Date of Award

Spring 6-7-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Tyra Dean-Ousley

Faculty Reader

Deborah Saknit

Faculty Reader

Bomin Shim

Executive Summary

Reducing Burnout with The Two-Break-Nurse Model: A quality Improvement project

Danjie Zheng


Burnout Syndrome (BOS) is defined as symptoms developed when there is a discrepancy between the expectations of the employee and the actual requirements of his or her position (Moss & Good, 2016). According to the literature, burnout syndrome was found to have unfavorable consequences, such as absent workers and high turnover rates (Dall’Ora et al., 2020). It can also increase hospital expenses (Muir et al., 2022). Additionally, burnout is associated with work neglect and poor quality of care (Dall’Ora et al., 2020).

Research had suggested that the negative strains experienced by burnout syndrome, such as fatigue and exhaustion, can be improved by rest breaks; Other positive effects of rest breaks are improving staff well-being, work performance, and most importantly, moderating turnover rates in understaffed conditions (Whedsche et al., 2017b).

Problem and Purpose Statements:

Although evidence has shown the benefits of rest breaks, institutional policies and staff shortages are some major factors that cause Registered Nurses to be unable to take scheduled breaks or experience interruptions during breaks (Nejati et al., 2016). More importantly, according to the state legislature, employers must provide employees with uninterrupted meals and rest breaks. Therefore, this DNP project focused on implementing a process change at an inpatient unit level that ensured scheduled breaks occurred and reduced interruptions. The proposed policy change was to provide two break nurses (2BRNs) instead of one. Although such a policy had been implemented in other acute care units, break models differed in each unit due to staff preference.


The project was implemented in an inpatient acute care unit in one of the major hospitals in the Pacific Northwest. Implementation followed the guidance of the Plan-Do-Study-Act (PDSA) cycle. Needs assessment survey was first sent out to staff and 85 percent of the respondents were in favor of this change. Another survey was sent to design the structure of rest breaks (specifically the preferred break times for staff and break nurses) and clarify the break nurse responsibilities. Unit Management had reviewed the survey results and set the trial start day on Sept 5, 2022. The trial lasted for 56 days. Throughout the trial period, management ensured enough staffing to guarantee two break nurses were present on day shift each day. Feedback was collected by charge RNs, unit experts, and myself throughout the trial. I then discussed alternatives with unit management and made appropriate adjustments to the break nurse responsibilities.


To evaluate burnout experienced by staff, a purposive sampling method was utilized to exclude new staff and travel nurses. A sample size of 45 was selected based on the inclusion criteria: Day shift nursing staff with more than one year's experience on the unit. A month before the start of the trial, a Maslach Burnout Inventory (MBI) pre-survey was sent to these 45 staff to assess their burnout levels. Immediately after the trial period, the same survey (post-survey) was sent out to those who responded to the pre-survey to reassess their burnout levels.


The survey measured emotional exhaustion (EE), depersonalization, and personal accomplishments. The results showed a statistically significant reduction in EE after implementing the two-break-RNs model. This project provided evidence that regular and uninterrupted rest breaks carried out through a well-designed break nurse structure can lead to reducing burnout symptoms.


Maintaining the current nurse-to-patient ratios while implementing the proposed change is crucial to ensure sustainability. Statistical outcomes that supported the change were reported to the Hospital Staffing Committee and the Nursing Practice Inquiry Council. Other long-term data collected by the facility such as turnover rates could also be used to support the proposed change. A potential increase in the total FTE needed for the unit, or an increase in the unit budget allowance to hire full-time or part-time break RNs could be beneficial. However, comprehensive cost-effective evaluation will have to come from administration, financial, and executive departments.


The positive outcomes of this project have emphasized the importance of scheduled rest breaks. It also served as evidence for other settings to create their preferred rest break structures. The potential benefits of break nurses not addressed in this DNP project could be early ambulation of patients, faster discharge, and reduced readmissions in hospitals. Additional benefits such as a reduction in falls, sepsis, and pressure injuries occurrences could be possible if more resources were available to provide the care patients need.


Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human Resources for Health, 18(1), 41.

Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behaviour, 2(2), 99–113.

Moss, M., & Good, V. S. (2016). An official critical care societies collaborative statement: burnout syndrome in critical care health care professionals: A call for action. American Journal of Critical Care, 25(4), 368–376.

Muir, K. J., Wanchek, T. N., Lobo, J. M., & Keim-Malpass, J. (2022). Evaluating the Costs of Nurse Burnout-Attributed Turnover: A Markov Modeling Approach. Journal of Patient Safety, 18(6), 351–357.

Nejati, A., Shepley, M., & Rodiek, S. (2016). A Review of design and policy interventions to promote nurses’ restorative breaks in health care workplaces. Workplace Health & Safety, 64(2), 70–77.

Wendsche, J., Ghadiri, A., Bengsch, A., & Wegge, J. (2017b). Antecedents and outcomes of nurses' rest break organization: A scoping review. International Journal of Nursing Studies, 75, 65–80.

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