Quality of nursing care across hospitals is variable, and this variation can result in poor patient outcomes. One aspect of quality nursing care is the amount of necessary care that is omitted. This article reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n = 4086) who provide direct patient care in 10 acute care hospitals. Missed nursing care patterns as well as reasons for missing care (labor resources, material resources, and communication) were common across all hospitals. Job title (ie, registered nurse vs nursing assistant), shift worked, absenteeism, perceived staffing adequacy, and patient work loads were significantly associated with missed care. The data from this study can inform quality improvement efforts to reduce missed nursing care and promote favorable patient outcomes.

Kalisch bj, lee h & rochman m. (2010) Journal of Nursing Management 18, 938–947Nursing staff teamwork and job satisfaction Aim The aim of the present study was to explore the influence of unit characteristics, staff characteristics and teamwork on job satisfaction with current position and occupation. Background Teamwork has been associated with a higher level of job satisfaction but few studies have focused on the acute care inpatient hospital nursing team. Methods This was a cross-sectional study with a sample of 3675 nursing staff from five hospitals and 80 patient care units. Participants completed the Nursing Teamwork Survey (NTS). Results Participants’ levels of job satisfaction with current position and satisfaction with occupation were both higher when they rated their teamwork higher (P < 0.001) and perceived their staffing as adequate more often (P < 0.001). Type of unit influenced both satisfaction variables (P < 0.05). Additionally, education, gender and job title influenced satisfaction with occupation (P < 0.05) but not with current position. Conclusions Results of this present study demonstrate that within nursing teams on acute care patient units, a higher level of teamwork and perceptions of adequate staffing leads to greater job satisfaction with current position and occupation. Implications for Nursing Management Findings suggest that efforts to improve teamwork and ensure adequate staffing in acute care settings would have a major impact on staff satisfaction.

There is a lack of an acceptable, reliable, and valid survey instruments to differentiate levels of nursing teamwork on inpatient units in acute care facilities. The aim of this study was to test the psychometric soundness of the Nursing Teamwork Survey (NTS). The survey was administered to 1,758 inpatient nursing staff members using the NTS (return rate = 56.9%), and measures of content, predictive (concurrent), and construct (factorial, contrast, and convergent) validity were completed. Content validity was established by a panel of experts. Concurrent validity showed a significant correlation between teamwork scores and an imbedded question related to overall satisfaction with teamwork (r = .633, p < .001). The exploratory factor analysis on a random half of the sample predicted a 33-item five-factor solution, whereas the confirmatory factor analysis on the remaining half of the sample confirmed the factor structure (comparative fit index = .884, root mean square error of approximation = 0.055, standardized root mean square residual = 0.045). Contrast validity showed that staff in a non-inpatient unit did not answer the questions in the same way (rWG(J) = .25) as the inpatient unit staff (rWG(J) > .90). Convergent validity of the teamwork tool was measured by correlating the Teamwork subscale of the Safety Attitudes Questionnaire with the NTS (r = .76, p < .01). The NTS had good test-retest reliability (r = .92 for overall 33 items; r = .77 to.87 for the five subscales) and internal consistency (alpha = .94 for overall items; alpha = .74 to.85 for the subscales). Aggregation of individual-level responses to the unit level was supported by intraclass correlation coefficient 1 = .16 (p < .001), intraclass correlation coefficient 2 = .9 (p < .001), and mean rWG(J) = .98. The NTS was demonstrated to have good psychometric properties. Further NTS research should include testing the tool in hospitals with varying characteristics and exploring the links to clinical and operational outcomes.

EXECUTIVE SUMMARY This study explores the impact of missed nursing care (required patient care that is omitted) on job satisfaction of nursing personnel. Data from 3,135 registered nurses (RNs) and 939 nursing assistants (NAs) on 110 patient care units in ten midwestern hospitals revealed that nursing staff who perceived less missed nursing care on the patient care unit where they work are more satisfied in their current position and occupation. Perceptions of staffing adequacy also significantly predicted both satisfaction variables. Focused interventions aimed at decreasing missed care and ensuring staffing adequacy are needed to improve job satisfaction and patient care.