Patient-Count and Perceived Workload Associations With Missed Nursing Care: A Multicenter Repeated-Measures Study.
Dhurata Ivziku, Daniela Tartaglini, Federica Maria Pia Ferramosca and 5 others
PMID 42708349WHAT IT FOUND
Nurses reported missing care activities on most shifts.
While workload and missed care were linked overall, no single workload measure stood out after statistical correction. Patient counts alone did not explain missed care, suggesting perceived workload dimensions require further study.
Key findings
01The seven workload indicators were jointly associated with missed nursing care, but no individual coefficient remained significant after correction for multiple testing.
02Perceived workload indicators were associated with missed care, whereas patient-count indicators were not clearly associated after adjustment.
03Nurses with higher average work rhythm/quantity reported more missed care (between-nurse), but shift-specific deviations from their own average were not clearly associated (within-nurse).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The observational design precludes causal inference. Missed care and perceived workload were concurrent self-reports, making the results vulnerable to common-method and response-style bias. The Unfinished Nursing Care Survey was adapted from a seven-day reference period to a single shift, and this adaptation was not psychometrically validated. Repeated observations were sparse, with a median of only two shifts per nurse, limiting the reliability of within-nurse analyses. Mental workload scores showed a ceiling effect, potentially reducing the ability to detect associations. Post-collection data harmonization was required for two hospitals due to reversed response coding, indicating data quality issues.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not interpret the joint association of workload indicators with missed care as proof that reducing work rhythm/quantity will prevent missed care. The study is observational, relies on self-report, and no individual workload measure survived statistical correction, meaning these findings are hypothesis-generating rather than evidence of a specific causal mechanism.