AIM: The main aim of the research was to describe and compare unfinished nursing care in selected European countries. BACKGROUND: The high prevalence of unfinished nursing care reported in recently published studies, as well as its connection to negative effects on nurse and patient outcomes, has made unfinished care an important phenomenon and a quality indicator for nursing activities. METHODS: A cross-sectional descriptive study was undertaken. Unfinished nursing care was measured using the Perceived Implicit Rationing of Nursing Care questionnaire (PIRNCA). The sample included 1,353 nurses from four European countries (Croatia, the Czech Republic, Poland and Slovakia). RESULTS: The percentage of nurses leaving one or more nursing activities unfinished ranged from 95.2% (Slovakia) to 97.8% (Czech Republic). Mean item scores on the 31 items of the PIRNCA in the total sample ranged from 1.13 to 1.92. Unfinished care was significantly associated with the type of hospital and quality of care. CONCLUSION: The research results confirmed the prevalence of unfinished nursing care in the countries surveyed. IMPLICATIONS FOR NURSING MANAGEMENT: The results are a useful tool for enabling nurse managers to look deeper into nurse staffing and other organizational issues that may influence patient safety and quality of care.

Department of Clinical Nursing Faculty of Health Sciences Wroclaw Medical University Wroclaw Poland

Department of Nursing and Midwifery Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Nursing Faculty of Health Sciences Palacky University in Olomouc Olomouc Czech Republic

Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovakia

Department of Nursing School of Health Sciences Cyprus University of Technology Limassol Cyprus

University Hospital Zagreb Zagreb Croatia

University of Applied Health Sciences Zagreb Croatia

See more in PubMed

Agency for Healthcare Research and Quality (AHRQ) . (2019). Missed nursing care. Retrieved from https://psnet.ahrq.gov/primers/primer/29/Missed-Nursing-Care

Aiken, L. H. , Clarke, S. P. , Sloane, D. M. , Sochalski, J. A. , Busse, R. , Clarke, H. , … Shamian, J. (2001). Nurses' reports on hospital care in five countries. Health Affairs (Millwood), 20(3), 43–53. 10.1377/hlthaff.20.3.43 PubMed DOI

Aiken, L. H. , Sermeus, W. , Van den Heede, K. , Sloane, D. M. , Busse, R. , McKee, M. , … Kutney‐Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717 10.1136/bmj.e1717 PubMed DOI PMC

Ausserhofer, D. , Zander, B. , Busse, R. , Schubert, M. , De Geest, S. , Rafferty, A. M. , … Schwendimann, R. (2014). Prevalence, patterns and predictors of nursing care left undone in European hospitals: Results from the multicountry cross‐sectional RN4CAST study. BMJ Quality Safety, 23(2), 126–135. 10.1136/bmjqs-2013-002318 PubMed DOI

Bail, K. , & Grealish, L. (2016). Failure to Maintain: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital. International Journal of Nursing Studies, 63, 146–161. 10.1016/j.ijnurstu.2016.08.001 PubMed DOI

Ball, J. E. , Murrells, T. , Rafferty, A. M. , Morrow, E. , & Griffiths, P. (2014). ‘Care left undone’ during nursing shifts: Associations with workload and perceived quality of care. BMJ Quality Safety, 23(2), 116–125. 10.1136/bmjqs-2012-001767 PubMed DOI PMC

Bekker, M. , Coetzee, S. K. , Klopper, H. C. , & Ellis, S. M. (2015). Non‐nursing tasks, nursing tasks left undone and job satisfaction among professional nurses in South African hospitals. Journal of Nursing Management, 23(8), 1115–1125. 10.1111/jonm.12261 PubMed DOI

Blackman, I. , Henderson, J. , Willis, E. , Hamilton, P. , Toffoli, L. , Verrall, C. , … Harvey, C. (2015). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24(1–2), 47–56. 10.1111/jocn.12688 PubMed DOI

