• Quality improvement
• Healthcare quality improvement
• Nurses

Brooks Carthon and colleagues1 assess the relationship between the quality of hospital work environments for registered nurses and ‘missed care’ reported by nurses. Similar to other authors, they define missed care as care that nurses regarded as necessary but left undone due to a lack of time.2–4 Brooks Carthon and colleagues1 also explore the relationship between both of these variables and hospital readmissions for heart failure. Their analysis represents an important step in moving beyond the literature describing relationships between nurse staffing and patient outcomes.5–7

For patients with heart failure in the large sample of hospitals included in their secondary analysis, Brooks Carthon et al1 find that nurses’ self-report of missing important elements of care correlates with readmissions in this group of ill, vulnerable patients. For 4 of the 10 nursing activities they studied, each 10-percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2%–8% after adjusting for patient and hospital characteristics. Interestingly, they also showed that missed nursing care no longer predicted readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (as opposed to processes of care such as care …