Digital Repository Masters Projects Spring 2025 Shift Breaks Effect on Job Satisfaction Sayley Timothy Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Timothy, S. 2025. Shift Breaks Effect on Job Satisfaction. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Shift Breaks Effect on Job Satisfaction Project Title by Sayley Timothy Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 4/26/2025 Date Sayley Timothy RN, BSN, MSN Student 4/26/2025 Student Name, Credentials (electronic signature) Date Jamie Wankier Randles, EdD, MSN, RN 04/21/2025 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. 04/26/2025 Date 1 Shift Breaks Effect on Job Satisfaction Sayley Timothy, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This MSN project aims to educate stakeholders and implement a shift break process in an ambulatory surgical center to increase job satisfaction and potentially decrease nurse burnout. Skipped work breaks can lead to emotional and physical exhaustion, fatigue, and back pain. Creating a shift break process can support nurses' well-being. Rationale/Background: This project was designed for an ambulatory surgical center that does not have a shift break process that allows nurses to take regular breaks during their shifts. Shift breaks can significantly lower fatigue, decrease burnout, and improve patient care. Methods: Stakeholders and staff nurses will be educated on the potential benefits of implementing a structured shift break process. Before the implementation, a pre-survey will be conducted to assess nurses' baseline job satisfaction. Scheduled breaks will then be incorporated into the schedule, allowing all nurses to take breaks covered by another nurse. After the implementation, a post-survey will be provided to evaluate the effectiveness based on changes in job satisfaction. Results: Implementing a process that allows nurses to take breaks during their shifts can increase job satisfaction, benefit nurses' well-being, and improve patient care. Conclusions: Providing ambulatory surgical centers with education and a shift break process can improve job satisfaction among nurses. Increased job satisfaction can indirectly enhance patient outcomes and decrease nurse burnout. This MSN project aims to help nurses feel more satisfied in their work by ensuring they can take their required breaks during their shifts. Keywords: job satisfaction, shift break process, nurse burnout. 3 Shift Breaks Effect on Job Satisfaction Nurses are assigned tasks throughout their shifts that require energy and productivity, often involving large amounts of time caring for patients. Due to increased patient care demands, nursing staff often cannot take a break during a shift. Providing a process for nurses to take a shift break has increased workers' productivity by preserving high vigor levels and alleviating fatigue (Albulesco et al., 2022). Research has demonstrated that skipped or interrupted breaks and the duration of meal breaks are linked to emotional and physical exhaustion, fatigue, and back pain, and taking a break can benefit nurses' emotional and physical health (Vieten et al., 2023). Establishing a standardized shift break duration and frequency can be beneficial in supporting the well-being of nursing staff (Vieten et al., 2023). Being able to take a shift break is associated with lowering fatigue in nurses (Sagherian et al., 2021). General practitioners have described breaks as "a valuable, desirable opportunity to remove oneself from the workplace as a feasible well-being improvement strategy" (O'Neill, 2022. p.7). The absence of a shift break culture in nursing and its potential impact on job satisfaction nurse burnout, and patient safety and satisfaction are significant concerns. The schedule changes daily in an ambulatory surgical center, and the workload varies tremendously. Some shifts require constant work for twelve hours, and others require less work for only eight hours; every day is different, and it is hard to predict. Due to the variability of the surgical center environment, the interruption of shift breaks can be a concern in this setting. Nurses are often unaware of how long their shifts will be, which can sometimes be up to fifteen hours long. The uniqueness of a surgical center setting makes it essential that a shift break system is in place to ensure that staff productivity is supported and fatigue is reduced. 4 Nurses who are overworked and do not receive breaks throughout their shifts can have physical and psychosocial impacts, potentially leading to burnout. Nurse burnout is a critical factor to address because of its effects on job satisfaction and patient safety. Low job satisfaction is associated with more sickness absences and low intention to stay at work (Hong et al., 2019). Structured shift breaks can decrease nurse burnout, improve patient care, and decrease potential errors (Montgomery et al., 2021; Stutting, 2023). Implementing a process that ensures nurses are provided a break would benefit the ambulatory surgical setting. This MSN Project aims to provide valuable insights for healthcare organizations by exploring the characteristics of shift breaks and their influence on job satisfaction among nurses. Statement of Problem Nursing tasks can be demanding and stressful for many nurses, affecting job satisfaction and burnout. A nurse's job satisfaction profoundly affects their patient's health and safety, directly affecting patient satisfaction. (Antonio et al., 2024). One aspect of job satisfaction is nursing burnout, a current issue in healthcare that can be addressed in many ways in the workplace (Galanis et al., 2023). One way to address nursing burnout is through simple shift breaks, which have been shown to decrease nurse burnout and improve patient care (Stutting, 2023). Research has demonstrated that being unable to take the appropriate breaks during the workday can lead to emotional and physical exhaustion in workers (Otto, 2020). It is shown that rest breaks can significantly lower fatigue in nurses during their shifts (Sagherian et al., 2021). This project aims to review the literature on the benefits of shift breaks on job satisfaction, provide education, and develop a process for nurses to utilize shift breaks in an ambulatory surgical setting. 