Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care

What motivates critical care nurses to stay in their job? - Structural aspects for empowering intrinsic motivation in permissive professional contexts: A scoping review

OBJECTIVE

In the wake of the COVID-19 pandemic, a significant number of critical care nurses have left their positions, citing overload, burnout, and moral distress. This scoping review is not just a theoretical exploration but a timely and crucial investigation into the aspects and structures of critical care nursing that can make the job fulfilling and appealing, thereby promoting intrinsic motivation and staff retention.

METHODOLOGY

A scoping review of studies reporting on factors that allow critical care nurses to fall back on their intrinsic job motivation. Qualitative, quantitative, and mixed methods studies from 2019 until 2023 that examined critical care nurses are included. This scoping review, which was conducted in 12 databases, follows the framework proposed by Arksey and O'Malley and the PRISMA framework.

RESULTS

22 studies met the inclusion criteria. The thematic synthesis identified 'meaning' as the overarching theme. Meaning can help critical nurses identify their intrinsic motivation and hold tight to it during professional challenges or low morale. Previous studies found meaning-making as an essential element of spirituality. In the present study, it is strongly related to the other subthemes: sense of pride and joy, personal relationships, thriving, and moral responsibility.

CONCLUSION

It makes sense for care management to create specific structures and work conditions, such as flexible scheduling, opportunities for professional development, and supportive team environments that encourage critical care nurses in their professional autonomy. Measures tailored to the individual needs and resources are also crucial. In this way, existing intrinsic motivation can be nurtured, and critical care nurses are enabled to autonomously discern values set by the employer into their own value system.

IMPLICATION FOR CLINICAL PRACTICE

Institutions need to offer critical care nurses decision-making discretion whenever possible, broad information sharing, and a climate of trust and respect, in which the individual may feel autonomous and can develop personally and professionally.

Job satisfaction, work environment, and burnout as predictors of missed nursing care in pediatric units: A descriptive cross-sectional study

PURPOSE

To examine the frequency and predictors of missed nursing care in pediatric units.

DESIGN AND METHODS

This study with a descriptive cross-sectional design was conducted in the pediatric clinics of two public university hospitals in Türkiye. The convenience sampling method was employed, including all nurses working in pediatric units, with a total of 123 nurses participating. Data were collected face-to-face from May to October 2023 using a sociodemographic and job-related characteristics form, the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Maslach Burnout Inventory (MBI), and missed nursing care activity questions. The data were analyzed using descriptive statistics and logistic regression analysis.

RESULTS

The most frequently missed care activities were found to be skin care (45.5 %), educating patients and families (40.7 %), and preparing patients and families for discharge (37.4 %). Predictors of missed nursing care were nurses' educational level, high nurse-to-patient ratios, low job satisfaction, enough opportunity to discuss patient care issues with other nurses, nursing foundations for quality of care, nurse manager's ability, leadership, and support for nurses, staffing and resource adequacy, and collegial nurse-physician relations, emotional exhaustion and personal accomplishment.

CONCLUSIONS

This study revealed that the most frequently missed care activities among nurses were related to skin care, education, and discharge preparation. Understanding the underlying causes is essential for reducing the rate of missed care.

PRACTICE IMPLICATIONS

To reduce the frequency of missed care, it is necessary to improve the work environment and make institutional investments in nursing, enabling nurses to effectively fulfill their duties.

Rationing of nursing care in a developing country: A cross-sectional study

AIM

This study aimed to determine the effect of nurses' work environment, individual and work schedule features on the rationing of nursing care.

INTRODUCTION

Rationing of nursing care is a concern in healthcare settings worldwide, as it is associated with negative outcomes for both patients and nursing staff.

BACKGROUND

Little is known about the precursors of rationing of nursing care in developing countries.

METHODS

This descriptive, correlational and cross-sectional study was conducted with 405 nurses in Türkiye. Data were collected Nurse Information Form, Basel Extent of Rationing of Nursing Care-R and Nursing Work Index-The Practice Work Environment Scale. The study was reported following the STROBE and RANCARE guideline.

