Date of Award

Spring 6-8-2023

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Bomin Shim

Faculty Reader

Dr. Darryl DuVall

Executive Summary

Title: Implementing One-minute Breathing to Decrease Nurses' Burnout on a Medical-Surgical Unit: A Quality Improvement Project

Background and Significance: Stress is the primary cause of nurse burnout, leading to about 80% of all job-related injuries and 40% of lack of workflow within the workplace (AIS, 2021). Nurse burnout impacts the turnover rate significantly. Earlier research found that, in 2018-2019, 54% of nurses suffered from moderate burnout (Kelly et al., 2021), giving rise to a 12% leaving rate mainly due to emotional exhaustion. Nationwide, nurses' turnover is 22% (NSI, 2022). The COVID-19 pandemic exposes nurses to additional stressors that cause a much higher turnover rate due to increased pressure on healthcare workers.

Problem and Purpose Statement: Nursing burnout is a psychological state that reduces nurses' energy which shows emotional tiredness, lack of motivation, and feelings of frustration, leading to reduced work efficacy. (Mudallal et al., 2017). It causes high turnover and economic costs, reduces patient care quality, and decreases practice safety (Kelly et al., 2021; Halter et al., 2017). This project aims to evaluate whether breathing relaxation exercises reduce the nurse burnout level effectively among nurses in the acute care unit. The aim of implementing practical breathing relaxation exercises is to increase awareness of self-care strategies among nurses, which has the potential to decrease nursing burnout and turnover and improve care quality over time.

Methods: The DNP project was designed to follow the Ottawa model, which comprises three phases with 2 surveys in 10 weeks. The project included two weeks on the pre-intervention survey in the first phase, three weeks of breathing implementation, three weeks completing the post-test survey in the second phase, and two weeks to evaluate data and outcomes in the third phase. Nurse burnout was measured with the Oldenburg Burnout Inventory (OLBI) pre- and post-survey. The OLBI, a type of scoring measurement widely used to be economical, reliable, and academically validated, was carried out to assess burnout (Tipa et al., 2019). Data were collected from the participants anonymously through Microsoft Forms, while Microsoft Excel was utilized as the data analysis tool. Descriptive statistics were used to analyze the quantitative data and thematic analysis was used to analyze the qualitative data.

Results/Outcomes: There were 25 (31.25%) responses during the two-weeks pre-survey period and 14 (17.5%) responses during the three-week post-survey period. The unpaired t-test (p=0.137) and Mann Whitney U test (p=0.113) indicated no significant difference in OLBI full total score between the pre-and post-survey. However, the qualitative feedback from participants revealed overwhelmingly positive responses regarding the impact of the one-minute breathing exercise. The three themes identified, namely relaxation and emotional regulation, cognitive reset and refocus, and knowing the benefits, collectively emphasize the beneficial influence of one-minute breathing exercises in alleviating nurses' burnout.

Sustainability: The DNP project increased agency leadership's awareness of nurse burnout. It provided opportunities for nurses to try out one-minute breathing exercises as one of the self-care strategies during shift changes. A one-minute breathing exercise is more likely to be adopted and expanded by agency leadership because it is cost-free and easy to implement. Additionally, using a simple and validated tool like the OBIL can help measure its effectiveness, making it a more appealing option for agency leadership.

Implications: The implications of this DNP project provide insight into the connection between reducing job-related burnout and the use of breathing techniques. This DNP project could provide a deeper understanding of the effectiveness profile of breathing exercises. The nurse leadership team, seeking effective breathing strategies that help nurses reduce their burnout levels, can use the findings in this project as a common starting point (Kelly et al., 2021). Though this project was only conducted in one acute care unit, the one-minute breathing technique can be modified to suit a broader range of healthcare facilities. The results of this project suggest that implementing a one-minute breathing exercise during shift changes may help nurses reduce their stress levels and lead to decreased burnout.


American Institute of Stress. (2021). Digesting the statistics of workplace stress.

Halter, M., Boiko, O., Pelone, F., Beighton, C., Harris, R., Gale, J., Gourlay, S., & Drennan,V.(2017). The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Services Research, 17(1), 824.

Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing outlook, 69(1), 96 102.

Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017). Nurses' Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits. Inquiry: a Journal of Medical care Organization, Provision and Financing, 54, 46958017724944.

National Academy of Medicine. (2021). Valid and reliable survey instruments to measure burnout, well-being, and other work-related dimensions. survey-instruments-measure-burnout-well-work-related-dimensions/

NSI Nursing Solutions, Inc. (2022). 2022 NSI national health care retention & RN staffing report. NationalHealth are Retention Report.pdf

Tipa, R. O., Tudose, C., & Pucarea, V. L. (2019). Measuring Burnout Among Psychiatric Residents Using the Oldenburg Burnout Inventory (OLBI) Instrument. Journal of Medicine and Life, 12(4), 354–360.