Blackman, I. , Papastavrou, E. , Palese, A. , Vryonides, S. , Henderson, J. , & Willis, E. (2018). Predicting variations to missed nursing care: A three‐nation comparison. Journal of Nursing Management, 26(1), 33–41. 10.1111/jonm.12514 PubMed DOI

Bragadóttir, H. , & Kalisch, B. J. (2018). Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals. Scandinavian Journal of Caring Sciences, 32(3), 1227–1236. 10.1111/scs.12570 PubMed DOI

Bragadóttir, H. , Kalisch, B. K. , Smáradóttir, S. B. , & Jónsdóttir, H. H. (2015). Translation and psychometric testing of the Icelandic version of the MISSCARE Survey. Scandinavian Journal of Caring Sciences, 29(3), 563–572. 10.1111/scs.12150 PubMed DOI

Bragadóttir, H. , Kalisch, B. J. , & Tryggvadóttir, G. B. (2017). Correlates and predictors of missed nursing care in hospitals. Journal of Clinical Nursing, 26(11–12), 1524–1534. 10.1111/jocn.13449 PubMed DOI

Dhaini, S. R. , Zúñiga, F. , Ausserhofer, D. , Simon, M. , Kunz, R. , De Geest, S. , & Shwendimann, R. (2017). Are nursing home care workers’ health and presenteeism associated with implicit rationing of care? A cross‐sectional multi‐site study. Geriatric Nursing, 38(1), 33–38. 10.1016/j.gerinurse.2016.07.003 PubMed DOI

Hessels, A. J. , Flynn, L. , Cimiotti, J. P. , Cadmus, E. , & Gershon, R. R. M. (2015). The impact of the nursing practice environment on missed nursing care. Clinical Nursing Studies, 3(4), 60–65. PubMed PMC

Institute of Medicine . (1990). Medicare: A strategy for quality assurance, Volume I. Washington, DC: The National Academies Press. PubMed

Jones, T. L. (2014). Validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) Instrument. Nursing Forum, 49(2), 77–87. 10.1111/nuf.12076 PubMed DOI

Jones, T. L. , Gemenihardt, G. , Thomson, J. A. , & Hamilton, P. (2016). Measuring unfinished nursing care: What to consider when choosing and scoring surveys. Journal of Nursing Care Quality, 31(1), 90–91. 10.1097/NCQ.0000000000000143 PubMed DOI

Jones, T. L. , Hamilton, P. , & Murry, N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International Journal of Nursing Studies, 52(6), 1121–1137. 10.1016/j.ijnurstu.2015.02.012 PubMed DOI

Jones T., Willis E., Amorim-Lopes M., Drach-Zahavy A., RANCARE Consortium COST - CA 15208 . (2019). Advancing the science of unfinished nursing care: Exploring the benefits of cross-disciplinary knowledge exchange, knowledge integration and transdisciplinarity. Journal of Advanced Nursing, 75(4), 905–917. 10.1111/jan.13948 PubMed DOI

Kalauz, S. , Orlic‐Sumić, M. , & Simunec, D. (2008). Nursing in Croatia: Past, present, and future. Croatian Medical Journal, 49(3), 298–306. PubMed PMC

Kalisch, B. J. , Doumit, M. , Lee, K. H. , & Zein, J. E. (2013). Missed nursing care, level of staffing and job satisfaction: Lebanon versus the United States. Journal of Nursing Administration, 43(5), 274–279. 10.1097/NNA.0b013e31828eebaa PubMed DOI

Kalisch, B. J. , Gosselin, K. , & Choi, S. H. (2012). A comparison of patient care units with high versus low levels of missed nursing care. Health Care Management Review, 37(4), 320–328. 10.1097/HMR.0b013e318249727e PubMed DOI