5 Significance of the Project This MSN project is essential in the ambulatory surgical setting because of the inconsistent shift lengths and poor shift break culture surrounding the shift break process. The project outcomes hold significant potential to enhance job satisfaction and reduce burnout among nurses, thereby benefiting both nurses and patients. The ability to take shift breaks is shown to affect nurses in the ambulatory setting by impacting job satisfaction, nurse burnout, and patient safety and satisfaction (Albulescu et al., 2022; Bokja et al., 2023; Hong et al., 2019; Stutting, 2023). Providing breaks throughout the shift is essential because it can benefit the nurses and increase job performance (Albulescu et al., 2022). Many nurses do not get a scheduled break in the ambulatory setting because there is no shift break system due to a schedule based on patients' needs and scheduled surgeries. Shift breaks are an essential tool that can decrease nurse burnout, increase nurse job satisfaction, and improve patient safety and satisfaction (Antonio et al., 2024; Sharifi et al., 2020). Interventions that reduce stress and increase moral resilience are needed to decrease nurse burnout and turnover intention (Galanis et al., 2024). One method that helps reduce stress and nurse burnout is implementing a process for regular shift breaks. Job satisfaction is an essential factor to consider when evaluating nurse burnout, patient satisfaction, and patient safety. Regular and structured shift breaks have the potential to increase job satisfaction, indirectly decrease nurse burnout, and benefit patient outcomes. Review of the Literature A literature review was conducted to examine the current research regarding job satisfaction and its association with shift breaks. This literature review included nurse 6 burnout and patient safety and satisfaction because they are indirectly affected by shift breaks. Research has shown that employees who do not get appropriate breaks at work can negatively affect their health (Vieten et al., 2023). Negative factors affecting health can include back pain, neck and shoulder pain, fatigue, and physical and emotional exhaustion (Vieten et al., 2023). Creating a shift break process and educating nurses on the importance of shift breaks can increase job satisfaction and patient safety and decrease burnout. The PICOT question inspiring the literature review of this MSN project is: In an ambulatory surgical center, how does implementing a shift break process affect nurse job satisfaction compared to not having appropriate breaks using an implemented break system? The 'Steven's Star Model was chosen for implementing this project, and its importance will be discussed in the framework section. Framework A model or framework is essential in project development because it provides a foundation and guide to follow. The model used for this MSN project is the Stevens Star Model of Knowledge Transformation. The Stevens Star Model provides the ideal framework for this project because it uses evidence to make a change and evaluate the outcome appropriately (Brunt & Morris, 2023). According to Brunt & Morris (2023), the Star Model of Transformation is an evidence-based practice model used to understand the cycle, nature, and characteristics of the knowledge found. The model consists of five steps: discovery research, evidence summary, translation to guidelines, practice integration, and process and outcome evaluation (Brunt & Morris, 2023). The first step of discovery research will be to find the research needed to support the project. The second step of evidence summary is combining all the discovered evidence and 7 finding themes in the evidence that support how shift breaks can affect job satisfaction. The third step is using the evidence to create a guideline or system allowing nurses to take appropriate breaks during their shifts. Then, that system is implemented to lead to the final step of evaluating the outcome. After evaluating the outcome, the system can be altered to be more effective. The Stevens Star Model of Transformation promotes evidence discovery by analyzing systemic reviews of the given topic (Dusin et al., 2023). According to research related to job satisfaction, using a systematic method of analyzing and finding the most compelling evidence can provide an effective framework for this project (Hong, 2019). The Star Model is also helpful in promoting the use of evidence in creating guidelines (Brunt & Morris, 2023). This MSN project will implement a new guideline or system to ensure nurses get the appropriate beaks during their shifts. Finding evidence regarding shift breaks and the associated benefits, analyzing and summarizing the evidence, and using it to create a guideline for nurse breaks follow the framework of the Star Model. Once the guideline has been developed, a shift break system can be implemented in the ambulatory setting. Strengths and Limitations There are various strengths and limitations to the Stevens Star Model that must be considered as well. All evidence-based practice (EBP) models and frameworks provide a process to transform evidence into clinical practice, which allows organizations to analyze a hospital system for readiness and willingness to change (Dusin et al., 2023). The Stevens Star Model allows the evidence to be explored and used to integrate a new workplace system (Brunt & Morris, 2023). Using the model as a framework to discover the evidence and find the reoccurring