Missed nursing care, non-nursing tasks, staffing adequacy, and job satisfaction among nurses in a teaching hospital in Egypt

The Relationship Between Missed Nursing Care and Nurse Job Satisfaction: A Systematic Review and Meta-Analysis

BACKGROUND

Missed nursing care is a global issue that refers to any aspect of patient care that is partially or entirely omitted or delayed. Although many studies have examined the relationship between missed nursing care and nurse job satisfaction, there is no synthesized evidence of these findings.

OBJECTIVE

To evaluate the relationship between missed nursing care and nurse job satisfaction.

METHODS

A systematic review and meta-analysis was carried out by searching the following databases: Web of Science, Scopus, EBSCO, PubMed, Science Direct, Cochrane, and Springer Link. The risk of bias was assessed using the Quality Assessment and Validity Tool for Correlational Studies. A random-effects model was used in the meta-analysis.

RESULTS

Out of 13 619 identified reports, 8 studies involving 10 418 nurses were identified as eligible for the meta-analysis. A significant negative relationship between missed nursing care and nurse job satisfaction was identified, with the summary effect size of r = -0.294 (95% CI: -0.364 to -0.219, P < .001).

CONCLUSIONS

The meta-analysis presented evidence regarding the significance of missed care in influencing nurse job satisfaction. As missed nursing care decreases, nurses' job satisfaction may increase.

Missed nursing care and associated factors among nurses and midwives in maternity wards of Sidama region public hospitals, Ethiopia

BACKGROUND

Missed nursing care refers to any aspect of care performed by nursing staff that is omitted or significantly delayed. Even though the potential impact of missing nursing care on maternal and fetal outcomes is significant, there is currently limited evidence regarding the extent of this issue specifically within the maternity wards. Therefore, this study aimed to assess missed nursing care and associated factors in the maternity wards of public hospitals in the Sidama region, Ethiopia 2022.

METHODS

A hospital-based cross-sectional study was conducted among 361 nurses and midwives in maternity wards of Sidama region public hospitals from March 28 to April 26, 2022. Simple random sampling was used to select participants. The data was collected using the MISSCARE survey tool and analyzed with SPSS version 26. Simple linear and multiple linear regression analyses were used to identify the factors associated with missed nursing care.

RESULTS

The overall mean missed nursing care score was 67 out of 130 (95% CI: 65.92, 68.02) and the average score for each nursing intervention was 2.58 out of 5 (95% CI: 2.54, 2.62). The intention to leave the institution (β = 3.812, 95% CI: 2.285, 5.340) and increasing weekly work hours (β = 0.203, 95% CI: 0.134, 0.272) were factors positively associated with missed nursing care. However, increased work experience (β= -0.963, 95%CI: -1.475, -0.452) and job satisfaction (β= -4.976, 95%CI: -6.431, -3.522) were negatively associated with missed nursing care.

CONCLUSION

This study found that the level of missed nursing care was significant. Factors positively associated with missed nursing care included an intention to leave the institution and an increase in weekly work hours. In contrast, an increase in work experience and higher job satisfaction were negatively associated with missed nursing care.

A comparative analysis of nurses' reported number of patients and perceived appropriate number of patients in integrated nursing care services

This study aimed to compare the number of assigned and appropriate patients per nurse in integrated nursing care service wards and analyze factors associated with the gap. For this cross-sectional secondary analysis, data were collected from surveys of 2312 nurses and institutional data from their affiliated 106 hospitals in Korea. We used the Wilcoxon signed-rank test and t-test to compare the number of patients assigned to nurses with the number they considered appropriate. We used ratio analysis for measuring the gap between these numbers, and robust regression to evaluate the factors affecting this gap. The results found an average gap of 1.45, indicating that the reported number of assigned patients per nurse was 1.45 times higher than the appropriate number. Gender, employment type, wage satisfaction, workload, overtime work, and hospital level of care were identified as factors associated with the gap. Findings suggest that the current nurse staffing standard should be revised to consider nurses' professional judgments of appropriate staffing levels and adopt policies that reduce nurses' workload.

"We do others' Jobs": a qualitative study of non-nursing task challenges and proposed solutions

INTRODUCTION

Non-nursing tasks (NNTs) have become a prevalent issue among healthcare professionals, affecting nurses globally. This study delves into the experiences of Jordanian nurses regarding NNTs, aiming to uncover challenges and propose solutions within the Jordanian healthcare context.

OBJECTIVE

Explore the impact of NNTs on Jordanian nurses' roles, workload, and satisfaction. Additionally, the study aims to identify various types of NNTs performed by nurses, understand their impact, and propose solutions to mitigate challenges associated with these tasks.

METHODS

A qualitative-exploratory research design was employed for this study. Semi-structured interviews were conducted with Jordanian nurses using a purposeful sampling approach to ensure a diverse representation of experiences and perspectives. Thematic analysis was used to identify recurring themes and patterns related to NNTs, their challenges, and potential solutions. Ethical guidelines were strictly followed to maintain participant confidentiality and ensure the integrity of the data collected.

