Missed Care
The reports of missed care by RNs and NAs were consistent with that of Kalisch et al.The most frequently reported missed care items included ambulating, turning of patients, feeding patients warm food, and mouth care. In addition, the nurses reported that attending interdisciplinary meetings was frequently missed. Table 3 displays data for most frequently
reported missed care items. The least frequent items of missed care reported by nurses were patient assessment, bedside
glucose monitoring, and hand washing and ensuring discharge planning. The most frequently reported reasons for missed care were consistent with those in the report of Kalisch et al.(See Table 4 below, which reflects the reasons for the most frequently reported missed care items by both the RN and NA groups.) The RNs and NAs were similar in their reports
of the reasons for care being missed on a routine basis. The top 6 reasons cited were items that made up the labor resources factor. They included an unexpected rise in patient volume or patient acuity,inadequate number of assistive personnel, heavy admission or discharge activity, level of staffing, and urgent patient situations. The top 3 reasons that
nurses reported for missed care reflected the ability to manage patient flow and rapidly changing patient and unit needs. Another reason cited by the RN in the communication factor was that the NA failed to communicate that care was not done. Approximately 50% of both RNs and NAs reported tension or communication breakdown occurring with support departments, medical staff, and the nursing staff as reasons for missed care. Kalisch et al reported that tension or communication breakdown with physicians was most frequently reported as a reason for missed care.