Relationships between nurse-patient assignment, perceived nursing workload, and missed care among intensive care unit...

Missed care is a key indicator of nursing care quality and has been associated with nursing workload. However, little is known about whether nursing workload affects specific nursing activities in intensive care units (ICUs). This study examined the association between nurse-patient assignment and perceived nursing workload among ICU nurses and investigated the associations between perceived workload and missed care activities.

This cross-sectional study analyzed survey data collected between June 27 and November 13, 2025, from 155 nurses working in adult ICUs in South Korea. Nurse-patient assignment was assessed using the number of assigned patients and satisfaction with assignments. Perceived workload was measured using the National Aeronautics and Space Administration Task Load Index, and missed care was measured using the revised MISSCARE Survey. Missed care activities were classified into five domains, comprising four direct care domains and one indirect domain, with a total of 25 individual activities. Multivariable linear regression analyses examined associations among assignment, perceived workload, and overall and domain-specific missed care. Multivariable logistic regression analyses examined associations between perceived workload and individual missed care activities.

Nurses were assigned an average of 2.0 patients, and the mean overall nursing workload score was 61.9 out of 100. Nurses assigned two patients reported higher perceived workload than those assigned one; however, nurses assigned three or more patients did not report higher workload than those assigned one. Perceived workload was not associated with overall missed care or any missed care domain. Among the individual missed care activities, higher workload was associated only with increased odds of missing "Full documentation of all necessary data" (odds ratio = 1.04, 95% confidence interval = 1.01-1.07).

Perceived workload did not increase consistently with the number of patients per nurse and was not associated with overall missed care. However, higher workload was associated with a small increase in the odds of missed documentation in item-level analyses. These findings suggest that examining individual nursing activities improves understanding of workload-related missed care.