Nurses’ Break Compliance in the Ambulatory Environment: Basis for a Strategic Quality Management Plan

( Vol-12,Issue-3,May - June 2026 )

Author(s): Katherine Ann A. Estimada, Maria Karmela C. Del Rosario

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Page No: 074-086
DOI: 10.22161/ijaems.123.7

Keywords:

Nurses’ Break Compliance; Ambulatory Environment; Strategic Quality Management Plan; Workforce Well-being; Patient Safety

Abstract:

This study assessed nurses’ break compliance in the ambulatory environment as a basis for developing a Strategic Quality Management Plan (SQMP). Specifically, the study determined the weekly and monthly break compliance rates of nurses from July to October 2025, identified trends in break adherence, analyzed the strengths, weaknesses, opportunities, and threats (SWOT) associated with break compliance, and proposed evidence-based strategic interventions to improve workforce well-being and patient safety. The study utilized a quality improvement case study approach conducted at the Sanford Urgent Care Clinic in Fargo, North Dakota, USA. Data were gathered from Sanford API Employee Meal Break Reports, staffing schedules, audit reports, and compliance monitoring records involving Registered Nurses, Licensed Practical Nurses, and Patient Care Technicians assigned to 8-hour and 12-hour shifts. Descriptive statistics, including frequencies, percentages, and monthly averages, were used to analyze compliance trends. Findings revealed that overall weekly break compliance remained low at 45.16%, while monthly compliance rates ranged from 43.47% in July to 52.54% in October 2025, indicating persistent challenges in maintaining uninterrupted mandatory breaks. Results further showed that staffing shortages, high patient volume, workload demands, and organizational culture significantly contributed to break non-compliance. The SWOT analysis highlighted operational strengths and opportunities, while emphasizing threats related to burnout, fatigue, and patient safety. Based on the findings, a Strategic Quality Management Plan was proposed focusing on staggered break scheduling, break nurse implementation, staffing optimization, real-time compliance monitoring, and wellness promotion programs to improve nurses’ break adherence and healthcare quality outcomes.

Received: 07 Apr 2026; Received in revised form: 04 May 2026; Accepted: 08 May 2026; Available online: 12 May 2026

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