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Recent reports1 ,2 stemming from a large study in Europe explore the concept of ‘missed care’ by nurses. Missed care is defined as the omission of any aspect of required patient care.3 Beyond the expected finding that nurse–patient staffing ratios are associated with missed care, the work environment and registered nurses (RN) carrying out non-nursing tasks were also important predictors.1 The frequency of missed care was also associated with nurses’ perceptions of patient safety.2 These findings are consistent with findings from a series of studies by Kalisch and colleagues in the USA.4 ,5 However, only recently has the issue of missed care been openly discussed in the literature. What are the implications of these findings?
Common activities are missed across hospitals and countries that have different national healthcare delivery systems. In these survey-based studies, nurses report prioritising direct patient care needs such as medication administration, but appear to assign lower priority to patient care interventions such as ambulation, psychosocial needs, care planning and patient education. The basis for these day-to-day, hour-to-hour, and in some cases minute-to-minute, decisions on what to prioritise is unknown, and poses extraordinarily rich questions for future research. Do nurses prioritise medications and treatments because they are formal physicians’ orders? Do they place greater value on medications and treatments over other interventions needed to prepare the patient (and their informal care givers) for discharge? Is medication administration prioritised over other interventions because it addresses an immediate need, and is now becoming easily tracked through electronic medication administration records relative to other interventions such as ambulation or discharge planning, which may by their nature be somewhat more amorphous? Alternatively, do nurses prioritise medication administration more because of the critical role played by pharmaceutical interventions and their self-perceived competency in medication administration …