Linking the work environment to missed nursing care in labour and delivery
Corresponding Author
Eileen T. Lake PhD, RN, FAAN
Professor
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
Correspondence
Eileen T. Lake, University of Pennsylvania, School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, PA.
Email: [email protected]
Search for more papers by this authorRachel French BSN, RN
Predoctoral Research Fellow
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorKathleen O'Rourke MSN, RNC-O
Nurse Manager, Intensive Care Nursery
Nursing Department, Women's Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Search for more papers by this authorJordan Sanders BSE, BSN, RN
Staff Nurse
Nursing Department, University of Vermont Medical Center, Burlington, Vermont
Search for more papers by this authorSindhu K. Srinivas MD, MS
Associate Professor
Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorCorresponding Author
Eileen T. Lake PhD, RN, FAAN
Professor
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
Correspondence
Eileen T. Lake, University of Pennsylvania, School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, PA.
Email: [email protected]
Search for more papers by this authorRachel French BSN, RN
Predoctoral Research Fellow
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorKathleen O'Rourke MSN, RNC-O
Nurse Manager, Intensive Care Nursery
Nursing Department, Women's Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Search for more papers by this authorJordan Sanders BSE, BSN, RN
Staff Nurse
Nursing Department, University of Vermont Medical Center, Burlington, Vermont
Search for more papers by this authorSindhu K. Srinivas MD, MS
Associate Professor
Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorFunding information
This study was supported by grants from the University of Pennsylvania School of Nursing Office of Nursing Research (J.S., PI; E.L., Sponsor) and the National Institute of Nursing Research (T32-NR-007104 and R01-NR-004513, to L.H. Aiken, principal investigator).
Abstract
Aim
To measure the association between the nurse work environment (NWE) and missed nursing care on labour and delivery (L&D) units.
Background
L&D units provide a sizable fraction of acute hospital services to a unique population that is a national and global priority. L&D nurses are the frontline providers during labour. Maternal morbidity and mortality may be influenced by the NWE and missed care.
Methods
This cross-sectional study utilized secondary data from 1,313 L&D staff nurses in 247 hospitals from a four-state nurse survey collected in 2005–2008.
Results
Half of nurses missed care (range: zero to 100% across hospitals). Nurses on average missed 1.25 of 10 activities. The most commonly missed activities were comforting/talking with patients and teaching/counselling. In better as compared to poor NWEs, the odds and frequency of missed care were significantly lower.
Conclusions
L&D nurses routinely miss necessary nursing activities. Labouring women's psychosocial, comfort and educational needs are compromised most often, likely impacting quality and outcomes. Nurse communication with colleagues and managers about missed care is warranted.
Implications for Nursing Management
The L&D NWE is modifiable and appears to influence missed care. Managers should discuss missed care with staff and measure their NWE to identify actionable weaknesses.
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