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

Article Content

In this issue of MCN, as part of our special topics series, we feature four articles about research on missed nursing care, nurse staffing, and the nursing work environment as they relate to patient outcomes in maternity, neonatal, and pediatric settings. Although there have been various definitions used in the literature, in general, missed care is essential nursing care that is delayed, unfinished, or completely missed. This concept has only recently been applied to nursing care beyond medical-surgical units in acute care hospitals. Three of the studies include the concept of missed care (Ogboenyiya et al., 2020; Roth et al., 2020; Simpson et al., 2020).


Two articles (Roth et al., 2020; Simpson et al., 2020) link nurse reports of their hospitals' adherence to the nurse staffing guidelines published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN, 2010) with their findings. Roth et al. (2020) found nurses practicing in hospitals following the AWHONN nurse staffing guidelines always or most of the time reported less frequency of "being swamped" as compared with those in hospitals that followed the guidelines some of the time, or rarely. Simpson et al. (2020) found that missed nursing care during labor and birth was an independent predictor of exclusive breast milk feeding during the hospitalization for childbirth. Following the AWHONN nurse staffing guidelines was likewise associated with exclusive breast milk feeding.


In their integrative review, Ogboenyiya et al. (2020) noted over one-third of pediatric and neonatal nurses reported missing at least one care activity on their last shift. Missed nursing care was associated with workload, patient acuity, work environment, nurse characteristics, and related to prolonged hospitalization of preterm infants (Ogboenyiya et al., 2020). Clark and Lake (2020) studied maternity nurses work environment as it relates to safety and quality. Concerning results include that nurses in the majority of hospitals with maternity units in four states representing a quarter of the nation's annual births felt their units do not provide excellent quality care and have a less than optimal safety climate.


These are important and timely contributions to the nursing literature since the AWHONN nurse staffing guidelines are in the process of being updated, and there has been limited research published in the last decade about maternity and neonatal care relative to nurses staffing and patient outcomes. Representative researchers from all three of the nursing teams in the United States studying maternity, neonatal, and pediatric nurse staffing participated in this MCN special topics series. We hope you will find these articles valuable.




Association of Women's Health, Obstetric and Neonatal Nurses. (2010). Guidelines for professional registered nurse staffing for perinatal units. [Context Link]


Clark R. R. S., Lake E. (2020). Association of clinical nursing work environment with quality and safety in maternity care in the United States. MCN. The American Journal of Maternal Child Nursing, 45(5). 265-270, DOI:10.1097/NMC.0000000000000653. [Context Link]


Ogboenyiya A. A., Tubbs Cooley H. L., Miller E., Johnson K., Bakas T. (2020). Missed nursing care in pediatric and neonatal care settings: An integrative review. MCN. The American Journal of Maternal Child Nursing, 45(5). 254-264, DOI:10.1097/NMC.0000000000000642. [Context Link]


Roth C., Brewer M. A., Bay R. C., Gosselin K. P. (2020). Nurses' experiences of "being swamped" in the clinical setting and association with adherence to AWHONN Nurse Staffing Guidelines. MCN. The American Journal of Maternal Child Nursing, 45(5). 271-279, DOI:10.1097/NMC.0000000000000643. [Context Link]


Simpson K. R., Lyndon A., Spetz J., Gay C. L., Landstrom G. L. (2020). Missed nursing care during labor and birth and exclusive breastfeeding during hospitalization for childbirth. MCN. The American Journal of Maternal Child Nursing, 45(5). 280-288, DOI:10.1097/NMC.0000000000000644. [Context Link]