal enforcement showcase the broader financial consequences of uncompensated work for U.S. healthcare workers. In August, preliminary approval for a $17 million settlement against Providence Health & Services in Washington state was granted, with allegations including improper compensation for missed breaks. In 2025, the Department of Labor reached a $1.9 million settlement with Kent County Memorial Hospital in Rhode Island for failure to compensate employees when they worked through automatic 30-minute-break deductions.

Though these monetary consequences are sobering, merely correcting payroll deductions isn’t the same as making work environments conducive to taking needed breaks. Healthcare workers face prevailing, often unpredictable patient-care obligations during each shift.

If healthcare organizations intend to continue touting meal and rest breaks as self-care, the burden and accountability of making self-care possible should fall not on the employee, but on the organization.

Recently, I’ve had the rare opportunity to take some uninterrupted meal breaks, where I used my designated self-care time to write this op-ed. For such occasions, I suppose I owe hospital administration credit where credit is due.

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Isabella Hower is a Florida-based occupational therapist and certified neonatal therapist. This column was produced for Progressive Perspectives, a project of The Progressive magazine, and distributed by Tribune News Service.

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