RESULTS

Nurses' mean rationing of nursing care score was 1.58 ± 0.59, and the mean work environment perception score was 2.58 ± 0.47, with no statistically significant relationship between the scale scores. However, working ward, working hours and working schedule significantly affected the total rationing of nursing care scores.

DISCUSSION

In this study, contrary to the literature, no relationship was found between the rationing of nursing care and the perception of the work environment. Supporting the literature, nurses' individual/work schedule features affected the rationing of nursing care.

CONCLUSION

Improving nurses' work schedule features and nurse staffing may help reduce the rationing of nursing care.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study emphasised the importance of nurses' work schedule features and nurse staffing in the rationing of nursing care. The data from this study can guide nurse managers in identifying factors related to work schedules that may affect the rationing of nursing care and strategies to follow to make the necessary improvements.

'Implicit rationing of nursing care processes'-Decision-making in ICU nurses' experiences: A qualitative study

BACKGROUND

Implicit rationing of nursing care is defined as the withholding of necessary nursing measures for patients because of a lack of nursing resources. However, no studies have explored the experience of decision-making about implicit rationing of nursing care in an intensive care unit (ICU).

AIM

To explore the process of ICU nurses' decisions and judgement based on the conceptual framework of implicit rationing of nursing care.

STUDY DESIGN

A qualitative study was undertaken between June 2020 and September 2020. The data collection methods were participative observation and interview. Eighteen ICU nurses participated in interviews. A thematic analysis was performed for the data analysis.

RESULTS

The following five themes emerged: assessment of the condition and nature of nursing and time taken; strategies for setting personal priorities; plan implementation under mitigation strategy; existing nursing in reality; evaluation of the implementation of implicit rationing care. Nurses choose different strategies during plan implementation.

CONCLUSIONS

In the absence of explicit guidelines on rationing nursing care, nurses often rely on intuitive and situational decision-making processes for setting priorities. Given the vulnerability of ICU patients and the absence of family caregivers, nurses bear a heightened ethical responsibility to provide care. Establishing a positive nursing culture is essential. It is both reasonable and effective to organize work by accurately quantifying workload, improving staffing levels and optimizing scheduling methods. These themes align with the decision-making process outlined in the conceptual framework and offer fresh perspectives.

RELEVANCE TO CLINICAL PRACTICE

Nurses have a greater responsibility to provide care in an ethical manner and to increase awareness of the importance of holistic nursing care for the patient, that is to raise awareness of the importance of care that is often missed. Nurses actively adopt strategies to reduce implicit rationing of nursing care, including teamwork, organized nursing, working overtime and ignoring quality. The findings highlight the importance of creating a positive nursing culture that encourages nurses to adopt positive strategies.

Culture of Family-Centered Care in the NICU

BACKGROUND

Family centered-care (FCC) has documented benefits for infants, parents, and staff, but is variably practiced.

PURPOSE

To describe parental and staff perspectives on the quality of FCC culture in a neonatal intensive care unit (NICU).

METHODS

Parents of hospitalized infants and staff at a referral NICU completed validated survey instruments to measure NICU FCC quality on topics including trust, communication, and shared decision-making at multiple time points. We compared parent and staff responses using a cumulative log-odds model with a single predictor to model the odds of a score lower than a prespecified value.

RESULTS

A total of 92 parents of 80 NICU infants and 96 NICU providers participated. Most rated items highly, indicating a positive experience with FCC. The items with the highest scores for parents were receiving guidance and being trusted in their infant's care (both 97.1% positive); for staff, listening to parents (95%). Receiving/providing emotional support received the lowest scores from parents (19.1% negative or neutral) and staff (24.5%). Parent and staff answers differed significantly for 6 of 8 questions, with lower scores reported by staff relative to parents.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Parents and staff have variable perspectives on different aspects of FCC. Understanding these nuances of centers' FCC culture can help target interventions and may strengthen FCC delivery for NICU infants and families and career satisfaction for staff. Future directions include assessing FCC quality over time and among specific infant, family, and staff cohorts, especially diverse populations to determine if FCC is equitably delivered.

Understanding the Experiences of Nurses' Work: Development and Psychometric Evaluation of an End of Shift Survey

AIM

To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction.

DESIGN

A retrospective cross-sectional survey of the experiences of nursing staff.

