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November 15, 2018

This hospital's secret to fighting nurse burnout? A walk in the garden.

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Feb. 19, 2019.

    Burnout impacts as many as a third of all nurses, but there may be a simple way to mitigate the problem—having nurses take an outdoor break in a garden, according to a study published in the American Journal of Critical Care.

    Study details

    For the study, researchers studied burnout levels among nurses at Legacy Emanuel Medical Center in Oregon for two summers. Nurses were randomly assigned to one of two groups: those who took a daily work break in the hospital's garden for six weeks and those who took daily work breaks indoors for six weeks. The groups then swapped break assignments for an additional six weeks.

    At the start and end of each six-week period, nurses took the Maslach Burnout Inventory-Human Services Survey (MBI), which is "considered the gold standard [tool] to measure burnout in health care workers," according to the researchers. The MBI measures the extent of burnout based on three components:

    • Emotional exhaustion;
    • Depersonalization; and
    • Personal accomplishment.

    The nurses were also asked to complete the Pediatric Quality of Life Present Functioning Visual Analog Scale (VAS) to measure their immediate psychological symptoms before and after each break. The VAS measures six symptoms:

    • Anger;
    • Anxiety;
    • Fatigue;
    • Fear;
    • Pain; and
    • Sadness.


    The researchers found significant improvements in MBI scores for emotional exhaustion and depersonalization among nurses taking garden breaks compared with indoor-only breaks. In particular, nurses had an emotional exhaustion score 4.5 points lower after the six weeks spent in the garden than before (on a seven-point scale). However, researchers found no improvement shown for personal accomplishment scores.

    Psychological scores also improved significantly among nurses taking garden breaks compared with those taking indoor-only breaks. Specifically, the researchers saw noticeable improvement in scores related to anger and tiredness.

    According to the researchers, many nurses reported feeling "less stressed after getting some fresh air" in the garden. In comparison, many reported that the indoor break rooms were "noisy and crowded," or that they "wished they could be outside."


    "Taking daily breaks in a garden might be a complementary strategy to other interventions known to mitigate burnout, such as mindfulness-based stress reduction and resiliency training," the researchers concluded. "Although nurses spent less time in the garden than indoors (20.5 vs. 24.4 average minutes respectively), the garden provided greater reduction in burnout."

    Roger Ulrich, co-project investigator and emeritus professor of architecture at Texas A&M University, said, "There is a pattern of evidence that suggests that well designed gardens can reduce stress, lower blood pressure, and relax people." He added that anything that can improve staff morale and help nurses cope with the demands of their job could potentially help hospitals provide better quality care.  (Knowles, Becker's Clinical Leadership & Infection Control, 11/7; Cordoza et. al., American Journal of Critical Care, 11/2018; Legacy Health release, 11/13).

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