Kalisch, B. J. , Landstrom, G. L. , & Hinshaw, A. S. (2009). Missed nursing care: A concept analysis. Journal of Advanced Nursing, 65(7), 1509–1517. 10.1111/j.1365-2648.2009.05027.x PubMed DOI

Kalisch, B. , Tschannen, D. , & Lee, H. (2011). Does missed nursing care predict job satisfaction? Journal of Healthcare Management, 56(2), 117–131. 10.1097/00115514-201103000-00007 PubMed DOI

Kramer, M. , & Schmalenberg, C. (2004). Development and evaluation of essentials of magnetism tool. Journal of Nursing Administration, 34(7/8), 365–378. 10.1097/00005110-200407000-00010 PubMed DOI

Liu, Y. , Aungsuroch, Y. , & Yunibhand, J. (2015). Job satisfaction in nursing: A concept analysis study. International Nursing Review, 63(1), 84–91. 10.1111/inr.12215 PubMed DOI

Lu, H. , Zhao, Y. , & While, A. (2019). Job satisfaction among hospital nurses: A literature review. International Journal of Nursing Studies, 94, 21–31. 10.1016/j.ijnurstu.2019.01.011 PubMed DOI

Lucero, R. J. , Lake, E. T. , & Aiken, L. H. (2009). Variations in nursing care quality across hospitals. Journal of Advanced Nursing, 65(11), 2299–2310. 10.1111/j.1365-2648.2009.05090.x PubMed DOI PMC

Marć, M. , Bartosiewicz, A. , Burzyńska, J. , Chmiel, Z. , & Januszewicz, P. (2019). A nursing shortage – a prospect of global and local policies. International Nursing Review, 66(1), 9–16. 10.1111/inr.12473 PubMed DOI

Mazzotta, P. C. (2016). Biomedical approaches to care and their influence on point of care nurses: A scoping review. Journal of Nursing Education and Practice, 6(8), 93–101. 10.5430/jnep.v6n8p93 DOI

Organisation for EconomicCo-operation and Development (OECD) . (2019). Nurses (indicator). 10.1787/283e64de-en. Retrieved from https://data.oecd.org/healthres/nurses.htm DOI

OECD/European Observatory on Health Systems and Policies . (2017). Croatia: Country Health Profile 2017, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels. 10.1787/9789264283312-en DOI

Palese, A. , Ambrosi, E. , Prosperi, L. , Guarnier, A. , Barelli, P. , Zambiasi, P. , … Saiani, L. (2015). Missed nursing care and predicting factors in the Italian medical care setting. Internal and Emergency Medicine, 10(6), 693–702. 10.1007/s11739-015-1232-6 PubMed DOI

Papastavrou, E. , Andreou, P. , & Efstathiou, G. (2014b). Rationing of nursing care and nurse patient outcomes: A systematic review of quantitative studies. International Journal of Health Planning and Management, 29(1), 3–25. 10.1002/hpm.2160 PubMed DOI

Papastavrou, E. , Andreou, P. , Tsangari, H. , & Merkouris, A. (2014a). Linking patient satisfaction with nursing care: The case of care rationing – a correlational study. BMC Nursing, 13, 26. org/10.1186/1472-6955-13-26 PubMed PMC

Papastavrou, E. , Charalambous, A. , Vryonides, S. , Eleftheriou, C. , & Merkouris, A. (2016). To what extent are patients' needs met on oncology units? The phenomenon of care rationing. European Journal of Oncology Nursing, 21, 48–56. 10.1016/j.ejon.2016.01.002 PubMed DOI

Recio‐Saucedo, A. , Dall'Ora, C. , Maruotti, A. , Ball, J. , Briggs, J. , Meredith, P. , … Griffiths, P. (2018). What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of Clinical Nursing, 27(11–12), 2248–2259. 10.1111/jocn.14058 PubMed DOI PMC

Schmalenberg, C. , & Kramer, M. (2008). Essentials of a productive nurse work environment. Nursing Research, 57(1), 2–13. 10.1097/01.NNR.0000280657.04008.2a PubMed DOI

