Linking the work environment to missed nursing care in labour and delivery

Aim To measure the association between the nurse work environment (NWE) and missed nursing care on labour and delivery (L&D) units. Background L&D units provide a sizable fraction of acute hospital services to a unique population that is a national and global priority. L&D nurses are the frontline providers during labour. Maternal morbidity and mortality may be influenced by the NWE and missed care. Methods This cross-sectional study utilized secondary data from 1,313 L&D staff nurses in 247 hospitals from a four-state nurse survey collected in 2005-2008. Results Half of nurses missed care (range: zero to 100% across hospitals). Nurses on average missed 1.25 of 10 activities. The most commonly missed activities were comforting/talking with patients and teaching/counselling. In better as compared to poor NWEs, the odds and frequency of missed care were significantly lower. Conclusions L&D nurses routinely miss necessary nursing activities. Labouring women's psychosocial, comfort and educational needs are compromised most often, likely impacting quality and outcomes. Nurse communication with colleagues and managers about missed care is warranted. Implications for Nursing Management The L&D NWE is modifiable and appears to influence missed care. Managers should discuss missed care with staff and measure their NWE to identify actionable weaknesses.