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Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study
  1. Dietmar Ausserhofer1,
  2. Britta Zander2,
  3. Reinhard Busse2,
  4. Maria Schubert3,
  5. Sabina De Geest1,4,
  6. Anne Marie Rafferty5,
  7. Jane Ball6,
  8. Anne Scott7,
  9. Juha Kinnunen8,
  10. Maud Heinen9,
  11. Ingeborg Strømseng Sjetne10,
  12. Teresa Moreno-Casbas11,
  13. Maria Kózka12,
  14. Rikard Lindqvist13,
  15. Marianna Diomidous14,
  16. Luk Bruyneel15,
  17. Walter Sermeus15,
  18. Linda H Aiken16,
  19. René Schwendimann1,
  20. on behalf of the RN4CAST consortium
  1. 1Institute of Nursing Science, University of Basel, Basel, Switzerland
  2. 2Department of Health Care Management, Berlin University of Technology, Berlin, Germany
  3. 3Centre of Clinical Nursing Science, Zurich University Hospital, Zurich, Switzerland
  4. 4Catholic University Leuven, Leuven, Belgium
  5. 5Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
  6. 6National Nursing Research Unit, Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
  7. 7School of Nursing and Human Sciences, Dublin City University, Dublin9, Ireland
  8. 8Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
  9. 9Radboud University Nijmegen Medical Centre. IQ healthcare, Nursing Science and Allied Healthcare (IQ 114), Nijmegen, The Netherlands
  10. 10The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
  11. 11Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
  12. 12Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Science Jagiellonian University Collegium Medicum, Krakow, Poland
  13. 13Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
  14. 14Faculty of Nursing, University of Athens, Athens, Greece
  15. 15Centre for Health Services & Nursing Research, Catholic University Leuven, Leuven, Belgium
  16. 16Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr René Schwendimann, Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel 4056, Switzerland; rene.schwendimann{at}


Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.

Aim The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors.

Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study.

Results Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone.

Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.

  • Health services research
  • Nurses
  • Patient safety

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