Schubert, M. , Aussserhofer, D. , Desmedt, M. , Schwendimann, R. , Lesaffre, E. , Li, B. , & De Geest, S. (2013). Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals – A cross sectional study. International Journal of Nursing Studies, 50(2), 230–239. 10.1016/j.ijnurstu.2012.09.016 PubMed DOI

Schubert, M. , Glass, T. R. , Clarke, S. P. , Aiken, L. H. , Schaffert‐Witvliet, B. , Sloane, D. M. , & De Geest, S. (2008). Rationing of nursing care and its relationship to patient outcomes: The Swiss extension of the international hospital outcomes study. International Journal of Quality and Health Care, 20(4), 227–237. 10.1093/intqhc/mzn017 PubMed DOI PMC

Schubert, M. , Glass, T. R. , Clarke, S. P. , Schaffert‐Witvliet, B. , & De Geest, S. (2007). Validation of the Basel extent of rationing of nursing care instrument. Nursing Research, 56(6), 416–424. 10.1097/01.NNR.0000299853.52429.62 PubMed DOI

Simunovic, V. J. , Zupanovic, M. , Mihanovic, F. , Zemunik, T. , Bradaric, N. , & Jankovic, S. (2010). In search of a Croatian model of nursing education. Croatian Medical Journal, 51(5), 383–395. 10.3325/cmj.2010.51.383 PubMed DOI PMC

Sist, L. , Contini, C. , Bandini, A. , Bandini, S. , Massa, L. , Zanin, R. , … Ferraresi, A. (2017). MISSCARE Survey‐Italian version: Findings from an Italian validation study. Igiene e Sanita Pubblica, 73(1), 29–45. PubMed

Ślusarska, B. , Zarzycka, D. , Dobrowolska, B. , Marcinowicz, L. , & Nowicki, G. (2018). Nursing education in Poland – The past and new development perspectives. Nurse Education in Practice, 31, 118–125. 10.1016/j.nepr.2018.05.010 PubMed DOI

Sochalski, J. (2004). Is more better? The relationship between nurse staffing and the quality of nursing care in hospitals. Medical Care, 42(Suppl. 2), 67–73. 10.1097/01.mlr.0000109127.76128.aa PubMed DOI

Tóthová, V. , & Sedláková, G. (2008). Nursing education in the Czech Republic. Nurse Education Today, 28(1), 33–38. 10.1016/j.nedt.2007.02.003 PubMed DOI

Tschannen, D. , Kalisch, B. J. , & Lee, K. H. (2010). Missed nursing care: The impact on intention to leave and turnover. The Canadian Journal of Nursing Research, 42(2), 22–39. PubMed

Van Fosson, C. A. (2017). Monthly variation of unfinished nursing care at the US Army Burn Center. The University of Texas at Austin. Dissertation Thesis. 190 p.

Yamaguchi, Y. , Inoue, T. , Harada, H. , & Oike, M. (2016). Job control, work‐family balance and nurses' intention to leave their profession and organization: A comparative cross‐sectional survey. International Journal of Nursing Studies, 64, 52–62. 10.1016/j.ijnurstu.2016.09.003 PubMed DOI

Zeleníková, R. , Gurková, E. , & Jarošová, D. (2019). Missed nursing care measured by MISSCARE survey – the first pilot study in the Czech Republic and Slovakia. Central European Journal of Nursing and Midwifery, 10(1), 958–966. 10.15452/CEJNM.2019.10.0002 DOI

Zúñiga, F. , Ausserhofer, D. , Hamers, J. P. , Engberg, S. , Simon, M. , & Schwendimann, R. (2015). The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross‐sectional study. International Journal of Nursing Studies, 52(9), 1463–1474. 10.1016/j.ijnurstu.2015.05.005 PubMed DOI

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