RESULTS

Analysis of the interviews revealed four major themes: challenges of NNTs, types of NNTs, impact of NNTs, and proposed solutions. Nurses faced significant difficulties due to task ambiguity, role confusion, and increased workload from NNTs, which included administrative duties, clerical work, and tasks typically performed by other healthcare professionals. These NNTs negatively impacted nurses' effectiveness, productivity, and job satisfaction by diverting time and energy from primary nursing responsibilities, causing professional strain. To address these issues, participants suggested clearer job descriptions, stricter task assignment protocols, and systemic changes to tackle the root causes of NNTs.

CONCLUSION

This study sheds light on the pervasive challenges posed by NNTs among Jordanian nurses and emphasizes the importance of addressing these issues to enhance nursing care quality and nurse well-being. By proposing actionable solutions tailored to the Jordanian context, this research contributes to the global discourse on NNTs and underscores the need for organizational support and advocacy to optimize nurses' roles and improve patient care outcomes.

Exploring the causes and consequences of non-nursing tasks among nurses in Jordan: An in-depth qualitative investigation

AIM

To investigate the perceptions of Jordanian nurses regarding Non-Nursing Tasks (NNTs) and their consequences, as well as the underlying factors that contribute to the occurrence of NNTs.

BACKGROUND

Nurses play a crucial role in providing high-quality patient care, but they often engage in NNTs, which can hinder their ability to deliver care effectively. Western countries have primarily conducted research on NNTs, while Middle Eastern countries such as Jordan have received limited attention. Expanding our understanding of NNTs is essential for improving nursing care.

METHODS

A qualitative-exploratory approach was adopted. The research was conducted at three hospitals in Amman, Jordan. A purposeful sampling approach was used to select the participant and a focus group-interview method was used to gather the data. The derived data were analyzed using a thematic analysis approach.

RESULTS

The final sample of this study included 38 participants. The findings highlighted that nurses often perform NNTs due to staff shortages and limited resources, as well as weaknesses in nursing administration and education. The finding also highlights the consequences of NNTs on nurses' professional lives, including impaired nursing care, physical and mental health strain, and a lack of efficiency and productivity.

CONCLUSIONS

The present study's results provide valuable insights into the impact of NNTs on nurses in Jordan. These findings underscore the need for healthcare stakeholders to actively address the issue of NNTs. It also emphasized the need for more explicit job descriptions and processes, along with support for nurses to fulfilling their responsibilities and prioritizing patient care.

Development and Validation Process of the Intensive Care Unit Omitted Nursing Care (ICU-ONC) Instrument Among French Canadian Nurses

Background and Purpose: The purpose of this article is to document the development and validation process of an instrument adapted for French-speaking nurses and to measure the occurrence of omitted nursing care (ONC) in the intensive care unit (ICU). Methods: An electronic Delphi panel, involving ICU nursing experts from the province of Quebec (Canada), was used to develop the intensive care unit omitted nursing care (ICU-ONC) instrument. For the validation process, an electronic cross-sectional survey was conducted. Results: A total of 564 nurses participated in the validation study. Exploratory factor analysis performed on 478 complete observations supports the presence of a single-factor structure for the 22-item ICU-ONC instrument. Coefficient alpha for the scale was .93, 95% confidence interval (CI) was [0.92, 0.94], item-partial total correlations ranged from .49 and .68, and the mean/median interitem correlations were .38 and .37, respectively. Moderate negative correlations were found between the ICU-ONC instrument overall score and two related constructs: nurses' perception of the quality as well as the safety of care. Conclusions: Our current understanding of ONC in the ICU is based on the results drawn from the administration of generic instruments to ICU nurses. The novel 22-item ICU-ONC instrument can help better estimate the occurrence of the phenomena in the ICU.

Job embeddedness and missed nursing care at the operating theatres: the mediating role of polychronicity

BACKGROUND

Perioperative missed nursing care is a serious issue that can compromise patient safety and quality of care. However, little is known about the factors that influence perioperative missed nursing care.

AIM

This study aimed to examine the effects of job embeddedness and polychronicity on perioperative missed nursing care as well as to test the mediating role of polychronicity on the relationship between job embeddeness and perioperative missed nursing care.

METHOD

This was a cross-sectional correlational study that used a convenience sample of 210 operating room nurses from nine hospitals in Egypt. Data were collected using self-administered questionnaires that measured job embeddedness, polychronicity, and perioperative missed nursing care. Structural equation modeling was used to test the hypothesized relationships among the variables.

RESULTS

The findings demonstrated a significant negative and moderate association between missed perioperative care and both nurses' job embeddedness and polychronicity. Moreover, there was a moderately positive and significant correlation between polychronicity and job embeddedness. Path analysis revealed a significant positive causal effect between job embeddedness and polychronicity. The results of mediation revealed that the indirect effect of job embeddedness on missed care through polychronicity was statistically significant; suggesting that polychronicity partially mediated this relationship.

