Nurses play a critical role in the provision of quality care and patient safety. Various studies show that there is a significant direct correlation between adequate nurse staffing and patient outcomes in hospitals. For example, a hospital with good nurse-patient ratios records better patient outcomes in various aspects such as mortality and reduced cases of failure-to-rescue (Agency for Health Research and Quality, 2015). There is, however, lack of good understanding of how nurse staffing ratios connect with patient outcomes. There are two possible ways to rationalize the relationship between patient outcomes and nurse staffing ratios; one is the quantity of patient condition assessment or surveillance, the second is missed care nursing. One strategy for determining the quality of care provided by nurses is through analysis of omitted necessary care.
Missed care in nursing, also known as an error of omission is defined as any delayed care that is needed by the patient, partly completed care or total failure to provide some nursing care considered necessary for the patient (Lake, Germack & Viscardi, 2015). Nurse-sensitive indicators showing that there is missed care within the healthcare organization or hospital includes increased nursing workloads and poor safety culture of nurses. Due to nursing shortage challenge that faces many United States hospitals, missed nursing care becomes inevitable. This is due to excess workload on the few available nurses on shift; thus, there is a lot to be done than the available labor resources and time (Lake, Germack & Viscardi, 2015).
Nurses have several roles in the provision of patient care; they organize, provide, and assess the various care interventions prescribed by physicians and medical doctors to treat diseases of patients who come to seek care or those who have been hospitalized. Additionally, nurses undertake the role of planning, delivering and evaluating care initiated by a nurse that aims to manage symptoms of the patient and the responses of patients to care, all these roles and activities aims at promoting good health and healing for patients (Agency for Health Research and Quality, 2015). Therefore, missed nursing care is a severe medical error which has a potential of affecting the safety of the patient, reducing patient satisfaction and increasing rates of adverse events in healthcare.
Missed nursing care conceptual model that was developed by Kalisch and colleagues explores different factors contributing to missed care. The factors are labor resource which includes nursing staff types, numbers, and their level of education, nurse competencies as well as their skills and experience (Kalisch, Tschannen, Lee & Friese, 2011). The second factor is material resources which comprised of availability of required equipment, medications, and supplies. Communication and teamwork are also other factors that contribute to missed care, communication among all those involved in patient care e.g. support staff, nurses and physicians are important in determining the patient outcomes.
When either one or more of the above-highlighted resources is missing in a healthcare organization and the process of care, it, therefore, means that the nurse in charge will have to prioritize various care activities. This leads to delayed nursing care or omission of care. In such a scenario where there is a lack of resources, nursing process is used to establish clinical priorities and decide on whether to delay or leave out some features of care (Agency for Health Research and Quality, 2015). Missed nursing care often occurs in ambulation, the teaching of patients, medications and patient turning.
Conclusively, missed care impacts negatively on continuous quality improvement in health care in several ways. One is that high missed care nursing leads to the development of preventable health complications such as pressure ulcers, various nosocomial infections e.g. ventilator-associated pneumonia, increased incidence of falls and atelectasis. All these complications lead to increase in length of stay or hospitalizations and leads to reduced patient satisfaction hence poor patient outcomes.
References
Agency for Health Research and Quality. (2015). Missed Nursing Care | AHRQ Patient Safety Network. Retrieved from https://psnet.ahrq.gov/primers/primer/29/missed-nursing-care#
Kalisch, B. J., Tschannen, D., Lee, H., & Friese, C. R. (2011). Hospital variation in missed nursing care. American Journal of Medical Quality, 1062860610395929.
Lake, T., Germack, D., & Viscardi, K. (2015). Missed Care -- Do Patients Notice? Retrieved from http://www.medscape.com/viewarticle/852945
