By Brigid M Gillespie, Professor, NHMRC Centre of Research Excellence in Wiser Would Care, Menzies Health Institute, Griffith University and Gold Coast Hospital and Health Service

Results of a national survey - latest research from the NHMRC Centre of Research Excellence in Wiser Wound Care

Missed nursing care (MNC) refers to situations where essential nursing interventions or activities are omitted or not performed as required, potentially compromising patient wellbeing. It can also threaten patient safety (Kalisch et al., 2009). 

MNC can occur due to various reasons such as high workloads, inadequate staffing levels, communication breakdowns, or competing priorities (Kalisch et al., 2009).

Commonly missed activities across clinical settings include timely administration of medications, proper monitoring of vital signs, patient education, and effective communication with other health care team members (Kalisch et al., 2009; Chaboyer, et al., 2021). 

Although MNC has been well studied in acute medical and surgical units, intensive care, paediatrics, and midwifery settings (Chaboyer, et al., 2021), there have been very few studies undertaken in the perioperative setting.

To address this gap, we conducted a national online survey of members of the Australian College of Perioperative Nurses (ACORN) to identify relationships between perioperative nurses’ age, years of experience in the operating room, perceived perioperative competence, job satisfaction, and intention to leave and MNC reported by operating room nurses (Gillespie et al., 2023). 

Survey tool

The online 111 item survey included three components:

1. Demographic items
2. MISSCARE Survey-Operating Room (Kalisch et al, 2021)
3. Perceived Perioperative Competence Scale-SF (Gillespie et al, 2023). 

The survey included questions about age, gender, location, clinical role, operating room experience, qualifications, job satisfaction, overtime hours in the past three months, intent to leave current position, and staffing levels. 

Key results

Demographics  

• Of the 5500 nurses invited, 853 (15.5%) responded but only 602 (70.6%) provided data that could be analysed(Gillespie et al., 2023).
• Most respondents were female (82.6%) and the average age of respondents in the sample was 46 years (SD 11.4 years).
• 64.1% of respondents reported they had 10 or more years of operating room experience.
• Respondents’ primary perioperative role was circulating/instrument nurse (50.5%).

Predictors of MNC

• Nurses’ age (β = −0.007, p<0.05), job satisfaction (β = −0.094, p<0.01), perceived perioperative competence (β = −0.169, p<0.001), and the reasons for MNC (β = 0.224, p<0.001) contributed to the frequency of MNC. 
• Intention to leave in the next six months (β = −0.031, p >0.05), and years of operating room experience (β = −0.005, p>0.05) did not contribute to the reported frequency of MNC.

Key takeaway messages

This study has offered novel insights into the contribution of nurse characteristics to missed nursing care in the operating room. 

Nurses’ age and job satisfaction were the strongest contributors to the frequency of NMC in the operating room. 

These results suggest that younger, more dissatisfied nurses reported higher occurrences of MNC in the operating room. 

Nurse managers play a crucial role in building a culture that values mutual respect and continuous improvement.

References
Chaboyer, W., Harbeck, E., Lee, B. O., & Grealish, L. (2021). Missed nursing care: An overview of reviews. The Kaohsiung Journal of Medical Sciences , 37(2), 82-91.

Gillespie, B. M., Harbeck, E., & Chaboyer, W. (2023). The Association between Operating Room Nurses’ Characteristics, Competence, and Missed Nursing Care: A National Survey. Journal of Nursing Management , 2023 .

Gillespie, B. M., Harbeck, E., Sutherland-Fraser, S., Nicholson, P., & Boric, T. (2023). Psychometric validation of the Perceived Perioperative Competence ScaleRevised Short Form. Journal of Advanced Nursing, 00, 1–15. https:// doi.org/10.1111/jan.15735

Kalisch, B; McLaughlin, M; Marsh, V; Nguyen, N &Talsma A. (2021). The development and testing of the MISSCARE survey OR. Journal of Nursing Measurement, vol. 29, (3), 541–555.

Kalisch, B. J., Landstrom, G. L., & Hinshaw, A. S. (2009). Missed nursing care: a concept analysis. Journal of Advanced Nursing , 65(7), 1509-1517

Reflective questions

1. Consider missed nursing care in your clinical setting. How might missed nursing care impact patient outcomes? 
2. What steps would you take to reduce these effects?
3. In your experience, what contextual factors contribute to the occurrence of missed nursing care in your clinical setting?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD