There has never been a shift where nurses can say I did everything that I needed to do today.

Nurses set very high standards for themselves because they know that the consequences of error can be catastrophic.

Nurses also know what the standard of care is like in the area where they are working.

The things that matter to nurses about where they work are positive relationships between staff, teamwork, autonomy and job satisfaction.

All of these things have a massive impact on the creation of a positive working environment.

And most importantly, the type of practice environment is a predictor of nursing quality and patient outcomes.

Unfinished care by nurses, or missed care, is an indicator of overall quality.

A study that looked at unfinished care by nurses found that the better the practice environment, the fewer were the activities that were not done.

The most common activities that were missed regularly was

1. comfort/talking with patients
2. educating patients, and
3. developing or updating nursing care plans.

The activities that were least likely to be missed were pain management and treatment and procedures.

More care was left undone on day and afternoon shifts than at night.

And up to 88% of shifts had at least one item of missed care.

As the authors said,

“Care is more likely to be left undone in wards where nurses perceive the practice environment to be worse.”

It turns out that missed care is a more direct measure of quality deficiencies that lead to adverse patient outcomes and experiences.

So if nurses know that the practice environment is worse than it should be, that in itself should be a call to action for everyone.

But that would need nurses to be brave about raising these matters with a management that would be prepared to listen and act.

What are the chances?

To learn more about the consequences of missed care,

Ball, Jane E., et al. “‘Care left undone’during nursing shifts: associations with workload and perceived quality of care.” BMJ quality & safety (2013): bmjqs-2012.