The association between nurse staffing and omissions in nursing care: A systematic review

Abstract

AimsTo identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing.BackgroundResearch has established associations between nurse staffing levels and adverse patient outcomes including in‐hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy.DesignSystematic review.Data SourcesWe searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles.Review MethodsTwo reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative.ResultsEighteen studies gave subjective reports of missed care. Seventy‐five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care.ConclusionsLow Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated.

Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes

“…These findings are consistent with previous studies in Korea and other countries (Ball, Murrells, Rafferty, Morrow, & Griffiths, 2014;Cho et al, 2015;Griffiths et al, 2018). Nurses who took care of more patients and perceived staffing to be insufficient reported missing more nursing activities.…”

“…Nurses in western countries taking care of fewer patients than our nurses also most frequently reported that they missed comforting/talking with patients and emotional and psychological support (Ausserhofer et al, 2014;Griffiths et al, 2018). Commonly missed highpriority activities were turning the patient and full documentation, suggesting that their prevalence of being missed would be reduced by improving nurse staffing.…”

Understanding assessment on a hospital ward for older people: A qualitative study

“…These findings resonate with current literature which highlights working within resource limitations which may lead to potential omissions in care (Griffiths et al, 2018;Jones, 2016;Maben, Adams, Peccei, Murrells, & Robert, 2012). These findings resonate with current literature which highlights working within resource limitations which may lead to potential omissions in care (Griffiths et al, 2018;Jones, 2016;Maben, Adams, Peccei, Murrells, & Robert, 2012).…”

Activity‐based funding for safety and quality: A policy discussion of issues and directions for nursing‐focused health services outcomes research

“…For some time, Linda Aiken, Clarke, Sloane, Sochalski, and Silber () have been instrumental in discovering relationships between nurse staffing characteristics and patient outcomes, more recently showing associations between reduced registered or professional nurse levels and mortality (Aiken et al, ). Other important nursing workforce research contributions showing associations between nurse staff levels and patient outcomes include studies on “missed care” (see, for example, Griffiths, et al, ; Jones, Hamilton, & Murry, ). The general conclusion of contributions to this significant body of research, largely from the United States and Canada, is that care and patient outcomes are substantially better when there is a higher proportion of bachelor‐degree prepared nurses employed (Needleman, ).…”