Perceptions and experiences of missed nursing care among junior nurses: a qualitative study using reflexive thematic analysis
TL;DR
Junior nurses' experiences of missed nursing care are shaped by multidimensional influences at the individual, organizational, and external levels, and such efforts may help reduce missed nursing care and improve the quality and safety of nursing services.
Abstract
Background Missed nursing care is an important indicator of healthcare quality and patient safety. Junior nurses undergoing the transition from student to professional practitioner are particularly vulnerable to missed nursing care due to limited clinical experience, insufficient professional competence, and challenges in adapting to complex clinical environments. However, the multidimensional factors contributing to missed nursing care among junior nurses remain insufficiently understood. Methods A qualitative descriptive study was conducted involving 12 junior nurses with ≤3 years of clinical experience. Participants were recruited through purposive sampling. Data were collected using semi-structured, in-depth interviews and analyzed using Braun and Clarke's six-phase thematic analysis approach. This study aimed to explore junior nurses’ perceptions and experiences of missed nursing care and to identify the underlying factors contributing to its occurrence in clinical practice. Results Three overarching themes and eight subthemes emerged from the analysis. (1) Individual factors, including insufficient knowledge and clinical skills, psychological stress and challenges in professional role transition, and weakened professional responsibility; (2) Organizational factors, including inadequate staffing and excessive workload, deficiencies in quality management and supervisory support, and limited career development opportunities and incentive mechanisms; and (3) External environmental factors, including challenges associated with healthcare system transformation and increasing expectations from patients and family members. Participants reported that missed nursing care often resulted from the interaction of personal limitations, organizational constraints, and external pressures. Conclusions Junior nurses' experiences of missed nursing care are shaped by multidimensional influences at the individual, organizational, and external levels. Addressing missed nursing care requires comprehensive and multilevel interventions, including competency-based education, strengthened psychological and transition support, optimized nursing management systems, and enhanced institutional and social support. Such efforts may help reduce missed nursing care and improve the quality and safety of nursing services.