Ball JE, Murrells T, Rafferty AM, Morrow E, Griffiths P, et al.
BMJ quality & safety. Date of publication 2014 Feb 1;volume 23(2):116-25.
1. BMJ Qual Saf. 2014 Feb;23(2):116-25. doi: 10.1136/bmjqs-2012-001767. Epub 2013
Jul 29.
'Care left undone' during nursing shifts: associations with workload and
perceived quality of care.
Ball JE(1), Murrells T, Rafferty AM, Morrow E, Griffiths P.
Author information:
(1)National Nursing Research Unit, Florence Nightingale School of Nursing and
Midwifery, King's College London, , London, UK.
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.
DOI: 10.1136/bmjqs-2012-001767
PMCID: PMC3913111
PMID: 23898215 [Indexed for MEDLINE]
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