METHODS

Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses.

RESULTS

All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative.

CONCLUSION

The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care.

REPORTING METHOD

We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Nurses' attitude toward futile treatment and its relationship with missed care at the end of life

BACKGROUND

Avoiding futile treatment for patients at the end of life is among one of the care challenges of nurses in intensive care units (ICUs).

AIMS

This study aimed to determine the attitude of intensive care unit nurses toward futile treatment and its relationship with missed care for patients at the end of life.

METHOD

This cross-sectional study was conducted on 307 ICU nurses. Eleven teaching hospitals were selected from three Iranian provinces, Zanjan Province, East Azerbaijan and West Azerbaijan, in 2021. The data were collected using The Attitudes Toward Futile Treatment Scale (ATFTS) and The Missed Nursing Care Survey (MISSCARE Survey) as self-reports.

RESULTS

According to the obtained results, 94.8% of the nurses agreed that futile treatment should not be performed. However, 97.7% of the nurses reported that missed care occurs less for patients at the end of life. The correlation between the MISSCARE Survey's total scale and the ATFTS's total scale was positive and statistically significant (r =.11).

CONCLUSION

This research contributes to understanding nurses' attitudes toward futile treatment. Nurses oppose futile treatment, so obstacles to avoiding it should be eliminated. This attitude does not have a significant impact on nursing care quality or missed care for patients at the end of life, but it can lead to enduring distress for nurses. It is recommended to study the reasons for futile treatment, and its link to nurses' mental and physical health.

Job satisfaction and intent to stay in neonatal nursing in England and Wales: a study protocol

BACKGROUND

Nursing shortages are an ongoing concern for neonatal units, with many struggling to meet recommended nurse to patient ratios. Workforce data underlines the high proportion of neonatal nurses nearing retirement and a reduced number of nurses joining the profession. In order to recommend strategies to increase recruitment and retention to neonatal nursing, we need to understand the current challenges nurses are facing within the profession. The aim of this study is to investigate current job satisfaction, burnout, and intent to stay in neonatal nursing in England and Wales.

METHODS

This study has two parts: (1) a systematic review exploring job satisfaction, burnout and intent to stay in neonatal nursing, and any previous interventions undertaken to enhance nurse retention, (2) an online survey of neonatal nurses in England and Wales exploring job satisfaction, burnout and intent to stay in neonatal nursing. We will measure job satisfaction using the McCloskey Mueller Satisfaction Scale (MMSS), burnout using the Copenhagen Burnout Inventory (CBI) and the Nurse Retention Index (NRI) will be used to measure intent to stay. All nurses working in neonatal units in England and Wales will be eligible to participate in the nursing survey.

DISCUSSION

Retention of neonatal nurses is a significant issue affecting neonatal units across England and Wales, which can impact the delivery of safe patient care. Exploring job satisfaction and intent to stay will enable the understanding of challenges being faced and how best to support neonatal nurses. Identifying localised initiatives for the geographical areas most at risk of nurses leaving would help to improve nurse retention.

Missed Nursing Care and Relationship to Burnout and Leave the Profession

Nurses are at high risk of burnout, desire to leave the profession, and possibly missed nursing care due to the exhausting nature of caring. Missed nursing care may also affect nurses' burnout and desire to leave the profession. Therefore, the objective of this study was to determine the missed nursing care and its relationship with burnout and desire to leave the profession among intensive care unit nurses. The participants of this descriptive analytical study were 249 Iranian nurses working in intensive care units in 2022. The data were collected using a Demographic Information Questionnaire, Kalish's Missed Nursing Care Questionnaire, Maslach Burnout Inventory, and desire to leave the profession questionnaire. The majority of nurses (71%) were females. The generalized linear regression model showed that there was a significant relationship between missed care with gender (B = 5.55, P < .001), marital status (B = -7.37, P = .04), working shift (B = 7.80, P < .001), and employment status (B = -2.87, P = .02). Using structural equation modeling, it was found that the effect of missed care on burnout was significant. Considering the effect of missed care on burnout among nurses working in intensive care units, it seems that creating better working conditions, providing sufficient resources for nurses, supporting them, and changing the factors affecting missed care in order to improve the conditions can reduce the possibility of missing nursing care and, finally, burnout.

