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Patterns and Correlates of Missed Nursing Care in Inpatient Oncology Units

Friese, Christopher R. PhD, RN, AOCN, FAAN; Kalisch, Beatrice J. PhD, RN, FAAN; Lee, Kyung Hee PhD, RN

doi: 10.1097/NCC.0b013e318275f552

Background: Missed nursing care influences the quality of hospital care, yet this problem has not been explored in the oncology setting, nor are the correlates of missed nursing care in inpatient oncology settings understood.

Objective: We examined the frequency of missed care in oncology units, differences in missed care between oncology and nononcology units, and the relationship between unit staffing and missed care.

Methods: We performed secondary analysis of survey data collected in 2008 to 2009 across 9 hospitals. The MISSCARE Survey was administered to nurses and medical assistants employed in 62 units (n = 2318). Descriptive statistics and linear regression were used to examine the frequency of missed care, differences between oncology (n = 12) and nononcology units (n=50), and the relationship between unit staffing and missed care.

Results: Oncology nursing unit personnel reported ambulation, care conference attendance, and mouth care as most frequently missed. Oncology units had significantly lower missed care than did nononcology units (P < .05). Higher patient assignments were associated with an increase in reported missed care (P < .05).

Conclusions: Missed care is a problem shared by inpatient oncology and nononcology units. Missed ambulation and mouth care are worrisome, given their importance to oncology patients. Suboptimal staffing increases missed care.

Implications for Practice: These data motivate quality improvement and evidence-based management. Clinicians can strategize to ensure patients receive adequate ambulation and mouth care. Managers can use our findings to support the importance of stable nurse staffing to reduce untoward patient outcomes.

Author Affiliations: School of Nursing, Division of Nursing Business and Health Systems, University of Michigan, Ann Arbor (Drs Friese and Kalisch); and School of Nursing, Duke University, Durham, North Carolina (Dr Lee).

This research was supported by Pathway to Independence award (R00 NR10750) from the National Institute of Nursing Research, National Institutes of Health (to Dr Friese). Original data collection was supported by a grant from the Blue Cross Blue Shield of Michigan Foundation (to Dr Kalisch). This research was also supported in part by the National Institutes of Health through the University of Michigan’s Cancer Center support grant (5 P30 CA46592).

The authors have no conflicts of interest to disclose.

Correspondence: Christopher R. Friese, PhD, RN, AOCN, FAAN, School of Nursing, Division of Nursing Business and Health Systems, University of Michigan, 400 N Ingalls #4162, Ann Arbor, MI 48109 (

Accepted for publication September 22, 2012.

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