themes related to this MSN project can benefit the project's strength. The Star Model also benefits this project topic by using patient and nurse job satisfaction as evidence. According to 8 the research on this model, expertise and patient preference are allowable as evidence (Dusin et al., 2023). Patient satisfaction and nurses' opinions of job satisfaction and burnout can be useful information in this project. Limitations of the model must be addressed prior to implementation. One limitation of this model is that evidence can often contain contradicting information (Dusin et al., 2023). Finding the best and most accurate evidence may require additional research. In addition, evidence-based models and frameworks have also been criticized for ignoring patients' values and preferences (Dusin et al., 2023). This project considers patients' values and preferences through nurse burnout and job satisfaction. Implementing shift breaks through this project can decrease nurse burnout, improve patient care, and decrease potential errors (Montgomery et al., 2021; Stutting, 2023). Analysis of Literature This literature review examined the current research regarding shift breaks and their association with job satisfaction in nursing. Job satisfaction is associated with job performance, sickness absences, and turnover intentions and is an important topic to address in nursing (Hong et al., 2019). The literature review explored the importance of shift breaks on employees' physical and mental health. Nurse burnout was also reviewed because it is indirectly affected by nurses' job satisfaction. In addition, patient safety and satisfaction are essential factors considered in this literature review because patients are indirectly affected. This literature review was conducted to educate nurses on the importance of taking shift breaks and its effects on job satisfaction, nurse burnout, and patient safety and satisfaction. 9 Search Strategies A literature search was conducted to identify the current evidence using Weber State 'University's Stewart Library's OneSearch and Advanced Search, Google Scholar, and CINAHL. Articles ranging from 2019 through 2024 were included in this literature review to keep the evidence current. The search included keywords: job satisfaction, shift breaks, rest breaks, employee satisfaction, breaks and satisfaction, nurse burnout, burnout symptoms, burnout causes, nurse fatigue, patient safety, patient satisfaction, ambulatory center, burnout education, and break benefits. Various Boolean combinations were used to create an expansive search of the literature. Synthesis of the Literature The literature review for this MSN project indicated three themes relevant to nurses utilizing shift breaks and the effects on job satisfaction and burnout. The first theme discussed in this literature reviewed how shift breaks can affect nurses' mental and physical health (Albulescu et al., 2022; Hong et al., 2019; Rettig et al., 2021; Sagherian et al., 2021; Vieten et al., 2023). The second theme is job satisfaction and its effects on nurse burnout and patient outcomes (Ashipala et al., Albulescu et al., 2022; Bokja et al., 2023; Montgomery et al., 2021; Otto et al., 2020; Ozer & Sari, 2024; Pagador et al., 2022; Sharifi et al., 2020; 2022; Stutting, 2023). The third and final theme discussed is the process and education required to implement a shift break method (Collins et al., 2021; Lyubykh et al., 2022; Phan & Beck, 2023). Shift Breaks Effects on Health A shift break is a scheduled time during 'employees' shifts when they can step away from the work environment and enter a state of recovery (Vieten et al., 2023). According to Vieten et al. (2023), employees who skip work breaks have increased mental and physical exhaustion, 10 back pain, and neck and shoulder pain. In healthcare, nurses often work long shifts and must prioritize patient care. In addition, nurses rely on other busy nurses to cover patient care while taking a shift break. These issues contribute to a culture where taking breaks is often unsupported. In the ambulatory setting, nurses must first care for their mental and physical health to maintain patient care and safety (Landis et al., 2021). Research showed that there is increased value when nurses take their required breaks, leading to the prevention of decreased health and increased job performance (Albulesco et al., 2022; Hong et al., 2019; Rettig et al., 2021; Sagherian et al., 2021; Vieten et al., 2023). Nurses not taking the appropriate shift breaks take the risk of harming their mental and physical health (Vieten et al., 2023). Breaks in the workday are shown in the literature to lift employees' moods and make the workday more enjoyable for employees (Rettig et al., 2021). Fatigue can affect mental and physical health, and rest breaks have been shown to lower acute fatigue in nurses (Sagherian et al., 2021). When nurse's health is taken care of, and they receive their breaks during the workday, they have increased work performance (Albulesco et al., 2022; Hong et al., 2019). Job performance is enhanced through decreased sickness absences and nurse turnover intentions (Hong et al., 2019). The literature showed the importance of shift breaks on 'employees' health and job performance and how they can have an adverse effect if not taken (Albulesco et al., 2022; Vieten et al., 2023). Job Satisfaction on Nurse Burnout and Patient Outcomes Job satisfaction 'is a positive emotional state resulting from job experiences (Montuori et al., 2022). Job satisfaction can be reflected through overall life quality, health status, job performance, work absenteeism, job turnover, and psychological health (Montuori et al., 2022). Job satisfaction is essential in nursing because it affects nurses' and patients' well-being. Nursing 11 has a high turnover rate, and there is currently a nursing shortage due to poor job satisfaction (Hu et al., 2022). When nurses do not feel satisfied with their jobs, it can lead to nurse burnout. Burnout is a work-related state of exhaustion that occurs among employees, characterized by extreme tiredness, reduced ability to regulate cognitive and emotional processes, and mental distancing" (Otto et al., 2020, p.1). Ashipala et al. (2022) found that nurse burnout has a negative impact on 'nurses' well-being physically and emotionally and can compromise performance, productivity, and satisfaction. The literature expressed that job satisfaction not only affects nurse burnout but can also affect patients (Montgomery et al., 2021). According to Montgomery et al. (2021), nurse burnout significantly predicts medication administration errors. Nurses experiencing burnout may have lowered alertness and vigilance, leading to poor job performance and a higher possibility of making errors that could potentially harm a patient (Montgomery et al., 2021). Nurses have reported that the causes of medical errors were excessive workloads, insufficient nursing staff, fatigue, and burnout (Montgomery et al., 2021). According to Ozer and Sari (2024), a significant relationship exists between missed nursing care and job satisfaction. Inadequate labor sources were the leading cause of nurses not fulfilling all nursing care tasks, and these missed tasks led to lower job satisfaction (Ozer & Sari, 2024). Organizations can proactively optimize job satisfaction in their nursing staff through various techniques, such as reducing workload and establishing a supportive nursing culture (Ashipala et al., 2022; Pagador et al.). Studies showed that an effective way to decrease nurse burnout is to give nurses rest breaks during their shifts (Stutting, 2023). Nurses who can take breaks during their shifts have increased performance and can deliver better quality care to their patients (Albulescu et al., 2022). When nurses are supported in taking breaks, job satisfaction can 12 increase, positively affecting patient safety culture (Bokja et al., 2023). In addition, nurse burnout is affected by implementing shift breaks through improved nurse retention, which impacts patient safety. (Hu et al., 2022; Montgomery et al., 2021). Creating a healthy and supportive work culture and reducing workload and job-related stressors can prevent or reduce nurse burnout (Sharifi et al., 2020). Shift Break Process This literature review explored the effects of a lack of shift breaks on ambulatory care nurses and the methods needed to implement a process in a busy surgical center environment (Collins et al., 2021). A shift break is a period during the workday when employees are not performing any tasks related to their jobs (Phan & Beck, 2023). In a busy hospital or clinic setting, nurses felt they could take breaks if the climate was supportive (Landis et al., 2021; Phan & Beck, 2023). Many nurses associated breaks with just enough time to eat so they may not experience hypoglycemia during their shift instead of resting (Landis et al., 2021). In ambulatory surgical centers, high acuity assignments or inadequate support structures can prevent nurses from taking breaks during their shifts (Landis et al., 2021). There is often not enough time or support from co-workers or managers to be able to take a break away from patient care. Breaks are often viewed as a luxury, to be taken only when the shift is going well and organizational support is available (Landis et al., 2021). An organizational process that includes breaks benefits employees' health, job performance, and job satisfaction (Qi et al., 2020). In a busy ambulatory setting, it is beneficial to have a process that allows nurses to take breaks during their shifts to focus on improving self-care (Rettig et al., 2021). 13 Methods to counteract nurses not taking breaks are providing education, support, and a process to give employees opportunities for breaks (Collins et al., 2021). Research showed that for an education and support process to be successful, a positive break climate must be in place in the environment (Phan & Beck, 2023). A positive break climate would be an environment where employees believed that their managers and co-workers valued breaks and the benefits of taking breaks (Phan & Beck, 2023). A positive break climate can be accomplished by educating employees and management on the importance of taking breaks and providing methods for nurses to cover each other for breaks (Collins et al., 2021; Phan & Beck, 2023) A micro-break system is one solution to schedule breaks for employees with variable working schedules. A micro-break is a break shorter than 30 minutes that employees voluntarily take (Phan & Beck, 2023). According to Lyubykh et al. (2022), having a micro-break strategy in the workplace can restore workers' energy levels and increase well-being. The recommended time for a micro-break to get the outcome of higher energy levels and increased productivity is at least ten minutes uninterrupted and should be in a place outside the unit where workers can relax (Collins et al., 2021; Lyubykh et al., 2022). Research showed that adequate education and practices encouraging shift breaks increased positive productivity levels (Collins et al., 2021; Lyubykh et al., 2022). Summary of Literature Review Findings and Application to the Project Shift breaks are essential in ambulatory settings because they increase job satisfaction, decrease nurse burnout, and increase patient safety (Albulesco et al., 2022; Bokja et al., 2023). An expansive review of the current literature on shift breaks' effects on health revealed that implementing a break process can make the workday more enjoyable, which helps increase job satisfaction among nurses (Rettig et al., 2019). Shift breaks also effectively lower acute fatigue, 14 sickness absences, and turnover intentions (Sagherian et al., 2021; Hong et al., 