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Nursing Home Nurses Often Unable to Complete Necessary Care Due to Lack of Time and Resources

For years, extensive evidence from hospitals has shown that nurses are more likely to leave necessary patient care undone when employed in settings with insufficient staff and resources.  This “missed care” has been linked to poor care quality, increased adverse events, and decreased satisfaction with the health system.  New research – from Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR) – finds similar evidence in nursing homes specifically, and identifies the strong relationship between missed care, nurse burnout, and job dissatisfaction. 

The CHOPR team used data from 540 nursing homes in California, Florida, New Jersey, and Pennsylvania to examine the relationship between job burnout/dissatisfaction and incidence of missed care reported by registered nurses (RNs). The results have recently been published in the Journal of the American Geriatrics Society (JAGS)

The researchers found that 72 percent of RNs reported missing one or more necessary care tasks on their last shift due to lack of time or resources. One in five RNs reported frequently being unable to complete necessary patient care. The activity most often skipped: comforting/talking with patients, followed by performing adequate patient surveillance, teaching patients and families, and developing care plans. 

Missed care was significantly more common among nursing home RNs who were dissatisfied with their jobs or experiencing burnout. Across all RNs, 31 percent were dissatisfied, and 30 percent exhibited burnout. Nurses with burnout were five times more likely than their colleagues to miss needed care, whereas RNs who were dissatisfied were 2.6 times more likely to miss care than RNs who were satisfied with their jobs.

The team discussed how organizational factors contribute to missed care and clinician well-being. They note that “work environments that provide adequate staff and resources, involve RNs in quality improvement processes, and support RNs through career pathways and leadership opportunities could help to promote employee engagement, reduce missed care, and improve patient safety in nursing homes.” Additionally, the researchers emphasize that creating a culture emphasizing the need to find a root-cause for systemic problems, rather than punishing staff for individual mistakes, can help identify organizational inefficiencies that result in missed care. 

While the data did not establish a causal link between burnout, job dissatisfaction, and missed care, the researchers point to a rich body of existing evidence that “RNs are more satisfied and experience less burnout when they have adequate staff and resources, supportive managers, productive colleague relationships, input into organizational affairs, and opportunities for advancement.” Even under tight fiscal constraints, the researchers observe, “nursing home leaders can take steps to improve work environments through a variety of evidence-based interventions.”