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When Care is omitted – new Research on a Taboo Topic

Registered nurses in hospitals often lack the time for nursing care activities, such as comfort or talk with patients or educating patients and relatives.

A study by the Institute of Nursing Sciences at the University of Basel shows that all European countries are affected, but variability in these and other important aspects of nursing care between and within countries was found. The results have been published in the journal "BMJ Quality & Safety".

Due to Budget constraints registered nurses are often confronted with difficult decisions: They have to decide which care activities they can offer to their patients and which to omit. Recent studies have analyzed this international phenomenon and revealed a correlation between omitted nursing care and increased patient mortality.

The Institute of Nursing Sciences at the University of Basel has for the first time conducted a study on the prevalence and nature of omitted nursing activities on general medical/surgical wards in acute care hospitals across Europe. Data analysis included responses of 33’659 nurses in 488 hospitals across twelve European countries, namely Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain and Switzerland. These survey data were originally collected for the international RN4CAST study (Nurse forecasting in Europe), which was funded within the European Union’s Seventh Framework Program.

Four out of thirteen care activities are left undone
Across Europe four out of thirteen nursing activities were omitted by healthcare professionals on average. However, high between-country and within-country variability was observed. The results show a similar pattern across Europe: Psychoeducational care (for example talking with patients or the education of patients and their relatives) were more often omitted than activities, such as the documenting and planning of care, patient monitoring, the turning of patients or administering medications on time.

"Although psychoeducational care activities have always been part of the core tasks of nursing our study demonstrates that they are often left undone due to limited resources and lack of time. Nurses give them lower priority, because they are time-consuming and the required time-effort is difficult to estimate", explains Dr. René Schwendimann, head of the Swiss research group.

Negative Influence on job satisfaction
Leaving nursing care undone is a taboo topic among healthcare professionals, since it potentially creates situations of moral and role conflict, which may erode job satisfaction and even increase job-related burnout. Thus, according to the authors, an open and honest discourse on this topic would be of great importance for health policy-makers and providers of health services to have.
Good management required
The study also showed that nursing care activities are omitted less often in hospitals with more favorable nurse work environments irrespective of national jurisdiction. The quality of the work environment is significantly influenced by aspects, such as the leadership skills of the nursing management, the teamwork between physicians and nurses and the amount nurses carry out non-nursing duties, such as cleaning.

"By optimizing the nurse work environment, the hospital management can help nurses avoid having to leave nursing care undone", says Schwendimann. However, current financial constraints on healthcare in many European countries could lead to greater prevalence of nursing care left undone. Regular surveys among the nurses could serve as a warning system to identify deficits early in the care process.

Original Citation
Ausserhofer, D., Zander, B., Busse, R., Schubert, M., De Geest, S., Rafferty, A., Ball, J., Scott, A., Kinnunen, J., Heinen, M., Strømseng, S., Moreno-Casbas, T., Kózka, N., Lindqvist, R., Diomidous, M., Bruyneel, L., Sermeus, W., Aiken, L., Schwendimann, R., on behalf of the RN4CAST consortium
Prevalence, patterns and predictors of nursing care left undone in European hospitals: Results from the multi-country cross-sectional RN4CAST study

BMJ Quality & Safety (2013) | doi: 10.1136/bmjqs-2013-002318

Further Information
Dr. René Schwendimann, University of Basel, Institute of Nursing Science, Tel. +41 61 267 09 19, Email:
Weitere Informationen:

Reto Caluori | Universität Basel
Further information:

Further reports about: BMJ Nursing Topic Maps healthcare professionals nursing care work environment

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