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‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care

‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care
‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care

Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’.

Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment.

Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England.

Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p<0.?001).

Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing.

nursing, staffing, safety, quality, nurse-patient ratios, quality of health care, nurse staffing, patient safety
2044-5415
116-125
Ball, Jane E.
85ac7d7a-b21e-42fd-858b-78d263c559c1
Murrells, Trevor
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Rafferty, Anne Marie
d82c2661-2b39-447c-b975-c42834480975
Morrow, Elizabeth
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Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Ball, Jane E.
85ac7d7a-b21e-42fd-858b-78d263c559c1
Murrells, Trevor
9a57589a-d893-415c-8c3d-8b25d052f42c
Rafferty, Anne Marie
d82c2661-2b39-447c-b975-c42834480975
Morrow, Elizabeth
06f05597-f184-42f5-b3b5-9d15e2613e2a
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Ball, Jane E., Murrells, Trevor, Rafferty, Anne Marie, Morrow, Elizabeth and Griffiths, Peter (2014) ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Quality and Safety, 23 (2), 116-125. (doi:10.1136/bmjqs-2012-001767). (PMID:23898215)

Record type: Article

Abstract

Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’.

Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment.

Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England.

Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p<0.?001).

Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing.

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More information

Accepted/In Press date: 6 June 2013
e-pub ahead of print date: 29 July 2013
Published date: February 2014
Keywords: nursing, staffing, safety, quality, nurse-patient ratios, quality of health care, nurse staffing, patient safety
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 355664
URI: http://eprints.soton.ac.uk/id/eprint/355664
ISSN: 2044-5415
PURE UUID: ae03342c-e08d-4ea1-9103-c9093b842b7a
ORCID for Jane E. Ball: ORCID iD orcid.org/0000-0002-8655-2994
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

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Date deposited: 03 Sep 2013 13:21
Last modified: 15 Mar 2024 03:51

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Contributors

Author: Jane E. Ball ORCID iD
Author: Trevor Murrells
Author: Anne Marie Rafferty
Author: Elizabeth Morrow
Author: Peter Griffiths ORCID iD

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