Discussion
Reports of RNs and NAs of missed care were widespread across the 3 institutions. The most prevalent care omissions from the 2 groups were lower level care activities that were routinely performed by the NA and included turning, ambulating, feeding, toileting, and mouth care. These activities of daily living are implicitly delegated activities seen in the NA job description, but may not be recognized as such by either the RNs or NAs. The most common reasons for missed care cited by both groups were an unexpected increase in volume or acuity, heavy admission or discharge activity, and inadequate support staff. Disturbing findings not previously noted in the literature were that 88% of the NMs stated that omissions had been reported to them, with 67% reporting that these omissions occurred frequently. Prime factors affecting successful delegation indicated by both groups were good communication, positive relationships and attitudes, workload, and
the NA’s competence and knowledge.