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Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals
  1. Eileen T Lake1,
  2. Hayley D Germack1,
  3. Molly Kreider Viscardi2
  1. 1Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2McKinsey & Company, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Eileen T Lake, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA; elake{at}


Background As nurses are the principal care provider in the hospital setting, the completion or omission of nursing care is likely to have a sizable impact on the patient care experience. However, this relationship has not been explored empirically.

Aim To describe the prevalence and patterns of missed nursing care and explore their relationship to the patient care experience.

Methods This cross-sectional study used secondary nurse and patient survey data from 409 adult non-federal acute care US hospitals in four states. Descriptive statistics were calculated and linear regression models were conducted at the hospital level. Regression models included controls for hospital structural characteristics.

Results In an average hospital, nurses missed 2.7 of 12 required care activities per shift. Three-fourths (73.4%) of nurses reported missing at least one activity on their last shift. This percentage ranged from 25 to 100 across hospitals. Nurses most commonly reported not being able to comfort or talk with patients (47.6%) and plan care (38.5%). 6 out of 10 patients rated hospitals highly. This proportion ranged from 33% to 90% across hospitals. At hospitals where nurses missed more care (1 SD higher=0.74 items), 2.2% fewer patients rated the hospital highly (p<0.001); a coefficient equivalent to a one-quarter SD change.

Conclusions Missed nursing care is common in US hospitals and varies widely. Most patients rate their hospital care experience highly, but this also varies widely across hospitals. Patients have poorer care experiences in hospitals where more nurses miss required nursing care. Supporting nurses’ ability to complete required care may optimise the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority.

  • Health services research
  • Nurses
  • Patient satisfaction

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