Smart decisions, strong teams: Reducing missed nursing care in emergency nursing

In emergency settings, effective clinical decision-making and teamwork play crucial roles in delivering safe, high quality nursing care. Because the likelihood of missed nursing care increases under critical conditions, this study aimed to examine the relationship between clinical decision-making and teamwork with missed nursing care among emergency nurses.

This cross-sectional descriptive correlational study was conducted in 2025 among 289 nurses working in the emergency departments of hospitals affiliated with Alborz University of Medical Sciences. Data were collected using a demographic questionnaire, the clinical decision-making questionnaire (Lauri et al., 2001), the TeamSTEPPS teamwork perception questionnaire (Keebler et al., 2014), and the missed nursing care Questionnaire (Kalisch et al., 2009).

Of the nurses, 60.9% were female. Interpretive-intuitive decision-making was the most common decision-making style (47.1%). Most nurses demonstrated acceptable teamwork (74.7%) and low levels of missed nursing care (82.7%). Teamwork (p < .001, β = -3.69) and clinical decision-making (p < .001, β = -0.36) were inversely associated with missed nursing care. Work experience was positively correlated with clinical decision-making (p < .001, r = 0.349) and teamwork (β = 0.049, SE (β) = 0.01, p < .001, R²_adj = 0.149). Work experience was also significantly and negatively correlated with missed nursing care (p < .001, r = -0.516).

The findings indicate that in emergency departments, higher levels of clinical decision-making and teamwork are significantly associated with lower levels of missed nursing care. To achieve a more comprehensive understanding of the variables studied, future research using mixed quantitative and qualitative methods are recommended.