Missed Nursing Care as a Mediator in the Relationship between Career Calling and Turnover Intention

AIM

To explore the role of missed nursing care in mediating the relationship between career calling and intention to leave among nurses.

INTRODUCTION

Increasing nurse turnover is still a major concern in the global healthcare system. The most reliable indicator of turnover is turnover intention. It is crucial to understand its affecting elements to suggest measures to lower nurses' turnover intention.

BACKGROUND

Turnover intention has been linked to career calling and missed nursing care. Little empirical research has investigated the possibility that missed nursing care mediates between career calling and turnover intention.

METHODS

A cross-sectional survey of 347 nurses was conducted. The survey instruments included the General Information Questionnaire, Calling Scale, Missed Nursing Care Scale and Turnover Intention Questionnaire. Structural equation models were used to build the model. This study made use of the STROBE checklist.

RESULTS

For 43.8% of nurses, turnover intention was high or very high. Missed nursing care and turnover intention were negatively correlated with career calling. Missed nursing care and turnover intention were positively related. Missed nursing care mediated the relationship between career calling and turnover intention.

DISCUSSION

Career calling and missed nursing care can both influence turnover intention. Career calling can reduce the likelihood of turnover by preventing missed nursing care.

CONCLUSION

Missed nursing care mediated the relationship between career calling and intention to leave.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Nursing managers should improve nurses' career calling through professional education and minimize missed nursing care by using electronic nursing reminder devices to reduce turnover intention.

Translation and psychometric testing of the Chinese version of the Perinatal Missed Care Survey

Objective

This study aimed to translate and evaluate the psychometric properties of the Perinatal Missed Care Survey in China.

Methods

The Perinatal Missed Care Survey was translated according to the guidelines of the cross-cultural debugging scale recommended by the American Academy of Orthopaedic Surgeons Evidence-Based Medicine Committee, including forward translation, back translation, cultural adaption, and content validation, and its Chinese version was used in a cross-sectional study conducted from February to April in 2023. A total of 491 midwives from 14 different level hospitals in southwest China were recruited through a convenience sampling method. The discrimination ability of the items was tested through item analysis, and construct validity was assessed through exploratory factory and confirmatory factor analyses. The content validity index and Cronbach's α coefficients evaluated content validity and reliability, respectively.

Results

The Chinese version's item-total correlation coefficients ranged from 0.641 to 0.866 in part A and from 0.644 to 0.819 in part B (P < 0.001). Parts A and B's scale-level content validity indexes were 0.95, and the item-level content validity indexes were from 0.86 to 1.00. The three common factors of part A (necessary care, basic care, and postnatal care) and part B (communication, labor resources, and material resources) were extracted, accounting for 70.186% and 71.984% of the total variance, respectively. Confirmatory factor analysis indicated that the good fit of the three-factor models was acceptable. The Cronbach's α coefficients were 0.968 (part A) and 0.940 (part B).

Conclusion

The Chinese version of the Perinatal Missed Care Survey is a reliable and valid instrument for assessing nursing care missed by midwives during labor and birth and the reasons it was missed. Studies with large sample sizes are needed to verify the instrument's applicability in China.

Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan

PURPOSE

Missed nursing care (MNC) is a worldwide patient safety issue. However, little is known about MNC in neonatal intensive care units (NICU). The aim of this paper is to explore the elements and factors influencing the occurrence of MNC in the NICU in a teaching hospital in Amman, Jordan.

DESIGN AND METHODS

The study used a qualitative descriptive design. Semi-structured interviews were conducted with NICU nurses. Purposeful sampling was used to select the participants and data collection was performed in the period August 2022 to September 2022. Data were analyzed using thematic analysis.

RESULTS

The participants included 15 female nurses. The majority of the participants held a bachelor's degree in nursing. Five themes emerged from the analysis of data namely: (1) Conceptualizations of MNC (2) Missed care elements in the NICU (3) Reasons behind MNC in the NICU (4) Consequences of MNC and (5) Strategies to reduce the occurrence of MNC. Feeding,changing diapers, monitoring vital signs, and medication administrationwere identified as missed care elements in the NICU.

