1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

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When nurses are too busy, things can be missed, even important things. Or perhaps instead of being missed, essential aspects of care are incompletely done or significantly delayed. This situation is common in the clinical setting (Kalisch, Landstrom, & Williams, 2009). In a study of nurses in three acute care hospitals, Kalisch et al. (2009) found that 44% of nurses reported missing assessment, 73% missed basic nursing care and interventions, and 71% missed planning care. Reasons cited included an unexpected rise in patient acuity, urgent patient situations, and inadequate staffing (Kalisch et al., 2009). This study did not include maternity or neonatal units; however, the reasons reported by nurse participants sound consistent with conditions that can be found in the perinatal setting.


What factors are involved in the conscious or unconscious decision by nurses about what nursing care gets done and what nursing care is delayed, partially done, or completely missed? Is this care allocation a type of care rationing when difficult decisions must be made in the context of insufficient resources? Do important changes in patient conditions get overlooked or go unnoticed when nurses are too busy? What are the potential results for patient outcomes? Does this represent an error of omission? What are the conditions that increase the risk of missed care? Missed nursing care has been the subject of much research in the medical-surgical setting over the past several years (Agency for Healthcare Research and Quality [AHRQ], 2015; Jones, Hamilton, & Murry, 2015; Kalisch et al., 2009; Kalisch, Tschannen, & Lee, 2011), but not about care provided by perinatal nurses. For the purposes of measurement, missed care has been conceptualized by researchers as nursing care that is not done in a timely manner, not done as completely as needed, or not done at all (i.e., delayed, unfinished, or missed care) (Jones, Gemeinhardt, Thompson, & Hamilton, 2016; VanFosson, Jones, & Yoder, 2016).


Missed care may likely be occurring in the perinatal setting; however, this concept has not yet been quantified for our nursing practice specialty. The Association of Women's Health, Obstetric, and Neonatal Nurses is sponsoring a study to evaluate missed care during labor and birth. Labor nurses in hospitals in several states have been invited to participate. The main goal is to determine if there are any relationships between missed nursing care, nurse staffing, and patient outcomes. Results are expected over the next several years. A helpful overview of the concept of missed nursing care is available as an AHRQ (2015)Patient Safety Primer. This may be a novel way of examining the care we provide (or are unable to provide) as we have the privilege of supporting women and their families through labor and birth. Research about the effects of nursing care on patient outcomes should not be limited to nurses and nursing units that care for medical-surgical patients.




Agency for Healthcare Research and Quality. (2015). Missed nursing care. AHRQ Patient Safety Network, Patient Safety Primer. Retrieved from[Context Link]


Jones T. L., Gemeinhardt G., Thompson J. A., Hamilton P. (2016). Measuring unfinished nursing care: What to consider when choosing and scoring surveys. Journal of Nursing Care Quality, 31(1), 90-97. doi:10.1097/ncq.0000000000000143 [Context Link]


Jones T. L., Hamilton P., Murry N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International Journal of Nursing Studies, 52(6), 1121-1137. doi:10.1016/j.ijnurstu.2015.02.012 [Context Link]


Kalisch B. J., Landstrom G., Williams R. A. (2009). Missed nursing care: Errors of omission. Nursing Outlook, 57(1), 3-9. doi:10.1016/j.outlook.2008.05.007 [Context Link]


Kalisch B. J., Tschannen D., Lee K. H. (2011). Do staffing levels predict missed nursing care? International Journal for Quality in Health Care, 23(3), 302-308. doi:10.1093/intqhc/mzr009 [Context Link]


VanFosson C. A., Jones T. L., Yoder L. H. (2016). Unfinished nursing care: An important performance measure for nursing care systems. Nursing Outlook, 1-3. doi:10.1016/j.outlook.2015.12.010 [Context Link]