Missed nursing care: Errors of omission

doi:10.1016/j.outlook.2008.05.007

Nursing Outlook

Volume 57, Issue 1, January–February 2009, Pages 3-9

https://doi.org/10.1016/j.outlook.2008.05.007 Get rights and content

This study examines what and why nursing care is missed. A sample of 459 nurses in 3 hospitals completed the Missed Nursing Care (MISSCARE) Survey. Assessment was reported to be missed by 44% of respondents while interventions, basic care, and planning were reported to be missed by > 70% of the survey respondents. Reasons for missed care were labor resources (85%), material resources (56%), and communication (38%). A comparison of the hospitals showed consistency across all 3 hospitals. Associate degree nurses reported more missed care than baccalaureate-prepared and diploma-educated nurses. The results of this study lead to the conclusion that a large proportion of all hospitalized patients are being placed in jeopardy because of missed nursing care or errors of omission. Furthermore, changes in Center for Medicare and Medicaid Services (CMS) regulations which will eliminate payment for acute care services when any one of a common set of complications occurs, such as pressure ulcers and patient falls, point to serious cost implications for hospitals.

Section snippets

Research questions

The research questions for this study were as follows:

•
What is the amount and type of missed nursing care?
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What are the reasons for missed care?
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Does the amount and type of missed care and do the reasons given for missing care vary by hospital and/or by demographic characteristics?

Design and Sample

The study was a descriptive design to examine the amount of missed care of staff nurses in 3 Michigan hospitals in geographically distant parts of the state. A total of 1189 surveys were distributed to all RNs who worked on 28 in-patient units including intensive care, intermediate care, cardiac, surgical, medical, renal, oncology, and rehabilitation. The return rate was 459 (38.6%) staff nurses who completed the Missed Nursing Care (MISSCARE) Survey.

The nurses on the units were 94.3% females

Volume of Missed Care

The results of this study show a significant amount of missed care occurs in acute care hospitals. Assessment was reported to be missed by 44% of respondents, while interventions and basic care were stated to be missed by 73% of the nurses, and planning by 71% of the survey respondents (Table 1).

The 6 most frequently cited missed items of care were ambulation (84%), assessing of the effectiveness of medications (83%), turning (82%), mouth care (82%), patient teaching (80%), and the timeliness

Discussion

Nurses reported missing an alarming amount of care in acute care hospitals. Assessment was missed the least but was still cited by close to half of the respondents. Interventions, basic care, and planning were cited as being missed by > 70% of the respondents. The findings of this study are consistent with previously cited studies of focused areas of care (i.e., ambulation, nutrition, medications, documentation, etc.).5, 6, 7, 8, 9, 10, 11, 12, 13, 14

As discussed above, missed nursing care is

Beatrice J. Kalisch, PhD, RN, FAAN, is Director, Nursing Business and Health Systems and Titus Distinguished Professor of Nursing, University of Michigan, Ann Arbor, MI.

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Cited by (250)

Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan
2023, Journal of Pediatric Nursing
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.
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.
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.
The findings of this research may inform the development of interventions that may reduce missed care incidents in the NICU.
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.
Nurses’ perception of missed nursing care in a Western Australian teaching hospital: A cross-sectional study
2023, Collegian
Missed nursing care (MNC) has gained increasing emphasis in nursing literature because of its association with nurse and patient outcomes in healthcare settings. While missed care has been widely studied, little evidence is available on the types and frequency of missed care, reasons for its occurrence, and predictors of missed care in Western Australia.
To determine nurses’ perceptions of the types of MNC, reasons for missed care and to identify factors predicting missed care occurrence in Western Australian acute care settings.
A cross-sectional study in medical and surgical wards was performed. The nurse MISSCARE survey tool was used to capture self-reported types and reasons for missed care and level of nurse job satisfaction from a sample of 204 nurses working in 16 acute care wards. Data analyses were carried out in International Business Machines Corperation located in Armonk, New York United States (IBM SPSS Statistics) (v 29).
The most common perceived missed activities included ambulation (87%), patient teaching (79%), interdisciplinary conference attendance (78%), mouth care (78%), intake and output (77%), and patient turning (75%). Labour resources ranked highest for reasons for missed care followed by material resources and communication. Significant relationships were observed between missed care and job satisfaction, role satisfaction, and teamwork.
Working overtime, job dissatisfaction, inadequate staffing, and heavy admissions and discharges were related to increased likelihood for missed care occurrence.
Although further studies examining the link between MNC and staffing methodologies are needed, this study provides evidence on nurse-reported missed care and the impact of missed care in Western Australia.
Examining the reasons for missed nursing care from the viewpoints of nurses in public, private, and university hospitals in Jordan: A cross-sectional research
2023, Collegian
Missed nursing care is an indicator of quality nursing care. It is a significant healthcare delivery problem, especially given increased demand and limited resources worldwide, including in Jordan. It is paramount to identify the reasons for missed care in hospital settings.
To identify the perceptions of registered nurses for missed nursing care in medical and surgical wards in Jordanian hospitals. We also aimed to identify differences in the reported reasons for missed nursing care across three healthcare sectors: public, private, and university.
A quantitative approach utilising a cross-sectional design was conducted by surveying registered nurses at 10 hospitals in Jordan. This study employed the MISSCARE Survey tool. The data collection was performed between March and July 2021. Descriptive statistics and analysis of variance were used to address the objectives.
A sample of 672 registered nurses working in medical and surgical wards in 10 acute care hospitals in Jordan were recruited. The major reason for missed nursing care was inadequate number of staff. Communication issues were more important to missed nursing care in university hospitals than public and private hospitals.
A study of Jordanian registered nurses revealed that a perceived shortage of human resources is the principal reason for missed nursing care in medical and surgical wards. Comparing the reasons for missed nursing care between the three hospital sectors could help nursing administrators to tailor operational interventions to mitigate the effect of these causes. Therefore, reducing missed nursing care.
Understanding family carer experiences and perceptions of engagement in delirium prevention and care for adults in hospital: Qualitative systematic review
2024, Journal of Clinical Nursing
Missed nursing care as reported by paediatric nurses: A cross-sectional study
2024, Journal of Clinical Nursing
Examining the Perspectives of Nurse Managers on Missed Nursing Care in Surgical Units
2024, Journal of Nursing Administration

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Beatrice J. Kalisch, PhD, RN, FAAN, is Director, Nursing Business and Health Systems and Titus Distinguished Professor of Nursing, University of Michigan, Ann Arbor, MI.

Gay Landstrom, MS, RN, is a Doctoral Student, University of Michigan, Ann Arbor, MI.

Reg Arthur Williams, PhD, RN, CS, FAAN, is a Professor, School of Nursing and Psychiatry, Medical School, University of Michigan, Ann Arbor, MI.

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ArticlePracticeMissed nursing care: Errors of omission

Section snippets

Research questions

Design and Sample

Volume of Missed Care

Discussion

Geriatr Nurs

Clin Nutr

J Am Med Dir Assoc

Chest

Clin Nutr

Am J Clin Nutr

Nurse staffing and quality of care. AHRQ Publication No. 151

Human Error

Missed nursing care: A qualitative study

J Nurs Care Qual