The goal of every nurse is to establish an excellent quality of care. If patient safety is well understood and more or less tightly linked to hospital policies, patient outcomes are less connected to them. Nurses have a variety of responsibilities pertaining to their duties. In the circumstances of limited time and crowded hospitals, nurses have to prioritize and sometimes omit certain aspects of their duties in order to establish patient safety, while outcomes may be in jeopardy. The significance of this issue in relation to quality of health care dictates the need for this paper to properly define missed nursing care, and apply theory, research, evidence and clinical judgment to elaborate ways to counter this issue.
Definition of Missed Care
Missed nursing care stems from the inadequate staffing policy when a nurse has to attend to multiple patients without giving each one a sufficient amount of care. Under such circumstances, a nurse has to prioritize and address urgent health issues while less critical problems are left temporarily unattended. The environment forces a nurse to lower the quality of service under such nurse-related indicators as hours of nursing care per day, or nurse staffing (Kalisch & Lee, 2010). According to Heslop and Lu (2014), there appears to be a strong correlation between nursing hours of care and the prevalence of hospital-related health issues such as falls and injuries, pressure ulcer, and quality outcomes such as patient and family satisfaction with care. Evidence of 2 216 nurses suggests that in acute care settings the level of interprofessional teamwork quality significantly influences the prevalence of missed care.
Despite the fact that there are strategies to cope with it, it seems that missed nursing care is best tackled with administrative measures. For instance, nurse-per-patient ratio needs to be adjusted in hospitals where there serious understaffing is observed. Such occurrences need to be reported by nurses themselves and monitored by professional nursing organizations. By tackling the root issue, one can relieve nurses from having to elaborate strategies to cope with consequences.
Missed Care and Continuous Quality Improvement
Missed care significantly undermines continuous quality improvement process. According to Hessels, Flynn, Cimiotti, Cadmus, and Gershon (2015), under the circumstances of staff shortage, the remaining nurses cannot possibly give high-quality care to patients as their activities are aimed at maintaining at least basic patient safety and tend to the most urgent needs. In such conditions, there is no room for improvement. In addition, stress and burnout that are often part of work process increase, not letting nurses retain positive attitude towards their working conditions. A tired nurse tends to forget to perform some of their duties or allocate less time to meaningful conversations with patients or family. Therefore, if even basic tasks cannot sometimes be carried out with due quality there distance to improvement is rather long.
All in all, missed nursing care can account for many issues that invoke short-term and long-term consequences. The quality of service and underperformance seem to have an effect on patient outcomes and on nurse job satisfaction. This problem requires strategic managerial and administration interventions such as better hiring policies, reporting, and monitoring of nurse-per-patient ratio. In hospital setting, teamwork enhancement interventions can be a temporary salutation to missing nursing care, yet interprofessional advocacy and aim for root problem elimination still seem the most prominent solution.
Heslop, L., & Lu, S. (2014). Nursing-sensitive indicators: A concept analysis. Journal of Advanced Nursing, 70(11), 2469–2482.
Hessels, A. J., Flynn, L., Cimiotti, J. P., Cadmus, E., & Gershon, R. R. M. (2015). The impact of the nursing practice environment on missed nursing care. Clinical Nursing Studies, 3(4), 60–65.
Kalisch, B. J., & Lee, K. H. (2010). The impact of teamwork on missed nursing care. Nursing Outlook, 58(5), 233–241.