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Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study

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Dietmar Ausserhofer, Britta Zander, Reinhard Busse, Maria Schubert, Sabina De Geest, Anne Marie Rafferty, Jane Ball, Anne Scott, Juha Kinnunen, Maud Heinen, Ingeborg Strømseng Sjetne, Teresa Moreno-Casbas, Maria Kózka, Rikard Lindqvist, Marianna Diomidous, Luk Bruyneel, Walter Sermeus, Linda H Aiken, René Schwendimann, RN4CAST Consortium

Original languageEnglish
Pages (from-to)126-135
Number of pages10
JournalBmj Quality & Safety
Issue number2
PublishedFeb 2014

King's Authors


Background: Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.

Aim: The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors.

Methods: Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study.

Results: Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone.

Conclusions: Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.

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