A cross-sectional study of 'care left undone' on nursing shifts in hospitals.
OBJECTIVE
To determine factors associated with variation in 'care left undone' (also referred to as 'missed care') by Registered Nurses (RNs) in acute hospital wards in Sweden.


BACKGROUND
'Care left undone' has been examined as a factor mediating the relationship between nurse staffing and patient outcomes. The context has not previously been explored to determine what other factors are associated with variation in 'care left undone' by RNs.


METHODS
Cross-sectional survey to explore the association of RN staffing and contextual factors such as time of shift, nursing role and patient acuity/dependency on 'care left undone' was examined using multi-level logistic regression.


METHODS
A survey of 10,174 RNs working on general medical and surgical wards in 79 acute care hospitals in Sweden (January-March 2010).


RESULTS
Seventy-four per cent of nurses reported some care was left undone on their last shift. The time of shift, patient mix, nurses' role, practice environment and staffing have a significant relationship with care left undone. The odds of care being left undone is halved on shifts where RN care for six patients or fewer compared with shifts where they care for 10 or more.


CONCLUSIONS
The previously observed relationship between RN staffing and care left undone is confirmed. Reports of care left undone are influenced by RN roles. Support worker staffing has little effect. Research is needed to identify how these factors relate to one another and whether care left undone is a predictor of adverse patient outcomes.
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Wessex, Southampton, UK.|Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet (KI), Stockholm, Sweden.
Jane E
JE
Ball
University of Southampton & NIHR CLAHRC, Wessex, UK.
Peter
P
Griffiths
Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK.
Anne Marie
AM
Rafferty
Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet (KI), Stockholm, Sweden.
Rikard
R
Lindqvist
Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK.
Trevor
T
Murrells
KI MMC, LIME KI & Innovation Centre, Karolinska University Hospital, Stockholm, Sweden.
Carol
C
Tishelman
D003430:Cross-Sectional Studies; D006801:Humans; D009741:Nursing Staff, Hospital; D063868:Patient Outcome Assessment; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care; D013548:Sweden
care left undone; missed care; nurse staffing; nursing workload; practice environment; safe staffing levels; workforce planning