What impact does nursing care left undone have on patient outcomes? Review of the literature.
Alejandra Recio-Saucedo, Chiara Dall'Ora, Antonello Maruotti and 8 others
PMID 28859254WHAT IT FOUND
Nursing care left undone was consistently linked with lower patient satisfaction and with more medication errors, infections, falls and readmissions.
Mortality was not shown to rise, and the evidence is mostly self-reported, so it does not prove missed care caused these outcomes.
Key findings
01Four hospital studies found missed care significantly decreased patient satisfaction, and a Swiss study reported patients were less likely to recommend the hospital (OR = 0.27; 95% CI = 0.11–0.67).
02In Swiss hospitals, rationing of nursing care was associated with higher nurse-reported bloodstream infections (OR = 3.01; 95% CI = 1.42–6.34), pneumonia (OR = 2.67; 95% CI = 1.11–6.39) and medication administration errors (OR = 2.51; 95% CI = 1.18–5.65).
03The review found insufficient evidence that missed care increases mortality, and an adjusted analysis reported no association with 30-day mortality (OR = 0.99; 95% CI = 0.89–1.10).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most evidence came from nurses or patients reporting missed care, so findings may reflect perception and recall rather than independently verified omissions. Included studies used different surveys and outcome definitions. Direct comparison is difficult. Most studies had significant limitations in internal or external validity, and no study was strong in both. Settings varied widely across hospitals and nursing homes, so results may not transfer to every unit. The review reports associations, not proof that missed care caused the outcomes.
The easy way to misread this
Do not read this review as proof that missed nursing care directly causes infections, falls, or death. The evidence is mostly self-reported association, and the mortality findings were inconsistent.