AIM: The aim of the study was to find differences in perceived reasons for implicit rationing of nursing care across hospital types and units. DESIGN: A descriptive multicentre study. METHODS: The study in 14 Czech acute care hospitals was conducted from September 2019 to October 2020. The sample consisted of 8316 nurses working in medical and surgical units. Items for rating the reasons for implicit rationing of nursing care were selected from the MISSCARE Survey. Nurses were asked to rate each item on a scale from 0 (a not significant reason) to 10 (the most significant reason). RESULTS: The most significant reasons for implicit rationing of nursing care were 'Inadequate number of staff', 'Inadequate number of assistive personnel' and 'Unexpected patient admission and discharge'. Most reasons were rated as more significant by nurses from non-university hospitals. Nurses from medical units perceived all reasons for implicit rationing of nursing care as more significant.

• Keywords
• hospital, implicit rationing of nursing care, nurse shortage, reasons,
• MeSH
• Humans MeSH
• Hospitals MeSH
• Nursing Care * MeSH
• Nursing Staff, Hospital * MeSH
• Health Care Rationing MeSH
• Cross-Sectional Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Studies performed in Central European countries showed a high prevalence of missed nursing care in various clinical settings before the COVID-19 pandemic. AIMS: The aim of the study was to investigate which domains of the work environment were significant predictors of missed nursing care activities in Czech hospitals during the COVID-19 pandemic. METHODS: A cross-sectional study was used. The RANCARE guideline and STROBE checklist were followed for reporting in the study. The sample consisted of 371 nurses from four acute care hospitals. The MISSCARE Survey and the Practice Environment Scale of the Nursing Work Index questionnaires were used to collect data. The data were analyzed using multiple linear and logistic regression analyses. RESULTS: Nurses reporting unfavorable environments consistently describe a higher frequency of episodes of missed care. Prevalence estimates of missed care in Czech acute care hospitals during the COVID-19 pandemic was predicted from the overtime work, the nurses' perception of the "Nursing foundations for the quality of care," and their satisfaction with their current position. CONCLUSIONS: Missed nursing care could be mitigated by improving the nurses' work environment. Domains of the nurse work environment are known as structural modifiable factors and their refinement could be a cornerstone for interventions to reduce the prevalence of missed nursing care. IMPLICATIONS FOR NURSING POLICY: Monitoring the conditions and aspects of the nurse work environment in hospitals and considering nurses' concerns about the work environment on an ongoing basis are important strategies for nurse supervision as well as for policymakers.

• Keywords
• COVID-19, hospitals, missed care, nurse work environment, nursing, quality of care,
• MeSH
• COVID-19 * epidemiology   MeSH
• Humans MeSH
• Hospitals MeSH
• Nursing Care * MeSH
• Pandemics MeSH
• Nursing Staff, Hospital * MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Background: Adverse events are indicators of patient safety and quality of care. Adverse events clearly have negative impacts on healthcare system costs. Organizational and unit characteristics are not very often studied in relation to adverse events. The aim of the study was to find the differences in the incidence of adverse events and healthcare-associated infections in hospitalized patients in Czech acute care hospitals according to type of hospital and type of unit. Methods: This cross-sectional multicentre study was conducted in 105 acute care medical and surgical units located in 14 acute care hospitals throughout the Czech Republic. The data on adverse events and healthcare-associated infections were reported monthly by nurse researchers. The data were collected from June 2020 to October 2020. Results: The incidence of healthcare-associated infections, pressure ulcers, and medication errors was significantly lower in large hospitals. Statistically significant differences have been further found between the incidence of pressure ulcers (<0.001), falls without injury (<0.001), and falls with injury (<0.001) in surgical and medical units. More pressure ulcers, falls without injury, and falls with injury have been reported in surgical units. Conclusion: The type of hospital and type of unit affected the incidence of adverse events at acute care hospitals. To reduce adverse events, a systematic adverse event measurement and reporting system should be promoted.

• Keywords
• adverse events, healthcare acquired infections, multicentre study, safety management,
• MeSH
• Patient Safety MeSH
• Pressure Ulcer * epidemiology   MeSH
• Incidence MeSH
• Humans MeSH
• Hospitals MeSH
• Cross-Sectional Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH