Beatrice J Kalisch

• PhD
• Professor at University of Michigan

Introduction Teamwork is identified as a key contributor to patient safety and good teamwork is recognized as one of the presumptions of healthy work environment in nursing. The importance of job satisfaction in nursing has repeatedly been confirmed, but only recently has the association of job satisfaction and nursing teamwork been identified. Ob...

Background An acceptable, reliable, and valid survey instrument to measure missed nursing care in perioperative settings has not been developed. Purpose To develop and conduct psychometric testing of the MISSCARE Survey OR . Methods Data were collected nationwide from 1,693 operating room (OR) nurses who completed the MISSCARE Survey OR . The sur...

Aims and objectives This study aimed to identify and compare missed nursing care types and reasons between South Korea and the United States of America. Background Patient safety has become a significant task of the healthcare delivery systems worldwide. The omission of nursing care constitutes a growing concern because it threatens both patient s...

Missed nursing care is a concern on inpatient hospital units but has not been adequately explored in the perioperative setting. This cross‐sectional study used results from a survey of 1,693 AORN members to investigate the amount and type of missed perioperative nursing care and evaluate associations between reported missed care and facility and nu...

Aim The purpose of this study is to describe the association of missed nursing care and the determinants of satisfaction with current position for direct care nurses. Background Missed nursing care and job satisfaction are important issues regarding quality patient care and safety in health care, globally. Method This was a cross‐sectional quanti...

Background: The satisfaction of parents of infants in neonatal intensive care is important to parent-infant bonding and parents' ability to care for their baby, including after discharge. Given the principal caregiver role of nurses in this setting, parent satisfaction is influenced by high quality nursing care. Nursing care that is required but mi...

Background: Missed nursing care has been recognized as a universal patient care issue that affects outcomes for patients, nurses, and healthcare institutions. The MISSCARE Survey was developed to measure and determine the reasons for missed nursing care episodes. An extensive literature review and expert nurse opinion revealed five additional reas...

Aims and objectives The purpose of this study was to examine the extent to which staffing adequacy predicts nursing teamwork, controlling for demographic and background variables. Background Findings from former studies indicate that hospital, unit and staff characteristics may be related to nursing teamwork, such as type of hospital and unit, rol...

The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses ( N = 5,861) from the National Dat...

Aim: To determine factors associated with nurses’ intent to leave their positions and absenteeism. Background: There is a recognized global shortage of nurses but limited data describ‐ ing and determining factors associated with nurse absenteeism and intent to leave. Methods: This study involved a secondary analysis of the results from direct‐care...

Aim Develop and test the validity and reliability of MISSCARE Survey‐Ped adapted from previous versions of the MISSCARE Survey, which measures omitted nursing activities and the reasons why they were left undone. Our secondary aim was to pre‐test the construct validity using Exploratory Factor Analysis. Background Missed Nursing Care is described...

Background Missed nursing care is an error of omission defined as standard, required nursing care that is not completed or is seriously delayed. Study findings from around the world show that missed nursing care is a global concern. Purpose The purpose of this study was to compare reports of missed nursing care by two types of nurses – registered...

Objective: to analyze the metric validity and reliability properties of the MISSCARE-BRASIL survey. Method: methodological research conducted by assessing construct validity and reliability via confirmatory factor analysis, known-groups validation, convergent construct validation, analysis of internal consistency and test-retest reliability. The s...

Aims and objectives: To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals. Background: A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted, or significa...

The purpose of this study was to test the psychometric properties of the Nursing Teamwork Survey-Icelandic (NTS-Icelandic), which was translated from US English to Icelandic. The Nursing Teamwork Survey, with 33 items, measures overall teamwork and five factors of teamwork: trust, team orientation, backup, shared mental models, and team leadership....

In this chapter, the concept of missed nursing care and studies that show the prevalence and type of nursing care that is left undone were reviewed. From this research, it can be concluded that the problem of missed nursing care is extensive and widespread. Particular areas of care tend to be missed more often than others (i.e., ambulation, interdi...

In this chapter, we reviewed the reasons for missing nursing care: lack of nursing staff resources; lack of material resources (including medications); communication and teamwork issues; interruptions; multitasking, and task switching; fatigue, and physical exhaustion; cognitive biases; lack of patient and family engagement; lack of human resources...

