Missed Nursing Care Results in Patients’ Unmet Needs, Dissatisfaction and Potential Infections and Adverse Events

By Kelly M. Pyrek

Editor’s note: In the first part of this series published in the February 2023 issue, we examined the impact of missed nursing care on infection prevention. In part two, we look at how missed nursing care impacts outcomes in patients.

Common sense, as well as numerous studies in the medical literature, tell us that missed nursing care as well as lower staffing levels contribute to the likelihood that patients can suffer harm, adverse outcomes and infections, or even die.

“There is a strong demonstrated link between staff-patient communication and improved outcomes for patients,” confirms Leah Binder, president and CEO of The Leapfrog Group, an organization representing employers and other purchasers of healthcare calling for improved safety and quality in hospitals. “The more nurses can communicate to the patient what care is supposed to be delivered and what is delivered, that provides a foundation for a more activated patient. Patients that are hospitalized are asked to complete a patient experience survey (HCAHPS) after their discharge from the hospital, which provides patients the opportunity to share their experience with nurse communication, doctor communication, and the responsiveness of the staff. The responsiveness of staff and perceptions of nursing is linked to research on patient outcomes and safety.  That’s why a hospital’s performance on those measures is included in Leapfrog’s Hospital Safety Grade and publicly reported on CMS’s Care Compare website. We need more measures of patient experience from more facilities, such as ASCs and pediatric care.”

In their review of the literature, Recio-Saucedo, et al. (2017) identified significantly decreased patient satisfaction associated with missed nursing care, as well as associated outcomes including medication errors, urinary tract infections, patient falls, pressure ulcers, critical incidents, quality of care and patient readmissions.

The medical literature points to myriad factors causing inadequate quality of nursing care that may lead to patient harm, including inadequate nurse staffing levels as well as resource inadequacy. Recio-Saucedo, et al. (2017)  say that “A considerable body of evidence supports the hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards and the risk of many aspects of care being either delayed or left undone.”

Patient outcomes reported in the missed-care literature that have been associated with quality of care delivered, include hospital-acquired infections, mortality, falls, inadequate patient mobilization, inadequate feeding, and lack of psychological and emotional support, among other subpar outcomes.

Recio-Saucedo, et al. (2017)  define delayed or unfinished care, more broadly identified as missed care, as encompassing “all aspects of clinical, emotional or administrative nursing care that have only been partially completed, were delayed or were not completed at all,” and point out that “The current literature on missed care provides mounting evidence of the pervasive nature of the problem and, more importantly, the threat it poses to patient safety.”

Read further from the April 2023 issue HERE