Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study

BMJ Qual Saf. 2014 Feb;23(2):126-35. doi: 10.1136/bmjqs-2013-002318. Epub 2013 Nov 10.


Background: Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.

Aim: The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors.

Methods: Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study.

Results: Across European hospitals, the most frequent nursing care activities left undone included 'Comfort/talk with patients' (53%), 'Developing or updating nursing care plans/care pathways' (42%) and 'Educating patients and families' (41%). In hospitals with more favourable work environments (B=-2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone.

Conclusions: Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.

Keywords: Health services research; Nurses; Patient safety.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Critical Pathways
  • Cross-Sectional Studies
  • Europe
  • Female
  • Hospitals
  • Humans
  • Male
  • Medical Errors
  • Nurse-Patient Relations*
  • Nursing Care / organization & administration
  • Nursing Care / standards*
  • Nursing Staff, Hospital / standards
  • Nursing Staff, Hospital / supply & distribution*
  • Practice Patterns, Nurses'*
  • Prevalence
  • Walking