2019). Skipping shift breaks can lead to adverse health effects on employees and cause more bodily pain and discomfort (Vieten et al., 2023). Other research on job satisfaction and shift breaks revealed that shift breaks affect job satisfaction, indirectly affecting burnout and patient safety. Shift breaks and job satisfaction significantly mitigate nurse burnout (Sharifi et al., 2020). Among the various strategies to combat nurse burnout, shift breaks are an effective tool organizations can use (Otto et al., 2020; Pagador et al., 2022). Shift breaks enhance employee performance and significantly boost job satisfaction (Albulesco et al., 2022). When nurses are content with their jobs, they are better equipped to provide quality patient care and are less likely to miss care (Ozer & Sari, 2024). Moreover, job satisfaction is directly linked to an improved patient safety culture (Bokja et al., 2023). Understanding the impact of shift breaks on nurses' health and well-being is crucial to job retention, decreased errors, and decreased nurse burnout (Rettig et al., 2019; Stutting, 2023; Ozer & Sari, 2024). Inadequate organizational structure and support can prevent nurses from taking breaks (Landis et al., 2021). A process encouraging shift breaks can positively affect 'nurses' well-being and restore energy levels throughout the workday (Lyubykh et al., 2022). Creating a shift break culture and developing a process that encourages nurses to take breaks can result in more nurses getting the necessary time away from patients (Phan & Beck, 2023). A specific break process, including staff education, a break schedule, and nursing coverage, can increase nurses' job satisfaction and retention (Hu et al., 2022). Implementing a break process in the ambulatory setting will impact nursing job satisfaction and promote patient safety (Albulesco et al., 2022; Bokja et al., 2023). 15 Project Plan and Implementation This MSN project aims to educate nurses and staff working in an ambulatory surgical center about the importance of shift breaks and their effects on job satisfaction and implement a process to improve job satisfaction. The shift break process will be accomplished by creating educational material that educates staff on the impact of shift breaks on job satisfaction, nurse burnout, staff health, and patient outcomes, combined with a detailed process. Plan and Implementation Process The Stevens Star Model of Knowledge Transformation framework will be used to implement this change and evaluate the results (Brunt & Morris, 2023). For the MSN project to be successful, support from the director of nursing, administrators, doctors, patients, families, and the MSN project lead will be required. The first step in this implementation process will include a meeting with the director of nursing to ensure that the project and new method can be appropriately implemented. This meeting will consist of a presentation on the importance of this process. Once approval has been obtained, the following steps are surveying the staff and delivering education. The MSN project lead will then send the educational information and research to affiliated doctors and board members to ensure they are notified of the change. Following the above steps, the MSN project lead will administer a pre-survey to nursing staff via email before presenting any educational material. The survey results will create a baseline of staff knowledge and guide the project. The pre-survey will determine how staff feel about the ambulatory center's current shift break process and their current job satisfaction level. After the survey responses have been recorded and analyzed, educational material on how shift breaks affect job satisfaction will be emailed to the nurses. Documentation will be required to 16 ensure the nursing staff reads and absorbs the project material. A flyer will be placed in the break room to encourage nurses to take their breaks and support others in taking their breaks. An educational flyer or poster can effectively educate nurses and encourage breaks (Collins et al., 2021). The educational information will emphasize the importance of shift breaks on nurses' job satisfaction, health, and burnout. Once the staff and management have been adequately educated about the reason for the change in the schedule, the shift break process will be incorporated into the schedule. This shift break process will include nurses covering their co-workers until the entire staff gets a break. The director of nursing will add the scheduled breaks to the schedule daily. Because nurses are covering for other nurses, this break can be uninterrupted and an opportunity for relaxation. The effectiveness of implementing a shift break process and providing education can be analyzed after three months of incorporating the shift break process. Analysis will occur with the administration of a post-survey given to nurses to evaluate their current job satisfaction, health, and burnout levels. In addition, a post-survey will be administered to the administration to measure if the shift break process was successful. Both surveys will help determine if this shift break process increases or maintains job satisfaction or if changes need to be made to make it more effective for nurses. This MSN project aims to increase job satisfaction through the newly implemented shift break process. If the survey results indicate that some component of the shift break process is inadequate, a meeting with staff and management will be held to evaluate changes further. Interdisciplinary Team The director of nursing, administrator, doctors, board members, nursing staff, MSN project lead, and patients all play essential roles in this project. The shift break process will 17 require collaboration and teamwork to be successful. Nurses must be team players and cover for their co-workers during breaks. The administration is