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Aims and Objectives: To characterise the problem of missed nursing care in Chilean hospitals and to test associations with hospital organisational variables., Background: Missed nursing care is a common problem in different countries, but it has not been studied in Chile., Design: Multihospital cross-sectional study (Supplementary file 1: STROBE guideline)., Methods: Study population of 45 adult high-complexity hospitals and 1853 registered nurses (RN) working on medical-surgical units. Primary data were collected through a nurse survey. Nurses reported, out of a list of nursing care activities, the ones left undone during their last shift. The main independent variables were the work environment, measured through the Practice Environment Scale of the Nursing Work Index, patient-to-nurse ratios and RN skillmix. Adjusted logistic regression analyses were used to test associations, accounting for clustering of nurses working in the same hospital., Results: The hospital response rate was 88.9% and, for nurses, 88.1%. The mean patient-to-nurse ratio was 14.5 (range 6-23). The average skillmix was 31% RN. Eighty-six percent of nurses missed at least one activity. The activities most frequently missed included patient education, comforting patients and surveillance. The adjusted model showed a significant association between the work environment, staffing ratios and missed care. The RN skillmix was not associated., Conclusions: Missed care is highly prevalent problem in Chilean hospitals. Clinical activities were the least missed. It is necessary to improve work environments and reduce the number of patients per nurse to improve the safety and quality of care., Relevance for Clinical Practice: The study results are relevant since they provide new data to Chile. Better work environments and adequate human resources are modifiable factors that can be addressed from a managerial perspective, with low-cost strategies to effectively reduce missed care and improve safety and quality., (© 2021 John Wiley & Sons Ltd.)

Aims and Objectives: To assess the nursing practice environments and nurse job-related outcomes in two types of hospitals in Saudi Arabia., Background: The nursing shortage is a challenging problem in Saudi hospitals. Studies have shown that poor practice environments and high patient-to-nurse ratios are associated with poor nurse job outcomes (i.e. job dissatisfaction, burnout and intention to leave) and that can lead to nurse turnover and compound the nursing shortage. However, little research has been conducted on this topic in Saudi Arabia., Design: A cross-sectional design. A model that links the nursing practice environment and patient-to-nurse ratio to nurse job outcomes was tested through a path analysis of survey data., Methods: A sample of 404 nurses from public and military hospitals in Saudi Arabia completed a survey that included the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory and questions related to job dissatisfaction and intention to leave the job. A model of nurse turnover was used to test the relationships among study variables. This study was carried out in accordance with the STROBE checklist for cross-sectional studies., Results: The nursing practice environment and nurse job outcomes were better in military hospital compared with public hospital. Overall, 53% of participants had high burnout, 39% were dissatisfied, and 26% intended to leave their jobs. The path analysis showed that the nursing practice environment and patient-to-nurse ratio were predictors of burnout and job dissatisfaction, which in turn lead to intention to leave. The tested model had good fit and explained the direct and indirect effects of study variables., Conclusion: Poor nursing practice environments and high patient-to-nurse ratios contribute to poor nurse job outcomes in Saudi hospitals., Relevance to Clinical Practice: Nurse leaders can focus on enhancing practice environments and reducing patient-to-nurse ratios as retention strategies to improve nurse job outcomes., (© 2020 John Wiley & Sons Ltd.)

Aim: To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals., Background: Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes., Design: Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US., Methods: Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment., Results: The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event., Conclusion: The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals., Relevance to Clinical Practice: The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery.