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Int J Nurs Stud. 2017 Oct;75:163-171. doi: 10.1016/j.ijnurstu.2017.08.003. Epub 2017 Aug 16.

Nurses' personal and ward accountability and missed nursing care: A cross-sectional study.

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School of Nursing, University of Haifa, Haifa, Israel. Electronic address:
School of Nursing, University of Haifa, Haifa, Israel.



Missed nursing care is considered an act of omission with potentially detrimental consequences for patients, nurses, and organizations. Although the theoretical conceptualization of missed nursing care specifies nurses' values, attitudes, and perceptions of their work environment as its core antecedents, empirical studies have mainly focused on nurses' socio-demographic and professional attributes. Furthermore, assessment of missed nursing care has been mainly based on same-source methods.


This study aimed to test the joint effects of personal and ward accountability on missed nursing care, by using both focal (the nurse whose missed nursing care is examined) and incoming (the nurse responsible for the same patients at the subsequent shift) nurses' assessments of missed nursing care.


A cross-sectional design, where nurses were nested in wards.


A total of 172 focal and 123 incoming nurses from 32 nursing wards in eight hospitals.


Missed nursing care was assessed with the 22-item MISSCARE survey using two sources: focal and incoming nurses. Personal and ward accountability were assessed by the focal nurse with two 19-item scales. Nurses' socio-demographics and ward and shift characteristics were also collected. Mixed linear models were used as the analysis strategy.


Focal and incoming nurses reported occasional missed nursing care of the focal nurse (Mean=1.87, SD=0.71 and Mean=2.09, SD=0.84, respectively; r=0.55, p<0.01). Regarding the focal nurse's assessment of his/her own missed nursing care, findings showed that, above and beyond nurses' overload and personal socio-demographic characteristics, higher personal accountability was significantly associated with decreased missed care (β=-0.29, p<0.01), whereas ward accountability was not (β=-0.23, p>0.05). The interaction effect was significant (β=-0.31, p<0.05); the higher the ward accountability, the stronger the negative relationship between nurses' personal accountability and missed nursing care. Similar patterns were obtained for the incoming nurses' assessment of focal nurse's missed care.


Use of focal and incoming nurses' missed nursing care assessments limited the common source bias and strengthened our findings. Personal and ward accountability are significant values, which are associated with lower missed nursing care, beyond scarce resources. Implementation of local and national education programs for nurses and managers, accompanied with empirical research, might increase personal and ward accountability, thereby decreasing missed nursing care. This might help to create a safety culture and reduce negative outcomes for patients, nurses, and organizations.


Missed nursing care; Nursing; Personal accountability; Ward accountability

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