The DOI matches its Crossref record; 46 of the 46 references it cites were found in a registry or an index.
. Care left undone during nursing shifts: associations with workload and perceived quality of care.
Open accessAbstract
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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“This measure has been validated by associations with hospitallevel mortality, patient satisfaction, and care processes. 27”
From Nurses’ Shift Length and Overtime Working in 12 European Countries: The Association With Perceived Quality of Care and Patient Safety (2014) · cites this paper as [27]
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Cites
Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
Aiken, L. H. (2002) · JAMA · doi:10.1001/jama.288.16.1987 · Cited by 5,226
Development of the practice environment scale of the nursing work index†‡
Lake, E. T. (2002) · Research in Nursing & Health · doi:10.1002/nur.10032 · Cited by 1,769 · cited 10×
“The average (mean) number of patients The practice environment (PES-28) was also significantly associated with missed care.”
BackgroundInfluentialThe Association of Registered Nurse Staffing Levels and Patient Outcomes
Kane, R. L., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2007) · Medical Care · doi:10.1097/mlr.0b013e3181468ca3 · Cited by 1,135 · cited 1×
“7 For example, in intensive care units (ICUs) higher RN staffing was associated with lower levels of hospital related mortality; each additional full time equivalent RN per patient day corresponds to a 9% reduction in odds of death in ICUs (ORs, 0.91; 95% CI 0.86 to 0.96), which would save 5 lives…”
BackgroundInfluentialNurse Staffing and Inpatient Hospital Mortality
Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1001025 · Cited by 942 · cited 1×
“13 In the USA, Needleman et al 14 used a retrospective observational study to analyse 176 000 shifts.”
BackgroundEffects of Hospital Care Environment on Patient Mortality and Nurse Outcomes
Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008) · JONA: The Journal of Nursing Administration · doi:10.1097/01.nna.0000312773.42352.d7 · Cited by 860 · cited 1×
“21 A failure to properly observe and respond to patient deterioration is also identified as being part of the causal pathway in the association between low staffing and death from treatable complications (often referred to as ‘ failure to rescue ’ ), although the staffing outcome relationship here…”
BackgroundEffects of Hospital Care Environment on Patient Mortality and Nurse Outcomes
Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2009) · JONA The Journal of Nursing Administration · doi:10.1097/nna.0b013e3181aeb4cf · Cited by 799
Rafferty, A. M., Clarke, S. P., Coles, J., Ball, J., James, P., McKee, M., & Aiken, L. H. (2006) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2006.08.003 · Cited by 522 · cited 1×
“12 Other research shows that in some cases variation in staffing levels and patient outcomes within hospitals is greater than that between hospitals, which can mask the effect of any relationship between nurse staffing and patient outcomes.”
BackgroundImportance of work environments on hospital outcomes in nine countries
Aiken, L. H., Sloane, D. M., Clarke, S. P., Poghosyan, L., Cho, E., You, L., Finlayson, C. M., Kanai‐Pak, M., & Aungsuroch, Y. (2011) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzr022 · Cited by 465
Schubert, M., Glass, T. R., Clarke, S. P., Aiken, L. H., Schaffert-Witvliet, B., Sloane, D. M., & Geest, S. D. (2008) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzn017 · Cited by 407 · cited 1×
“29 These were: ▸ adequate patient surveillance ▸ adequate documentation of nursing care ▸ administering medication on time ▸ comfort/talk with patients ▸ develop or update nursing care plans/care pathways ▸ educating patients and/or family ▸ frequent changing of patient ’ s position ▸ oral hygiene…”
BackgroundNurse forecasting in Europe (RN4CAST): Rationale, design and methodology
Sermeus, W., Aiken, L. H., den Heede, K. V., Rafferty, A. M., Griffiths, P., Moreno‐Casbas, T., Busse, R., Lindqvist, R., Scott, P. A., Bruyneel, L., et al. (2011) · BMC Nursing · doi:10.1186/1472-6955-10-6 · Cited by 399
Research works printed but not linked: 1
- Hendrich, 2008, Maximising the impact of nursing quality: a closer look at the hospital work environment and the nurse's impact on patient-care quality, Healthc Leadersh White Paper Ser, 4, 1
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Unfinished nursing care, missed care, and implicitly rationed care: State of the science review
Jones, T., Hamilton, P., & Murry, N. (2015) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2015.02.012 · Cited by 756
“The three parent instruments for these respective approaches included: tasks undone survey with seven items (TU-7; Aiken et al., 2001b); Basal Extent of Rationing of Nursing Care (BERNCA) Instrument (Schubert et al., 2007); and The Missed Nursing Care (MISSCARE) Survey (Kalisch and Williams, 2009).”
BackgroundInfluentialAiken, L. H., Sloane, D. M., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M. D., Maier, C. B., Moreno‐Casbas, T., Ball, J., Ausserhofer, D., et al. (2016) · BMJ Quality & Safety · doi:10.1136/bmjqs-2016-005567 · Cited by 746
The association between nurse staffing and omissions in nursing care: A systematic review
Griffiths, P., Recio-Saucedo, A., Dall'ora, C., Briggs, J. S., Maruotti, A., Meredith, P., Smith, G. B., & Ball, J. (2018) · Journal of Advanced Nursing · doi:10.1111/jan.13564 · Cited by 545
“Four studies explored aspects of skill mix (Ball et al., 2014; Ball et al., 2016; Dabney & Kalisch, 2015; Palese et al., 2015).”
BackgroundAusserhofer, D., Zander, B., Busse, R., Schubert, M., Geest, S. D., Rafferty, A. M., Ball, J., Scott, P. A., Kinnunen, J., Heinen, M. M., et al. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-002318 · Cited by 585
Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study
Ball, J., Bruyneel, L., Aiken, L. H., Sermeus, W., Sloane, D. M., Rafferty, A. M., Lindqvist, R., Tishelman, C., & Griffiths, P. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.08.004 · Cited by 545
“Previously published analysis has explored the prevalence and nature of care left undone by care activity type and found a pattern: clinical activities were less likely to be reported as missed due to lack of time compared with communication and planning activity (Ball et al., 2014; Jones et al., 2015).”
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Metadata
- Authors
- Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., & Griffiths, P.
- Affiliations
- King's College London (GB)
- University of Southampton (GB)
- Corresponding author
- Ball, Jane E
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2013-07-29
- Volume
- 23
- Issue
- 2
- Pages
- 116-125
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- PMC
- PMC3913111
- OpenAlex
- W2147808390
- Cited by
- 666
- References
- 46
- Citations by year
- 2026: 39 · 2025: 35 · 2024: 52 · 2023: 51 · 2022: 51 · 2021: 87 · 2020: 64 · 2019: 66 · 2018: 49 · 2017: 47 · 2016: 52 · 2015: 48 · 2014: 19 · 2013: 5
- FWCI
- 121.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Quality & Safety (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- King's College London
- European Commission
- Menzies Centre for Australian Studies, King's College London, University of London
- Topics
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
- Keywords
- missed nursing care, nurse staffing, nursing workload, time pressure, nursing care quality, patient education, nursing care plan, patient comfort, early warning indicators, hospital wards
- MeSH terms
- Continuity of Patient Care, England, Humans, National Health Programs, Nurse-Patient Relations, Nursing Staff, Hospital, Patient Care Planning, Patient Education as Topic, Quality of Health Care, Work Schedule Tolerance, Workload, Medical Errors
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