CONCLUSION

This study sheds light on the intricate relationship between nurses' job embeddedness, missed care, and polychronicity in the operating theater context. By enhancing job embeddedness and fostering polychronicity among nurses, healthcare organizations can reduce perioperative missed care and ultimately improve patient care outcomes in this critical healthcare setting.

The characteristics and factors associated with omitted nursing care in the intensive care unit: A cross-sectional study

INTRODUCTION

Prior research showed that work environment features in acute care settings influence nurses' capacity to provide care and impacts patient outcomes (e.g., falls). However, little is known about this phenomenon in the intensive care unit. The objectives of this study were to describe the characteristics of omitted nursing care, and to examine the associations between work environment features, omitted nursing care and nurse-reported outcomes in the intensive care unit.

METHODS

An electronic cross-sectional correlational study was conducted in the province of Quebec, Canada. Over September 2021, nurses were asked to complete the Healthy Work Environment Assessment Tool (HWEAT), the Intensive Care Unit Omitted Nursing Care instrument (ICU-ONC) and to report their perceptions of nurse-reported outcomes (e.g., quality of care). The associations between these variables were estimated using multivariable cluster-robust regression models, adjusted for nurse and hospital characteristics.

RESULTS

A total of 493 nurses from 42 distinct hospitals participated to this study. On average, nurses felt that their work environment was acceptable, and that the quality and safety of patient care was good. Basic care activities (e.g., mobilisation) were most frequently reported as omitted as opposed to those related to surveillance and medical interventions. In multivariable analyses, higher work environment scores were associated with reduced omitted nursing care scores (p < 0.001) and better ratings for nurse-reported outcomes (p < 0.001). Also, higher omitted nursing care scores were associated with more negative perceptions about the quality and safety of care (p < 0.001).

CONCLUSION

Our study portrays the characteristics and some factors associated with omitted nursing care in the intensive care unit. Further research should determine whether intensive care nurses' reports of organisational features and omitted nursing care are associated with objectively captured patient outcomes.

Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review

BACKGROUND

Missed nursing care undermines nursing standards of care and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept is a neglected aspect of human resource for health thinking, and it remains understudied in low-income and middle-income country (LMIC) settings which have 90% of the global nursing workforce shortages. Our objective in this review was to document the prevalence of missed nursing care in LMIC, identify the categories of nursing care that are most missed and summarise the reasons for this.

METHODS

We conducted a systematic review searching Medline, Embase, Global Health, WHO Global index medicus and CINAHL from their inception up until August 2021. Publications were included if they were conducted in an LMIC and reported on any combination of categories, reasons and factors associated with missed nursing care within in-patient settings. We assessed the quality of studies using the Newcastle Ottawa Scale.

RESULTS

Thirty-one studies met our inclusion criteria. These studies were mainly cross-sectional, from upper middle-income settings and mostly relied on nurses' self-report of missed nursing care. The measurement tools used, and their reporting were inconsistent across the literature. Nursing care most frequently missed were non-clinical nursing activities including those of comfort and communication. Inadequate personnel numbers were the most important reasons given for missed care.

CONCLUSIONS

Missed nursing care is reported for all key nursing task areas threatening care quality and safety. Data suggest nurses prioritise technical activities with more non-clinical activities missed, this undermines holistic nursing care. Improving staffing levels seems a key intervention potentially including sharing of less skilled activities. More research on missed nursing care and interventions to tackle it to improve quality and safety is needed in LMIC. PROSPERO registration number: CRD42021286897.

An Overview of Missed Nursing Care and Its Predictors in Saudi Arabia: A Cross-Sectional Study

Background

Nursing care is holistic, and missing any aspect of care can be critical to patients' health. However, due to the complex and intense nature of the nursing practice, nurses have to unintentionally prioritize some activities, forcing them to omit some aspects of nursing care.

Aim

To explore the dimensions of missed nursing care and its predictors within the Saudi Arabian healthcare system.

Methods

Quantitative, cross-sectional study used the MISSCARE survey by utilizing nonprobability convenience sampling to collect the data of 604 staff nurses working in inpatient wards in Jazan, Saudi Arabia.

Results

The overall mean of missed nursing care is (m = 1.37, SD = 0.45). Missed nursing care activities were mostly failure to attend interdisciplinary care conferences (m = 1.66, SD = 0.96) and patient ambulation thrice a day (m = 1.63, SD = 0.97). Missed nursing care was mainly caused by human resource shortage (m = 3.53, SD = 0.88). Missed nursing care is predicted by the turnover intention (B = 2.380, t = 3.829, p < 001) and job satisfaction (B = −0.864, t = −4.788, p < 001).

Conclusion

Although missed nursing care is evident in Saudi Arabia, it is significantly lower than the international rates, and it is mainly caused by labor resource shortage which directly influences nurses' job satisfaction and intention to leave. Optimizing the recruitment process, resource allocation and effective nurses' retention programs are proposed solutions that may be beneficial to mitigate missed nursing care.

Missed nursing care in acute care hospital settings in low-middle income countries: a systematic review protocol

Background:  Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings. Methods and analysis:  This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS). Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals PROSPERO registration number: CRD42021286897 (27 th October 2021).