The Missed List: Revelations of Busy NICU Nurses

Laura A. Stokowski, RN, MS


January 12, 2015

A Descriptive Study of Nurse-Reported Missed Care in Neonatal Intensive Care Units

Tubbs-Cooley HL, Pickler RH, Younger JB, Mark BA
J Adv Nurs. 2014 Nov 27. [Epub ahead of print]

What Is Missed Care and Does It Matter?

Previous nursing research has established that nurse staffing levels and nurse-to-patient ratios influence patient outcomes, and "missed" nursing care is believed to be a mediator in this relationship.[1] A nurse can only do so much during a shift, regardless of the setting.

Previous studies of missed care (necessary nursing care that is omitted either entirely or partly during the shift) have focused on adults in acute or intensive care settings, finding that such nursing tasks as ambulation, turning, feedings, patient teaching, discharge planning, emotional support, oral hygiene, bathing, and comfort care are among those most often sacrificed when time runs short.[2] These are concrete missed tasks, but overstretched nurses also may be unable to provide adequate surveillance of and appropriate response to changing patient conditions. Their interactions with patients and families can be rushed and unsatisfactory, and tasks may be performed less carefully or thoroughly than is customary.

NICU Nurse Survey

Addressing a gap in the literature, Tubbs-Cooley and colleagues conducted a study of missed nursing care in the neonatal intensive care unit (NICU). The aim of this descriptive study was to describe the frequency of nurse-reported missed care and reasons for missed nursing care in NICUs.

Using a database obtained from the American Nurses Credentialing Center, the investigators invited a random sample of certified NICU nurses from seven states (California, Florida, Washington, Iowa, Texas, New York, and Illinois) to participate in the study. The MISSCARE survey, which includes questions related to the frequency of missed nursing care activities and the reasons that these activities were missed, was adapted to reflect nursing care in the NICU setting during a single shift. This Web-based survey asked nurses to report missed nursing care activities on the last shift worked from a list of 35 nursing care items.

The invited sample of 1850 nurses returned 402 surveys, for a response rate of 22%. Respondents were predominantly female and white; 69% had a bachelor's or master's degree, and all had worked from 3 to 44 years in the NICU. Most nurses reported working in level 3 NICUs, nearly half of which were in magnet hospitals. On the last shift worked, which was the focus of the survey, more than 90% of responding nurses reported caring for two or more infants, and 5.6% reported caring for four or more infants.


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