Unfinished care is a significant problem in acute-care hospitals internationally . Prioritization strategies of nurses leave patients vulnerable to unmet educational , emotional , and psychological needs . Key limitations of the science include the threat of common method / source bias , a lack of transparency regarding the use of combined samples and secondary analysis , inconsistency in the reporting format for unfinished care prevalence , and a paucity of intervention studies .” the subordination of teaching and emotional support activities to those related to physiologic needs and organizational audits . Predictors of unfinished care included perceived team interactions , adequacy of resources , safety climate , and nurse staffing . Unfinished care is a predictor of decreased nurse-reported care quality , decreased patient satisfaction ; increased adverse events ; increased turnover ; decreased job and occupational satisfaction ; and increased intent to leave .”
As the researchers observe , “ Unfinished care is a significant problem in acute-care hospitals internationally . Prioritization strategies of nurses leave patients vulnerable to unmet educational , emotional , and psychological needs . Key limitations of the science include the threat of common method / source bias , a lack of transparency regarding the use of combined samples and secondary analysis , inconsistency in the reporting format for unfinished care prevalence , and a paucity of intervention studies .”
While many studies have examined individual nurse-level factors related to missed nursing care , organizational factors such as patient safety climate , teamwork , and resource adequacy also are associated with missed nursing care . In one large review , missed nursing care was correlated with quality of care and adverse events and had a moderate effect on patient outcomes . Statistically significant impacts were demonstrated on medication errors , patient falls , nosocomial infections , pressure ulcers , mortality , and patient satisfaction .
While missed care may be attributed to many factors , some researchers believe it is primarily triggered by lack of adequate staffing .
Bragadottir , et al . ( 2016 ) found that among 31,627 RNs from 488 hospitals in 12 European countries , the odds of nurses leaving care undone were increased by 26 percent when nurses were caring for more than 11.5 patients , compared with nurses caring for fewer than six patients . In the U . S . a study of 4,086 nursing staff in 10 hospitals by ( Kalisch , Tschannen , et al ., 2011 ) found that staff who cared for more patients reported more missed care . They also found that higher nursing hours per patient day were associated with lower level of missed care .
A unit-level nurse staffing study conducted by Columbia University School of Nursing found an association between nurse understaffing and HAIs in patients , demonstrating that understaffing increases the risk of HAIs , which in turn adds billions to healthcare costs annually . HAIs included in the analysis were urinary tract infections , bloodstream infections , and cases of pneumonia . Shang , et al . ( 2019 ) conducted their study using cross-sectional data from a large urban hospital system .
According to the study , which examined data from more than 100,000 patients , 15 percent of patient-days had one shift understaffed with registered nurses ( defined as registered nurse [ RN ] staffing below 80 percent of the unit median for a shift ) and 6.2 percent had both day and night shifts RN understaffed . Patients on units with both shifts understaffed with RNs were 15 percent more likely to develop HAIs on or after the third day of exposure to these periods of understaffing than were patients in units with both day and night shifts adequately staffed . The study also found units were understaffed with nursing supporting staff , defined as licensed practical nurses and nurse assistants , and this also increased patients ’ risk of HAIs .
“ As they often serve as coordinators within multidisciplinary healthcare teams , nurses play a critical role in preventing HAIs , which is a top priority for improving quality of care and reducing hospital costs ,” said lead author Jingjing Shang , PhD , associate professor at Columbia Nursing . “ Being at the forefront of infection control and prevention is a unique responsibility and opportunity for nurses , and our study shows that hospital administrators should ensure adequate nurse staffing to provide the safest patient care . This could be achieved through better nurse recruitment and retention practices , together with methods of managing burnout and fatigue .”
According to the study ’ s authors , when a unit was understaffed , nurses in the unit experienced excessive workloads . Such working conditions may compromise infection prevention practices and surveillance activities intended to recognize the signs and symptoms of infection . In addition , continuous understaffing may negatively impact nurses ’ wellbeing and patient care .
Shang , et al . ( 2019 ) analyzed cross-sectional data between 2007 and 2012 from a large urban hospital system . HAIs were diagnosed using the Centers for Disease Control and Prevention ( CDC )’ s National Healthcare Safety Network ( NHSN ) definitions . Fifteen percent of patient-days had one shift understaffed , defined as staffing below 80 percent of the unit median for a shift , and 6.2 percent had both day and night shifts understaffed . Patients on units with both shifts understaffed were significantly more likely to develop HAIs two days later .
AHRQ ( 2019 ) confirms that “ Units with better staffing appear to have lower rates of missed nursing care . This finding suggests that improving staffing will reduce missed nursing care , but this hypothesis has not yet been tested in an intervention study . A study of an intra-nursing teamwork training intervention showed improved short-term teamwork and less missed care at two months post-intervention . Though this intervention is potentially promising , there was no longer-term evaluation of sustainability and no testing of patient outcomes .”
Almost all studies identified by Bragadottir , et al . ( 2016 ) found that low nurse staffing levels were related to higher reports of missed care . The findings from most studies related to RN staffing levels . As the researchers observe , “ Evidence related to the skill mix of the nursing team pointed to either no benefit or a negative effect from higher levels of support workers although a single study found that when healthcare