The impact of clinical nursing work environment, moral sensitivity, and humanistic care ability on missed nursing care: A longitudinal study

Missed nursing care is a widespread issue in clinical practice and represents a global challenge. Reducing missed nursing care is crucial for improving care quality and implementing high-quality nursing services. This study conducted a longitudinal survey among clinical nurses to investigate the impact and underlying mechanisms of the nursing work environment, moral sensitivity, and humanistic care ability on missed nursing care, aiming to provide theoretical evidence for optimizing the work environment and enhancing nursing quality.

From October 2024 to April 2025, a longitudinal survey was conducted at three time points among 989 clinical nurses using the Nursing Work Environment Scale, Missed Nursing Care Scale, Moral Sensitivity Questionnaire, and the Nurse Humanistic Care Ability Scale. A total of 902 valid responses were included in the final analysis. Structural equation modeling and mediation pathway analysis were performed using AMOS 26.0, and data analysis was conducted using SPSS 25.0.

The mean score of missed nursing care among clinical nurses was 43.10 ± 15.87. The clinical nursing work environment was negatively correlated with missed nursing care (r = -0.502, P < 0.01), and positively correlated with both moral sensitivity (r = 0.241, P < 0.01) and humanistic care ability (r = 0.312, P < 0.01). Moral sensitivity was positively correlated with humanistic care ability (r = 0.228, P < 0.01) and negatively correlated with missed nursing care (r = -0.430, P < 0.01). Furthermore, humanistic care ability was negatively correlated with missed nursing care (r = -0.526, P < 0.01). Moral sensitivity and humanistic care ability served as a chain mediating pathway between the nursing work environment and missed nursing care (β = -0.015, P < 0.001), and the overall model demonstrated good fit indices.

The clinical nursing work environment is a key factor influencing missed nursing care. Moral sensitivity and humanistic care ability among nurses act as a mediating mechanism linking the nursing work environment to missed nursing care. Therefore, healthcare administrators may consider strengthening nurses' moral sensitivity and humanistic care capacity as strategic entry points for developing targeted interventions to reduce missed nursing care.