In this chapter, the reports of missed nursing care by RN's were compared to those reports by NAs. The perceptions of missed care were similar between RNs and NAs for only 3 of 24 elements of care (two RN-only responsibilities and one NA-only responsibility; i.e., PRN medication requests addressed within 15 minutes, focused reassessments according...

The findings of this study highlight the value of hospital nursing organizations working toward and achieving Magnet status. It appears that the level of staffing in a hospital is an important but not sufficient element in achieving excellence in nursing care. It is critical that nursing organizations work toward the creation and maintenance of str...

In this chapter, the results of an international study of missed nursing care in seven countries are reported. There were significant differences in the total amount of missed nursing care among the countries with Italy reporting the most missed care. Inadequate staffing resources was the top reason for missed care reported by RNs across the countr...

In this chapter, we described the care that OR nurses provide to patients and the safety implications of not completing that care. Using the Preoperative Safety Bundle made up of six required actions (allergies checked, patient identified, operative consent, health and physical completed, site marked, and time-out performed), we studied a number of...

Contained in this chapter are summaries of several studies of patient-reported missed nursing care. First, the result of a qualitative study with the aim to determine what elements of missed nursing care can be reported by patients showed that there are fully reportable, partially reportable, and not reportable elements of nursing care. In this stu...

Although there have been numerous studies (noted in previous chapter) which link staffing levels with patient outcomes, there has been less research that explains why these linkage exist. Findings of this study explain, at least in part, what is occurring within the process of providing nursing care. It reveals the fact that certain aspects of nurs...

Patient engagement as a strategy to decease missed nursing care was the subject of this chapter. Positive outcomes and barriers to patient engagement, along with specific strategies to overcome these issues, are described. These include: liberal visitation, interdisciplinary rounds at the patient's bedside, including family members in rounds, provi...

In this chapter, research on the consequences of not providing nursing care are summarized. Overall missed nursing care has been shown to result in an increase in patient falls and the adverse events of skin breakdown and pressure ulcers, medication errors, new infections, IVs running dry, and IVs infiltrating. The impact of missing specific elemen...

Nursing teamwork was the focus of this chapter. We started with the results of two qualitative studies to determine what teamwork looks like (specific behaviors of teamwork) and found that the Salas framework is applicable to nursing teams. The development of a nursing teamwork survey (Nursing Teamwork Survey) to measure the level of teamwork was d...

This chapter contains a discussion of organizational culture and leadership styles that promote safety and are needed to reduce missed nursing care. The change process and strategic planning are explained as methods to systematically change a culture to the desired safe, quality-oriented one. Transactional and transformational leadership styles are...

Missed nursing care predicts nursing staff satisfaction and intent to leave. The more nursing care that is missed, the lower the rates of satisfaction with their current position and with their occupation and the higher their intent to leave. Potential theories (i.e., relational job design theory, moral distress, compassion fatigue, and burnout) th...

Strategies for enhancing teamwork are examined in this chapter, including the redesign of patient units, team training, and making changes in the model of nursing care delivery. Because the most critical forms of communication in hospitals are handoffs, methods for improving these processes are presented.

As technology improvements and advancements continue, they will be implemented in the clinical setting at a rapid pace. Extensive research will be needed to determine the impact of these technologies on nursing practice, quality of care, and safety. Interoperability of HIT is a national priority, and as such, future technologies must be able to int...

To report additional mediation findings from a descriptive cross sectional study to examine if nurses' perceptions of the impact of healthcare information technology on their practice mediates the relationship between electronic nursing care reminder use and missed nursing care. The study used a descriptive design. The sample (N = 165) was composed...

The aim of this study is to report the results of a replication study of the relationship between self-reported nursing care reminder (NCR) use and missed nursing care. A descriptive cross-sectional correlational design was used. The sample (N = 124) was composed of medical/surgical and ICU RNs working on acute care hospital units in a large Midwes...

A total of 729 inpatients were surveyed using the MISSCARE Survey-Patient. Missed timeliness, patient reports of the time it took for them to receive care from nursing staff, was negatively associated with total nursing staff hours of care per patient-day (r = -0.09, P = .015), registered nurse (RN) hours per patient-day (r = -0.14, P = .0002), and...

Little is known regarding nurses' usage of clinical decision support systems. A review of the literature was conducted to understand the extant knowledge surrounding the topic of nurses' usage of clinical decision support systems. The common themes that emerged from the review of literature on clinical decision support systems usage by nurses inclu...