CONCLUSIONS

The findings of this research may inform the development of interventions that may reduce missed care incidents in the NICU.

PRACTICE IMPLICATIONS

Addressing staff shortages and the provision of necessary materials and equipment appear to be the key factors that may reduce the frequency of MNC. Thus, enhancing patient safety and quality healthcare in this challenging healthcare environment.

Missed nursing care: A cross-sectional and multi-centric study from Turkey

AIM

The aim of this study is to explore the extent of missed nursing care in Turkey and identify its predictors.

DESIGN

This was a descriptive, cross-sectional, multicentre study.

METHODS

A total of 477 nurses working in seven public hospitals participated in this study from March to July 2019. The survey included two components: a personal and professional characteristics data form and the MISSCARE survey.

RESULTS

The study revealed that emotional support, patient bathing and ambulation were the most frequently missed nursing care activities. An inadequate number of assistive personnel and staff, along with an unexpected increase in patient volume, were identified as the primary reasons for missed nursing care. Of the 21 missed nursing care activities, nine predictive models showed statistical significance (p < 0.05). Factors such as the type of unit, years of work experience, working hours, number of patients cared for in a shift and intention to leave the unit were found to be significant predictors of seven missed nursing care activities (p < 0.05).

CONCLUSION

This study found that numerous variables influence each care activity, which suggests the need to devise more targeted and specific strategies to minimize missed nursing care. Thorough investigation into the impact of these strategies on each care activity is essential.

The Experiences and Perceptions of Neonatal Clinicians When Using a Responsive Bassinet

BACKGROUND

Innovative technologies, such as the SNOO Smart Sleeper responsive bassinet (SNOO), may offer support to neonatal clinicians in their work environment.

PURPOSE

The objectives of this study were to describe the experiences of clinicians when using the SNOO in their clinical settings, including their perceptions of the SNOO on the quality of infant care and their work environment.

METHODS

A retrospective, secondary analysis was conducted using 2021 survey data across 44 hospitals participating in the SNOO donation program. Respondents included 204 clinicians, predominantly neonatal nurses.

RESULTS

The SNOO was used in a variety of clinical scenarios, including with fussy, preterm, and healthy full-term infants, as well as substance-exposed infants experiencing withdrawal. The SNOO was perceived as a driver of positive infant and parent experiences, including enhanced quality of care. Respondents perceived the SNOO as providing them with support in their daily caring for newborns, reducing their stress, and helping them in lieu of hospital volunteers. Clinicians reported an average time savings of 2.2 hours per shift.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Results from this study provide evidence for future evaluation of the SNOO as a technology for hospitals to adopt to improve neonatal clinician satisfaction and retention, as well as improve the quality of patient care and parental satisfaction.

Global prevalence of turnover intention among intensive care nurses: A meta-analysis

BACKGROUND

Nurse turnover is considered a major cause of nurse shortage, representing problems for health care systems in terms of both quality and cost of care for patients, and intention to leave is the strongest practical predictor variable of actual turnover.

AIM

This systematic review and meta-analysis aims at exploring the global prevalence of turnover intention in intensive care nurses.

DESIGN

This was a systematic literature review.

METHODS

A systematic review of empirical quantitative studies on turnover intention in nurses of intensive care units (ICUs), published in English till March 2021, was conducted. The databases PubMed, Embase, ISI Web of Knowledge, and CINAHL were searched. Eligible studies were observational or descriptive studies that reported the prevalence of turnover intention among nurses in all types of ICUs. The quality of studies was assessed using a modified Newcastle-Ottawa Scale. A random effect meta-analysis was conducted to estimate the pooled prevalence of turnover intention among ICU nurses.

RESULTS

We identified 18 cross-sectional studies investigating a total of 23 140 intensive care nurses from 23 countries. The intention to leave rate was ranged from 3.0% to 75.0%. The pooled prevalence of turnover intention was 27.7% (95% confidence interval: 21.6%-34.3%).

CONCLUSIONS

This meta-analysis showed that more than 27% of the intensive care nurses had the intention to leave worldwide. In the current context of nursing shortage, efforts should be made to improve conditions for this important group of care providers.

