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Nurses' and Nursing Assistants' Reports of Missed Care and Delegation

Gravlin, Gayle EdD, RN, NEA-BC; Phoenix Bittner, Nancy PhD, RN, CCRN

Journal of Nursing Administration: July-August 2010 - Volume 40 - Issue 7/8 - p 329-335
doi: 10.1097/NNA.0b013e3181e9395e

Objective: Measure RNs' and nursing assistants' reports of frequency and reasons for missed nursing care and identify factors related to successful delegation.

Background: Routine nursing tasks were identified as the most commonly occurring omissions. Reasons for omissions included poor utilization of staff resources, time required for the nursing interventions, poor teamwork, ineffective delegation, habit, and denial.

Methods: Quantitative, descriptive design.

Results: Widespread reports of missed care included turning, ambulating, feeding, mouth care, and toileting. Frequently reported reasons were unexpected increase in volume or acuity, heavy admission or discharge activity, and inadequate support staff. Factors affecting successful delegation were communication and relationship, nursing assistant competence and knowledge, and attitude and workload.

Conclusion: Nurse leaders must focus on implementing strategies to mitigate factors and the consequences of care omissions, including poor patient outcomes. An analysis of point-of-care delivery system failures and ineffective processes is essential.

Authors' Affiliations: Associate Chief Nurse (Dr Gravlin), Nursing Education, Research & Professional Development, Lahey Clinic, Burlington, Massachusetts; Assistant Dean and Professor (Dr Phoenix Bittner), School of Nursing and Health Professions, Regis College, Weston, Massachusetts.

Corresponding author: Dr Phoenix Bittner, Regis College, 235 Wellesley St, Weston, MA 02493 (

© 2010 Lippincott Williams & Wilkins, Inc.