Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2018


Doctor of Nursing Practice (DNP)

Primary Advisor

Ellen T. Kurtzman, PhD, MPH, RN, FAAN; John Welton, PhD, RN, FAAN


Background: Missed nursing care is defined as any lapse in essential patient care. It is a previously studied, persistent phenomenon. If unrecognized, it can compromise patients’ recoveries, trigger adverse events, and increase healthcare costs.

Objectives: To examine the prevalence of missed nursing care reported by medical-surgical registered nurses (RNs) and contributing factors for its occurrence.

Methods: The project used a cross-sectional, correlational design. A convenience sample of 96 RNs, recruited from three medical-surgical units, completed the MISSCARE Survey between September and October 2017. An analysis of survey responses quantified the frequency, nature, and common contributing factors for care omissions. The project was set in a small, Northeast, Pathway to Excellence® designated hospital.

Results: Fifty-two RNs completed surveys, most who were female (94.2%), held a Bachelor’s in Nursing degree (53.8%), and had 10+ years of work experience (34.6%). Over 1 in 5 respondents reported five nursing tasks were “frequently” or “always” missed: care conferences (46.1%), scheduled ambulation (36.5%), turning (34.6%), monitoring intake and output (23.1%), and timely medications administration (23.1%). Significant contributors to care omissions were: heavy admission/discharge activity (57.7%), fewer assistive personnel (55.8%), staff shortages (50.0%), and unbalanced patient assignments (40.4%).

Conclusions: RNs identified the top five missed nursing care items in a small, community hospital and cited patient turnover, labor resource shortages, and unbalanced assignments as key, contributing factors. Inter-professional communication and teamwork effectiveness were not reported as contributing factors. Project results should inform nurse leaders’ efforts to devise interventions to safeguard patients, improve quality, and decrease cost.

Open Access




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.