in charge of keeping everyone working as a team and ensuring the process runs smoothly. Creating an environment prioritizing teamwork can create a more satisfying workplace for nurses (Sulaiman et al., 2022). This teamwork will allow the process to work smoothly and improve patient outcomes. Using teamwork to provide shift breaks can decrease nurse burnout, improve patient care, and decrease potential errors (Montgomery et al., 2021; Stutting, 2023). Director of Nursing The director of nursing is one of the main stakeholders that allows the successful implementation of a shift break process. The director manages the nursing staff at the facility and manages shift scheduling. The project lead will work closely with the nursing director to ensure that the shift break process is implemented into the schedule and that nurses know their role. The director of nursing can help make this a successful and beneficial project for nurses at the surgical center. Administrator The administrator is a primary stakeholder, as it is their job to oversee the facility and ensure everyone is complying with the policies and procedures. They will be vital to this project because they can ensure it is implemented correctly and encourage staff to participate. They are also the stakeholders who approve all educational material and surveys given to staff. Doctors Many doctors perform their procedures at the surgical center during the week. It is important that they are aware of the nurse's shift break process and that they allow it to be implemented appropriately. Operating room nurses working closely with the doctors will be part 18 of this process and must take breaks during procedures. Doctors need to know about this temporary nurse coverage and understand why it is being implemented. Board Members The ambulatory surgical center has a board of directors that oversees the facility and all the policies. It will be necessary to notify the board of directors, share research, and gain buy-in for the approval of the MSN project initiatives. These stakeholders can provide insight that will steer changes as needed to improve the process. Nursing Staff Nursing staff are an essential stakeholder to consider when implementing this project. The nursing staff is the focus of this project, and their participation is necessary for the project to be successful. Nurses must collaborate and use teamwork to adjust to the change in the shift break process. Nurses will need to cover their co-workers for their breaks; another nurse will cover their breaks in return. For this project to work, nurses must be compliant and willing to help others. MSN Project Lead The MSN project lead will oversee the implementation process and ensure that all the stakeholders are well-informed and approve of the change. The project lead will also create all educational material and surveys. Other MSN Project lead tasks will include analyzing the survey results and reporting changes to the administration. They will implement the shift break process for nurses with the assistance of the director of nursing, who oversees the nursing staff daily. The project lead will work closely with all stakeholders to implement the project correctly and make any needed changes. Patients 19 Patients are stakeholders in this project because this process may affect their care. Nurses who have higher job satisfaction and less burnout have a decrease in medication errors (Montgomery et al., 2021). This project may indirectly benefit patient care, so they must be aware of any nurse changes due to shift break coverage. Description and Development of Project Deliverables This MSN project will be presented using six deliverables. The following deliverables will be used: (1) a PowerPoint presentation that will be used to educate management, doctors, and board members of the importance of the shift break process, (2) pre and post-surveys that will be given to nurses to measure job satisfaction, (3) a PowerPoint presentation that will educate the nursing staff on the importance of their participation in the process, (4) a poster for the breakroom that encourages nurses to take their breaks, (5) a timeline that can be used to notify all staff of the timeline of the process, and (6) a sign-up sheet to determine when staff have reviewed the education. The following sections will explain the deliverables and their importance in this MSN project. PowerPoint Presentation for Management, Doctors, and Board Members The first deliverable will be an educational PowerPoint presentation highlighting shift breaks' importance on job satisfaction (see Appendix A). This presentation will be given to management, including the administrator and director of nursing. Doctors and board members will also be provided with this presentation so they are notified of the importance of the changes. The presentation will highlight the key findings of the effects of shift breaks on job satisfaction. Pre- and Post-Surveys 20 Surveys are an essential deliverable to include in this MSN project, as they will allow the project lead to measure the effectiveness of the shift break process (see Appendix B). Before any changes are made, the administered pre-survey will measure how nurses feel about their jobs and the current shift break process. The post-survey will be provided after the shift break process has been implemented for three months. Survey results will allow the MSN Project lead to measure whether the process was effective and what changes must be made. PowerPoint Presentation to Educate Nursing Staff A PowerPoint presentation will be given to nursing staff to educate them on the importance of their participation and what benefits they can have from the shift break system (see Appendix C). This presentation will be sent to nurses for review, encouraging them to take breaks and give their co-workers their breaks. They will be instructed