RELEVANCE TO CLINICAL PRACTICE

The prevalence of turnover intention is relatively high among intensive care nurses. Nurse managers should take this intention seriously, as the intention to leave may lead to an actual decision to leave the profession.

Clinical nurses' patient safety competency, systems thinking and missed nursing care: A cross-sectional survey

AIM

The aim of this study was to examine the relationships among patient safety competency, systems thinking and missed nursing care.

BACKGROUND

Patient safety competency and systems thinking are important nurse attributes that promote patient safety. Missed nursing care is known to negatively impact patient safety. However, how nurses' patient safety competency and systems thinking relate to missed nursing care is unknown.

METHODS

A cross-sectional survey design was used to collect data from nurses practicing in two general hospitals in South Korea. Data were collected between 3 March and 17 April 2020. Questionnaires were distributed to nurses providing direct care in general and specialty units. Patient safety competency, systems thinking and missed nursing care were measured using reliable and valid instruments. A total of 432 complete sets of data were used in final analysis.

RESULTS

Higher patient safety competency of nurses was associated with lower missed nursing care. Systems thinking partially mediated the relationship between knowledge of patient safety competency and missed nursing care, and attitudes of patient safety competency and missed nursing care.

CONCLUSIONS

The knowledge, skills and attitudes sub-scales of patient safety competency showed somewhat different effects in the relationship between missed nursing care and systems thinking, suggesting that each attribute may tap into a separate aspect of patient safety.

Work-related support needs of registered nurses in a neonatal intensive care unit in the Tshwane District

Background

Registered nurses in neonatal intensive care units (NICU) are working under stressful environment caused by the need and commitment to provide care for the critically ill neonates. Therefore, there is an imperative need to know and understand the work-related support strategies that can be adapted for registered nurses working in a NICU in the Tshwane District to enable them to provide quality care for the admitted neonates.

Aim

To explore and describe the work-related support needs of registered nurses working in a specific NICU situated in the Tshwane District.

Setting

The study was conducted in a selected NICU in Tshwane District.

Method

A qualitative, exploratory, descriptive, and contextual design was used in this study. In-depth unstructured individual face-to-face interviews were conducted with nine registered nurses working at the selected NICU of an academic hospital. Thematic data analysis was conducted.

Results

Three themes, namely teamwork between registered nurses and doctors, staff development in the form of peer seminars, workshops and in-service training, and availability of adequate resources within the workplace arose.

Conclusion

This study revealed that the registered nurses working in the NICU in the Tshwane District are in need of work-related support, as it will improve their well-being.

Contribution

The contribution of this study will be used by the hospital management to plan strategies that can be adapted for the betterment of the work environment for registered nurses in the NICU and the hospital in general.

Linking nurse practice environment, safety climate and job dimensions to missed nursing care

AIM

This study examined the aspects of the nurse practice environment and patient safety climate and the various job dimensions that contribute to the occurrence of missed nursing care.

BACKGROUND

Missed nursing care is a crucial healthcare concern that poses significant threats to patient safety. The available literature on missed nursing care is confined to high-resource nations, where hospital policies, mechanisms and processes to support professional nursing practice are well established.

METHODS

This is a multi-centre, cross-sectional study, using self-report scales, which involves 624 clinical nurses in selected hospitals in the Philippines.

RESULTS

Patient safety climate (β = -0.148, p = 0.001), decision authority (β = -0.101, p = 0.018) and staffing/resource adequacy (β = -0.086, p = 0.014) significantly predicted missed nursing care. Nurse, unit and hospital variables were not related with missed nursing care.

DISCUSSION

Nurses who perceived greater decision authority, positive safety climate and adequate staffing/resources were less likely to miss or omit patient care activities.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Institutional measures to foster decision authority in nurses, improve safety climate and address staffing/resource issues can be a viable solution to reduce the occurrence of missed nursing care.

Missed nursing care in hospital environments during the COVID-19 pandemic

BACKGROUND

Studies performed in Central European countries showed a high prevalence of missed nursing care in various clinical settings before the COVID-19 pandemic.

