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Missed Nursing Care, Staffing, and Patient Falls

Kalisch, Beatrice J. PhD, RN, FAAN; Tschannen, Dana PhD, RN; Lee, Kyung Hee MPH, RN

doi: 10.1097/NCQ.0b013e318225aa23

Patient falls in hospitals continue to be a major and costly problem. This study tested the mediating effect of missed nursing care on the relationship of staffing levels (hours per patient day [HPPD]) and patient falls. The sample was 124 patient units in 11 hospitals. The HPPD was negatively associated with patient falls (r = −0.36, P < .01), and missed nursing care was found to mediate the relationship between HPPD and patient falls.

School of Nursing, University of Michigan, Ann Arbor, Michigan (Drs Kalisch and Tschannen and Ms Lee).

Correspondence: Beatrice J. Kalisch, PhD, RN, FAAN, Nursing Business and Health Systems, University of Michigan, School of Nursing, 400 N Ingalls St, Ann Arbor, MI 48109 (

This project was funded by the Blue Cross Blue Shield Foundation of Michigan and the Michigan Center for Health Intervention, University of Michigan School of Nursing, National Institutes of Health, National Institute of Nursing Research (P30 NR009000).

The authors declare no conflict of interest.

Accepted for publication: May 25, 2011.

Published online before print: July 6, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.