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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000443762.89516.81
In the News

Nursing Care Left Undone in European Hospitals

Carter, David

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Nurses in supportive work settings get more nursing done.

A country's economic status clearly has profound effects on its health care system, but does austerity directly affect nursing care? A study of hospitals in 12 European countries was undertaken to determine the prevalence and patterns of nursing care not performed. The researchers hypothesized that it would be hospital-level factors rather than national economics that determined how much nursing work was left undone—and they were right.

The researchers used data from their three-year (2009 to 2011) multilevel Nurse Forecasting: Human Resources Planning in Nursing (RN4CAST) study. Data came from nurse and patient surveys, hospital administrative data, and patient discharge data. A total of 488 hospitals participated in the RN4CAST study, and 33,659 professional nurses were surveyed.

Participation in the study was voluntary and anonymous. Surveyed nurses were given a list of 13 nursing activities that are considered necessary and asked which they hadn't had time to perform on their most recent shift. The quality of the nursing work environment was also assessed.

Rates at which work was left undone varied widely, but according to task and hospital, not country, from 9% (treatments and procedures) to 53% (comforting, talking with patients); 33.9% of the study participants said that they had “often” performed nonnursing tasks. Analysis of the study data suggests that nurses make hierarchical decisions about which tasks not to perform, with the “physical needs of the patients” receiving the highest priority and time-consuming or psychosocial activities receiving the lowest priority. Hospitals with better work environments, lower patient–nurse ratios, and fewer nonnursing tasks performed by nurses had lower rates of nursing tasks left undone.

The study authors recommend studying “care processes in each country's highest-performing hospitals in more depth so that their practices can be adopted by other hospitals.”—David Carter

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Ausserhofer D, et al.BMJ Qual Saf 2013 Nov 10. [Epub ahead of print.]

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