to review the presentation and sign a document stating they read and understand the material. Poster to Encourage Breaks A simplified poster will be hung in the breakroom to remind and encourage nurses to take breaks (see Appendix D). Nurses can get very busy during their shifts, and the breakroom is a common area that nurses often walk through. This poster will be a gentle reminder of the shift break process and their needed participation. Sign-up Sheet This sign-up sheet will be used at the end of week three of the project (see Appendix E). The sign-up sheet will be posted in a central area in the surgical center where nurses can sign to confirm that they have reviewed the nursing educational presentation and understand the material. This sheet is beneficial in keeping the nursing staff accountable for reviewing the presentation on their own. 21 Timeline The timeline of this project encompasses four months and is broken up by the week (see Appendix F). It is vital to give adequate time for each step due to nurses' differing schedules and their ability to complete the steps in the process. The first week will consist of providing management and doctors with the educational presentation and gaining their approval to proceed with the project. The second week will give the nurses time to complete the pre-survey to determine their feelings of job satisfaction before implementation. The nurses' educational presentation will be sent out during the third week for nurses to review. Then, in the next three months, the shift break process will be in action in weeks four through fifteen. During week sixteen, the post-surveys will be sent out to determine the effects of the break system. The seventeenth week will consist of revising the shift break process based on the survey responses. During the four months this project will be implemented, nurses will continue to be encouraged to take breaks and participate in the shift break process. Education will be provided to highlight the benefits and importance of this MSN project. Surveys will be used to determine the effectiveness of shift breaks and job satisfaction levels. These findings will then be discussed and evaluated with management and administration to determine changes that can be made. Project Evaluation Evaluation is a critical component of determining the impact and quality of the project (Adams & Neville, 2020). An evaluation method that includes stakeholder feedback can allow for a greater understanding when developing a project (Adams & Neville, 2020). Surveys (see Appendix B) will be used to evaluate the effectiveness of this MSN project. Nursing staff will complete a pre-survey before the implementation of the shift break process to assess their feelings and thoughts before the process. The pre-survey will be conducted during week two of 22 the project plan. During week sixteen, a post-survey will be provided to the same nursing staff to assess changes regarding burnout, job satisfaction, and the effectiveness of the newly implemented shift break process. These surveys will provide management and the project lead feedback on where improvement is needed. With any project evaluation, it is essential to evaluate the effectiveness of the project but also the ethical implications of the implementation. Ethical Considerations Quality improvement projects can have significant benefits and unanticipated outcomes that must be considered (Hunt et al., 2021). Ethical considerations such as dignity, respect, harm, and justice must be well thought out, and potential staff harm must be considered before project implementation (Hunt et al., 2021). This MSN project will encourage honesty through the use of anonymous surveys. The pre-and post-surveys used in this project will not ask for any identifying information, ensuring the nursing staff will be anonymous with their answers. Using anonymous surveys will protect privacy throughout the project's implementation. This MSN project encourages non-discriminative behaviors by treating every nursing staff member equally. Every nurse will receive the same length of break and opportunity as every other nurse. Nursing staff who choose not to participate will be excluded from the shift break schedule without consequences, which will not adversely affect the project results. As a staff nurse in the area where the project is being implemented, my involvement could affect the data. The survey data will be kept confidential and anonymous through the education process to avoid personal bias. Additionally, I will maintain a neutral perspective and acknowledge my role in the education and shift break process to the administration and staff. Ethical considerations are essential while implementing this MSN project. The project must maintain an ethical standard protecting the participants and patients from harm. 23 Considering the potential ethical problems of this project will ensure that action is taken to avoid them and preserve the integrity of the project. Discussion Implementing a structured shift break process in ambulatory settings is beneficial because it increases job satisfaction, nurse burnout, and patient safety (Albulesco et al., 2022; Bokja et al., 2023). Educating nursing staff and other stakeholders about the benefits of shift breaks is vital for implementing this process. The primary goal of this process is to implement a shift break process to increase job satisfaction among nurses, potentially decrease burnout, and improve patient safety and overall outcomes. The following sections will discuss the plan for project dissemination, benefits to nurses, implications, recommendations, and the conclusion. Evidence-based Solutions for Dissemination After implementing the shift break process, MSN project results will be disseminated through various methods. The survey responses will be analyzed and recorded to determine if job