Abstract
AIM: To document how changes in the hospital work environment and nurse staffing over time are associated with changes in missed nursing care. BACKGROUND: Missed nursing care is considered an indicator of poorer care quality and has been associated with worse patient care experiences and health outcomes. Several systematic reviews of cross-sectional studies report that nurses in hospitals with supportive work environments and higher staffing miss less care. Causal evidence demonstrating these relationships is needed. METHODS: This panel study utilized secondary data from 23,650 nurses surveyed in 2006 and 14,935 surveyed in 2016 in 458 hospitals from a four-state survey of random samples of licensed nurses. RESULTS: Over the 10-year period, most hospitals exhibited improved work environments, better nurse staffing and more missed care. In hospitals with improved work environments or nurse staffing, the prevalence and frequency of missed care decreased significantly. The effect on missed care of changes in the work environment was greater than that of nurse staffing. CONCLUSIONS: Changes in the hospital work environment and staffing influence missed care. IMPLICATIONS FOR NURSING MANAGEMENT: Modifications in the work environment and staffing are strategies to mitigate care compromise. Nurse managers should investigate work settings in order to identify weaknesses.