Missed Nursing Care in the Emergency Department: A Qualitative Interview Study

Emergency departments are high-risk settings for missed nursing care, which jeopardizes patient safety and nurses' physical and mental well-being. However, specific manifestations, multifaceted factors, and consequences of missed nursing care in emergency departments require further investigation. This study aims to explore the manifestations, multifaceted factors, and consequences of missed nursing care in the emergency department to guide quality improvement.

Semistructured interviews were conducted from December 2025 to February 2026, with participants recruited via purposive sampling. The sample comprised 5 emergency nursing leaders, 14 emergency clinical nurses, and 5 emergency patients. Interview data were sorted and coded in NVivo 12 and analyzed following Colaizzi's 7-step phenomenological approach to extract core themes.

The analysis identified 9 themes and 34 subthemes, systematically revealing the manifestations, causes, and impacts of missed nursing care in the emergency department. Missed nursing care content included: time-sensitive interruptions to critical care and life support; challenges and omissions in fundamental and therapeutic nursing care; and rigidity of assessment, observation, and documentation. Contributing factors were categorized into system and resource factors, team and individual nursing factors, and patient and clinical characteristics. Participants reported consequences affecting patients, nurses, and hospitals.

Missed nursing care in the emergency department represents a multifaceted phenomenon driven by multifactorial causes specific to the emergency context. Given its severe clinical consequences, clinical leaders must implement targeted interventions to address the root causes of missed nursing care, thereby safeguarding patient safety and improving nursing practice.