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Nurses' Perceptions of Reasons for Missed Nursing Care in Hospitals: A Qualitative Systematic Review
Sara Mandahl Ellehave1,2, Siri Lygum Voldbjerg1,2,3, Rikke Jørgensen4,5
1Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.
Aim:
To identify and synthesise qualitative evidence on nurses' perceptions of reasons for missed nursing care in hospitals.
Design:
Systematic review of qualitative evidence.
Methods:
An extensive search of all relevant databases was conducted. Study selection, quality assessment, data extraction and meta-aggregation were performed independently by two reviewers according to the JBI guidelines for systematic reviews of qualitative evidence. Confidence in the findings was assessed using the ConQual approach.
Data Sources:
The electronic databases CINAHL, PubMed, Embase, PsychInfo, and Scopus were searched in January 2024 and repeated in May 2025.
Results:
Thirty-one studies from hospital settings worldwide were included following critical appraisal, with overall quality rated moderate to high. The studies contributed 168 findings, which were organised into 10 categories and three synthesised findings: Organisational and system-level factors influencing missed nursing care, Teamwork and cultural factors influencing missed nursing care, and Individual nurse- and patient-related factors influencing missed nursing care.
Conclusions:
Reasons for missed nursing care represent an interplay of systemic, organisational, and individual factors within complex resource-constrained contexts.
Implications For The Profession And/Or Patient Care:
Healthcare organisations are recommended to implement system-level interventions, rather than relying solely on behaviour-focused solutions. Healthcare leaders should ensure flexible staffing, strong managerial support, and adequate resources to enable fundamental care. Building collaborative, interprofessional cultures that value relational and fundamental care as well as technical tasks is essential, together with education and mentorship that support nurses' decision-making, resilience, and clinical competence.
Impact:
Hospital leaders, policymakers, and nurse managers can use the recommendations to reduce missed nursing care and promote a safe person-centred practice. Implementing systemic changes will improve nurses' working conditions and capacity to deliver comprehensive care, ultimately enhancing patient satisfaction and outcomes.
Reporting Method:
The 'enhancing transparency in reporting the synthesis of qualitative research statement'.
Patient Or Public Contribution:
No patient or public involvement.
Trial And Protocol Registration:
The review is registered in the International Prospective Register of Systematic Reviews. PROSPERO CRD42023438198 (https://www.crd.york.ac.uk/PROSPERO/search).
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