Learn how to define, identify, and ultimately avoid missed nursing care within your organization.

The purpose of the study was to explore relationships between nurses' perceptions of the impact of health information technology on their clinical practice in the acute care setting, their use of electronic nursing care reminders, and episodes of missed nursing care. The study aims were accomplished with a descriptive design using adjusted correlat...

Background Missed nursing care, required standard care that is not provided, is a relatively new concept in nursing, and prior to this study, it had not been discussed in Iceland. AimTo successfully translate the MISSCARE Survey from US English to Icelandic. Method The translation and psychometric testing of the MISSCARE Survey-Icelandic was comple...

The aim of this study was to examine the relationship between staffing and job satisfaction of registered nurses (RNs) and nursing assistants (NAs). Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that u...

A series of studies on missed nursing care (i.e., required standard nursing care that is not completed) is summarized. Missed nursing care is substantial and similar levels are found across hospitals. Reasons for missed nursing care are staffing resources, material resources, and communication and these are also similar across hospitals. The higher...

The purpose of this study was to test the use of virtual simulation to improve teamwork among nursing staff. Using a quasi-experimental design, nursing staff (n = 43) from one patient care unit participated in a 1-hr session, which focused on common nursing teamwork problems. The overall mean teamwork scores improved from pre- (M = 3.25, SD = 0.58)...

The objective of this study was to investigate the association between shift level nurse staffing, and survival to discharge for patients sustaining an in-hospital cardiac arrest (IHCA). In many instances, the most likely first responder to witness IHCA and provide needed treatment is the registered nurse. Delays in treatment are associated with de...

Teamwork is essential for patient safety and results in less missed nursing care. The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care. This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and...

To review current research evidence on the outcomes of mobilising hospitalised adults. Although immobility is known to cause functional decline or complications, inpatient ambulation emerged as the most often missed element of nursing care. This study is designed to review research studies that give evidence as to the consequences of mobilising or...

The aim of this study was to determine the extent and type of missed nursing care as reported by patients and the association with patient-reported adverse outcomes. A total of 729 inpatients on 20 units in 2 acute care hospitals were surveyed. The MISSCARE Survey-Patient was used to collect patient reports of missed care. Patients reported more mi...

Missed nursing care refers to omission of standard required nursing care of patients in acute care hospitals. The objective of this study was to compare the amounts and reasons of missed nursing care, the level of nurse staffing, and job satisfaction between the United States and Lebanon. Several studies in the United States have shown that a signi...

The aims of this methodological research were to culturally adapt the MISSCARE Survey instrument to Brazil and analyze the internal consistency of the adapted version. The instrument consists of 41 items, presented in two parts. Part A contains 24 items listing elements of missed nursing care. Part B is comprised of 17 items, related to the reasons...

The aim of this exploratory study was to determine whether the level of nursing teamwork is correlated to call light answering time in acute care hospital patient care units. Background: Teamwork has been shown to improve productivity. In this study, we examine the relationship between unit call light response time as a measure of productivity and...

This article examines literature that provides evidence about the safety of mobilizing hospitalized adults. A search of electronic databases and hand searches yielded 24 studies that were included in the review. Evidence of mobilization safety was found in 4 clinical settings (medical, surgical, cardiac procedure, and intensive care), and the findi...

Background: Missed nursing care influences the quality of hospital care, yet this problem has not been explored in the oncology setting, nor are the correlates of missed nursing care in inpatient oncology settings understood. Objective: We examined the frequency of missed care in oncology units, differences in missed care between oncology and no...

The objective of this study was to test the congruence of the perceptions of unit-based nurse leaders (managers, advanced practice nurses) and nursing staff members (registered nurses, nursing assistants, unit secretaries) in acute care hospitals as to the extent and type of missed nursing care and nursing teamwork. Based on the leader-member excha...

Challenging the belief that each patient should be cared for by just one nurse.

The objective of this study was to examine whether the amount, type, and reasons of missed nursing care differ between Magnet and non-Magnet hospitals. Data were collected from 124 medical-surgical, intermediate, intensive care, and rehabilitation units in 11 hospitals located in the Midwest and Western regions of the United States. A cross-section...

A series of studies involving nursing staff perception have shown that a significant amount of standard nursing care is being "missed"-that is, aspects of required patient care are omitted or significantly delayed. A study was conducted to (1) determine the elements of nursing care that patients are able to report on and (2) to gain insight into th...

The aim of this study is to determine the relationship between the team and unit size and level of nursing teamwork. The sample for the study was 2,265 direct care nursing providers from 53 units in four hospitals. Pearson correlation coefficients were calculated to determine if five variables to measure unit size (average daily census, number of r...

The aim of this cross-sectional study was to examine the relationship among hospital, patient units, and staff characteristics and nursing teamwork. Using multiple linear regression analysis, we found that nursing role, shift, absenteeism, perceived adequacy of staffing, and unit type were significant predictors of teamwork.

: In a previous study, the nursing staff on 110 patient care units in 10 hospitals participated in a quantitative study of missed nursing care. : The aim of this study was to gain an understanding of the differences in patient care units that had the most missed nursing care with those with the least missed nursing care. : Focus groups were conduct...

One measure of the process of nursing care is missed nursing care, which refers to any aspect of required care that is omitted either in part or in whole or delayed. Little is understood about how the quality and processes of nursing care differs among countries around the world. The aims of this study were (a) to test the psychometric properties o...

Evidence points to the omission of required nursing care as a pervasive problem in acute care hospitals. Labor and material resource constraints, increasing patient complexity, ineffective delegation, and poor communication have been identified as contributing factors. Nurse executives should examine the degree and causes of missed care in their or...

Patient falls in hospitals continue to be a major and costly problem. This study tested the mediating effect of missed nursing care on the relationship of staffing levels (hours per patient day [HPPD]) and patient falls. The sample was 124 patient units in 11 hospitals. The HPPD was negatively associated with patient falls (r = -0.36, P < .01), and...

Researchers frequently use nurse staffing measures to examine hospital quality of care. Measure choices include nurse-reported perception of staffing adequacy, nurse-reported patient workloads, and empirically derived hours per patient day (HPPD). To examine the correlations across these measures and identify factors associated with these staffing...

Quality of nursing care across hospitals is variable, and this variation can result in poor patient outcomes. One aspect of quality nursing care is the amount of necessary care that is omitted. This article reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n...

To examine whether actual nurse staffing predicts missed nursing care, controlling for other unit characteristics. This study utilized a cross-sectional, descriptive design. Ten hospitals in the Midwestern region of the USA. Nursing staff members with direct care responsibilities (n = 4288) on 110 care units. The MISSCARE Survey was utilized to cap...

To determine if nurse staffing predicts teamwork. A cross-sectional, descriptive design with a sample of nursing staff (N = 2,545) on 52 patient care units in four hospitals was utilized. The Nursing Teamwork Survey was utilized to collect data on the level of perceived nursing teamwork on each of the study units. In addition, nursing staffing data...

This study explores the impact of missed nursing care (required patient care that is omitted) on job satisfaction of nursing personnel. Data from 3,135 registered nurses (RNs) and 939 nursing assistants (NAs) on 110 patient care units in ten midwestern hospitals revealed that nursing staff who perceived less missed nursing care on the patient care...

The purpose of the study was to examine the relationship between missed nursing care, nurse turnover, and intention to leave. A cross-sectional study using the MISSCARE Survey was conducted. The sample comprised 110 patient-care units in 10 acute-care hospitals. Staffing data, turnover rates, and unit-level Case Mix Index were collected from the pa...

The purpose of the study was to examine the relationship between missed nursing care, nurse turnover, and intention to leave. A cross-sectional study using the MISSCARE Survey was conducted. The sample comprised 110 patient-care units in 10 acute-care hospitals. Staffing data, turnover rates, and unit-level Case Mix Index were collected from the pa...

kalisch bj, lee h & rochman m. (2010) Journal of Nursing Management 18, 938–947 Nursing staff teamwork and job satisfaction Aim The aim of the present study was to explore the influence of unit characteristics, staff characteristics and teamwork on job satisfaction with current position and occupation. Background Teamwork has been associated with a...

Previous studies have shown that missed nursing care is a significant problem in acute care hospitals. Other studies have demonstrated that teamwork is a critical element in assuring patient safety and quality of care. The purpose of this study was to determine if the level of nursing teamwork impacts the extent and nature of missed nursing care. A...

The environment surrounding registered nurses (RNs) has been described as fast-paced and unpredictable, and nurses' cognitive load as exceptionally heavy. Studies of interruptions and multitasking in health care are limited, and most have focused on physicians. The extent and type of interruptions and multitasking of nurses, as well as patient erro...