Contributing factors to missed nursing care: A systematic review with clinical implications for practice and patient safety

Objectives

Missed Nursing Care (MNC) is increasingly recognized as an indicator of care quality and a potential contributor to adverse events. This systematic review aimed to explore the correlation between MNC and adverse events in hospitalized patients across public and private settings.

Methods

A systematic review was conducted according to PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, CINAHL, Scopus, and TripDatabase between January and February 2025. Included studies were quantitative, published in English or Italian, and focused on acute hospital settings. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist; risk of bias was evaluated with ROBINS-I.

Results

Seven studies met the inclusion criteria, involving 13,619 nurses and 902 patients. Study designs included four cross-sectional, two observational (one correlational), and one secondary data analysis. Five studies reported a positive association between MNC and adverse events, while two found inverse or non-significant relationships. Common adverse outcomes included falls, infections, pressure ulcers, and medication errors.

Conclusions

Despite methodological heterogeneity and limitations—such as the use of non-validated tools or contextual differences—the evidence suggests a consistent association between MNC and adverse events. These findings underscore the importance of addressing missed care as a patient safety concern. Further longitudinal studies are needed to confirm causality and inform predictive models.

Implications for nursing practice

Recognition of the link between MNC and adverse events should prompt healthcare organizations to address care omissions through staffing optimization, safety culture, and clinical governance. Targeted interventions may reduce preventable harm and improve care quality.