satisfaction has increased among nursing staff. These findings will help determine if the shift break process has benefited the ambulatory surgical center. The project lead, management, and administration will evaluate if the process needs adjustments to maintain implementation. The project lead will then present findings in this MSN project through a poster presentation to Weber State University Annie Taylor Dee School of Nursing faculty and peers. Significance to Advance Nursing Practice This project is aimed to benefit staff nurses in the ambulatory surgical center by providing a shift break process that allows nurses to take breaks during their shifts. Research has shown that there is increased value when nurses take their required breaks, leading to 24 improvements in both health and job performance (Albulesco et al., 2022; Hong et al., 2019; Rettig et al., 2021; Sagherian et al., 2021; Vieten et al., 2023). A supportive work culture and reduced workload and job-related stressors through breaks have been shown to prevent or reduce nurse burnout (Sharifi et al., 2020). Nurses who are provided breaks during their shifts have increased performance and can deliver better quality patient care (Albulescu et al., 2022). When nurses are supported in taking breaks, job satisfaction can increase, positively affecting patient safety culture (Bokja et al., 2023). This project benefits ambulatory units by providing their nurses with a positive work culture that prioritizes scheduled breaks during their shifts. Furthermore, this project can expand to additional units in the nursing field, as nurses across all healthcare areas require breaks during their shifts. Implications This MSN project has various potential strengths and limitations associated with the implementation. A strength of this project is that it uses different methods to educate stakeholders on the process. The educational poster can effectively educate nurses and encourage them to take breaks (Collins et al., 2021). PowerPoint presentations, a visual timeline, and surveys are also used to strengthen the project's effectiveness. This project also uses anonymous surveys, which are beneficial for getting honest answers and measuring job satisfaction and nurse burnout levels. Using the Stevens Star Model as a framework allows the evidence to be explored and provides a foundation to integrate a new workplace system (Brunt & Morris, 2023). A limitation of this MSN project would be the small sample size available. This process is implemented in a small ambulatory center with fewer than twenty nurses. Additionally, staff willingness to participate may be a barrier, as some nurses may resist participating in the change. If nurses are unwilling to participate, they will be removed from the break schedule. 25 Recommendations To improve this project, continued evaluation of the effectiveness of the shift break process will occur, with adjustments made as necessary. Staff nurses may give input that could improve the shift break process. The literature thoroughly discussed the effects of shift breaks on nurse burnout, health, and patient outcomes (Ashipala et al., Albulescu et al., 2022; Bokja et al., 2023; Montgomery et al., 2021; Otto et al., 2020; Ozer & Sari, 2024; Pagador et al., 2022; Sharifi et al., 2020; 2022; Stutting, 2023). However, there are few research studies on the direct impact of shift breaks on job satisfaction. Therefore, it is recommended that others continue to research this topic and educate stakeholders on the effects of shift breaks on job satisfaction. A similar process could also be implemented with a larger sample size, such as at a larger ambulatory center or hospital setting. Expanding the process into other areas would provide this project with more feedback and a larger sample size to retrieve more data on job satisfaction. This MSN project can help guide shift break processes in other healthcare settings. Conclusions A nurse's level of job satisfaction affects the nurse and the patients they care for (Antonio et al., 2024). One aspect of job satisfaction is nursing burnout, a current issue many nurses face (Galanis et al., 2023). A shift break process has been shown to decrease nurse burnout and improve patient care (Stutting, 2023). Research has also demonstrated that being unable to take the appropriate breaks during the workday can lead to emotional and physical exhaustion in workers (Otto, 2020). Rest breaks can significantly lower fatigue in nurses during their shifts (Sagherian et al., 2021). A process that includes shift breaks, benefits employees' health, job performance, and job satisfaction (Qi et al., 2020). 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Psychology, Health & Medicine, 27(8), 1782–1792. https://doi.org/10.1080/13548506.2021.1950784 32 Appendix A Shift Break Stakeholder Presentation The project lead will provide a PowerPoint presentation to administrators, the director of nursing, doctors, and board members to educate them on the importance of shift breaks for job satisfaction and gain approval. 33 34 35 36 37 38 39 40 Appendix B Shift Break Pre and Post-Survey Surveys will be conducted before and after implementing the shift break process. They will help determine the project's effectiveness. 41 42 Appendix C Shift Break Nursing Education Presentation A PowerPoint presentation will educate nurses on the importance of shift breaks and encourage them to participate in the process. 43 44 45 46 Appendix D Shift Break Poster A poster will be hung in the breakroom to encourage nurses to remember to take their breaks during their shifts and give their co-workers their breaks. 47 Appendix E Sign-up Sheet A document that nursing staff can sign after they have reviewed the education provided. 48 Appendix F Timeline A visual timeline is used to notify all stakeholders of the project's timeline and what to expect each week.