Examining the Relationship Between Hospital Nurses' Structural Empowerment, Missed Nursing Care and Quality of Care: A Cross‐Sectional Study

ABSTRACT

Aim

To examine relationships between structural empowerment, missed nursing care and quality of care among hospital-based, direct-care nurses.

Design

Cross-sectional study.

Methods

A convenience sample of 161 nurses completed the Conditions for Work Effectiveness-II Questionnaire, the MISSCARE and a single-question rating of quality of care. Correlation, T-tests, regression and ANOVA were used to analyse data.

Results

Nurses reported high structural empowerment (total CWEQ-II = 22.8). Higher empowerment was significantly correlated with less missed care. Most nurses (77.7%) worked at Magnet hospitals; however, no difference in missed care was found between Magnet and non-Magnet nurses. The average number of patients on the last shift was 5.1. The number of patients cared for was not significantly correlated to missed care; however, nurses' perceptions of better staffing adequacy, teamwork and job satisfaction were. Nurses who intended to leave (25.5%) missed more care. Intention to leave and access to resources predicted missed care.

Conclusion

This appears to be the first study examining the relationship between structural empowerment and missed care, demonstrating that higher empowerment was related to greater nurse work effectiveness and improved care delivery. Work environment factors, specifically subjective perceptions of staffing and resource adequacy, were linked to missed care, while nurse–patient ratio was not. Subjective factors may contribute more to missed care than is recognised.

Implications

Creating and sustaining empowering work environments, ensuring resource adequacy and enhancing factors that promote retention may reduce missed care. No patient/public contribution.

Financial Conflicts of Interest

None.

Reporting Method

STROBE checklist for cross-sectional studies.