Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals

BMJ Qual Saf. 2016 Jul;25(7):535-43. doi: 10.1136/bmjqs-2015-003961. Epub 2015 Sep 16.


Background: As nurses are the principal care provider in the hospital setting, the completion or omission of nursing care is likely to have a sizable impact on the patient care experience. However, this relationship has not been explored empirically.

Aim: To describe the prevalence and patterns of missed nursing care and explore their relationship to the patient care experience.

Methods: This cross-sectional study used secondary nurse and patient survey data from 409 adult non-federal acute care US hospitals in four states. Descriptive statistics were calculated and linear regression models were conducted at the hospital level. Regression models included controls for hospital structural characteristics.

Results: In an average hospital, nurses missed 2.7 of 12 required care activities per shift. Three-fourths (73.4%) of nurses reported missing at least one activity on their last shift. This percentage ranged from 25 to 100 across hospitals. Nurses most commonly reported not being able to comfort or talk with patients (47.6%) and plan care (38.5%). 6 out of 10 patients rated hospitals highly. This proportion ranged from 33% to 90% across hospitals. At hospitals where nurses missed more care (1 SD higher=0.74 items), 2.2% fewer patients rated the hospital highly (p<0.001); a coefficient equivalent to a one-quarter SD change.

Conclusions: Missed nursing care is common in US hospitals and varies widely. Most patients rate their hospital care experience highly, but this also varies widely across hospitals. Patients have poorer care experiences in hospitals where more nurses miss required nursing care. Supporting nurses' ability to complete required care may optimise the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority.

Keywords: Health services research; Nurses; Patient satisfaction.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Hospitals / standards*
  • Hospitals / statistics & numerical data
  • Humans
  • Medical Errors / statistics & numerical data*
  • Nursing Staff, Hospital / standards
  • Nursing Staff, Hospital / statistics & numerical data*
  • Patient Satisfaction* / statistics & numerical data
  • United States