AIMS

The aim of the study was to investigate which domains of the work environment were significant predictors of missed nursing care activities in Czech hospitals during the COVID-19 pandemic.

METHODS

A cross-sectional study was used. The RANCARE guideline and STROBE checklist were followed for reporting in the study. The sample consisted of 371 nurses from four acute care hospitals. The MISSCARE Survey and the Practice Environment Scale of the Nursing Work Index questionnaires were used to collect data. The data were analyzed using multiple linear and logistic regression analyses.

RESULTS

Nurses reporting unfavorable environments consistently describe a higher frequency of episodes of missed care. Prevalence estimates of missed care in Czech acute care hospitals during the COVID-19 pandemic was predicted from the overtime work, the nurses' perception of the "Nursing foundations for the quality of care," and their satisfaction with their current position.

CONCLUSIONS

Missed nursing care could be mitigated by improving the nurses' work environment. Domains of the nurse work environment are known as structural modifiable factors and their refinement could be a cornerstone for interventions to reduce the prevalence of missed nursing care.

IMPLICATIONS FOR NURSING POLICY

Monitoring the conditions and aspects of the nurse work environment in hospitals and considering nurses' concerns about the work environment on an ongoing basis are important strategies for nurse supervision as well as for policymakers.

Missed nursing care, non-nursing tasks, staffing adequacy, and job satisfaction among nurses in a teaching hospital in Egypt

BACKGROUND

Missed nursing care (MNC) has been linked to patient harm in a growing body of literature. However, this issue is still not adequately investigated in developing countries. The aim of the study is to measure the extent of missed nursing care, to identify its types, and to determine factors contributing to missed nursing care.

METHODS

A cross-sectional design was used. The study was conducted among 50 units at 1762-beds teaching Hospital in Alexandria that employs 1211 nurses in inpatient areas. A sample of 553 nurses were interviewed using the MISSCARE and the N4CAST survey. The MISSCARE survey measured the amount of missed nursing care (MNC) that was experienced on the last worked shift by each nurse. The N4CAST survey was used to collect data about level of non-nursing work carried out by nurses and the nurses' job satisfaction.

RESULTS

The overall mean score for the missed nursing care was 2.26 ± 0.96 out of 5, with highest mean score attributed to "Planning" and lowest mean score attributed to "Assessment and Vital Signs" (2.64 and 1.96, respectively). Missed nursing care was significantly associated with number of patients admitted and cared for in the last shift and perceived staffing adequacy. Almost all non-nursing care tasks and most of satisfaction elements showed negative weak correlation with overall missed nursing care.

CONCLUSION

Missed Nursing Care is common in study hospital which may endanger patient safety. MNC Missed Nursing Care is positively associated with nursing adequacy. There is no association between MNC and neither nurses' job satisfaction nor non-nursing tasks. Nursing leaders should monitor missed nursing care and the environmental and staffing conditions associated with it in order to design strategies to reduce such phenomena.

Burnout, job dissatisfaction and missed care among maternity nurses

AIM

This study examined the prevalence of job dissatisfaction and burnout among maternity nurses and the association of job dissatisfaction and burnout with missed care.

BACKGROUND

Nurse burnout and job dissatisfaction affect the quality and safety of care and are amenable to intervention. Little is known about job dissatisfaction and burnout among maternity nurses or how these factors are associated with missed care in maternity units.

METHODS

This was a cross-sectional secondary analysis of the 2015 RN4CAST survey data and the American Hospital Association's 2015 Annual Survey. Robust logistic regression models at the nurse level examined the association of job dissatisfaction and burnout with missed care.

RESULTS

One-quarter of nurses screened positive for burnout, and almost one-fifth reported job dissatisfaction. While 56.4% of nurses in the total sample reported any missed care, 72.6% of nurses with job dissatisfaction and 84.5% of nurses with burnout reported any missed care (p < .001).

CONCLUSIONS

The association of job dissatisfaction and burnout, which are modifiable states, with increased rates of missed maternity care suggests that addressing job dissatisfaction and burnout may improve care quality.

IMPLICATIONS FOR NURSING MANAGEMENT

Job dissatisfaction, burnout and missed care may decrease with an improved work environment.