title: Nurses' and nursing assistants' reports of missed care and delegation.
abstract: OBJECTIVE
  Measure RNs' and nursing assistants' reports of frequency and reasons for missed nursing care and identify factors related to successful delegation.
  
  
  BACKGROUND
  Routine nursing tasks were identified as the most commonly occurring omissions. Reasons for omissions included poor utilization of staff resources, time required for the nursing interventions, poor teamwork, ineffective delegation, habit, and denial.
  
  
  METHODS
  Quantitative, descriptive design.
  
  
  RESULTS
  Widespread reports of missed care included turning, ambulating, feeding, mouth care, and toileting. Frequently reported reasons were unexpected increase in volume or acuity, heavy admission or discharge activity, and inadequate support staff. Factors affecting successful delegation were communication and relationship, nursing assistant competence and knowledge, and attitude and workload.
  
  
  CONCLUSIONS
  Nurse leaders must focus on implementing strategies to mitigate factors and the consequences of care omissions, including poor patient outcomes. An analysis of point-of-care delivery system failures and ineffective processes is essential.
authors.affiliation: Nursing Education, Research & Professional Development, Lahey Clinic, Burlington, Massachusetts, USA.
authors.forename: Gayle
authors.initials: G
authors.lastname: Gravlin
authors.forename: Nancy
authors.initials: N
authors.lastname: Phoenix Bittner
mesh_terms: D017598:Efficiency, Organizational; D019538:Health Care Surveys; D006801:Humans; D009511:New England; D009728:Nursing Assistants / Q000458:organization & administration*; D009732:Nursing Care / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care; D016526:Workload