Association of Patient Acuity and Missed Nursing Care in U.S. Neonatal Intensive Care Units

Med Care Res Rev. 2020 Oct;77(5):451-460. doi: 10.1177/1077558718806743. Epub 2018 Oct 26.


The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses (N = 5,861) from the National Database of Nursing Quality Indicators, we found that 36% of nurses missed one or more care activities on the past shift. Missed care prevalence varied widely across units. Nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care. The most common activities missed involved patient comfort and counseling and parent education. Workloads have increased and work environments have deteriorated compared with 8 years ago. Nurses' assignments should account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.

Keywords: missed nursing care; neonatal intensive care; nurse work environment; nurse workload; patient acuity.

Publication types

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

MeSH terms

  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Neonatal*
  • Male
  • Nursing Staff, Hospital
  • Patient Acuity*
  • Surveys and Questionnaires
  • United States
  • Workload