Monthly variation of unfinished nursing care at the US Army burn center
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Unfinished nursing care (UNC) is a problem of time scarcity and has been classified as an error of underuse. More than half of hospital nurses (52-98%) report leaving at least one element of care unfinished due to time scarcity. Relationships between UNC, nursing staff supply, and working conditions were identified in previous cross sectional studies at civilian hospitals; no studies occurred in the burn care or military environments. The purpose of this study was to identify the prevalence and patterns of UNC in relation to variations in nursing staff supply and working conditions at the US Army Burn Center. Registered nurses and licensed vocational nurses working at the 40-bed burn center were asked to complete a 50-item, paper survey once a month for six months. Administrative data related to nursing staff supply and working conditions (e.g., supply/demand ratio, patient turnover, and overtime paid) were collected. Descriptive statistics and multilevel modeling were used in the analysis. The mean response rate for the survey was 44.9% (n = 36-50). Cronbach’s alpha was .96-.98. Each month, 85.7%-100% of all nurses reported leaving at least one element of care unfinished. The mean composite score on the Perceived Implicit Rationing of Nursing Care instrument was 1.69-2.27. Elements of care most frequently left unfinished were: documentation of care, emotional support, and reviewing interdisciplinary documentation to inform nursing care. Elements of care least frequently left unfinished were: the provision of enteral/parenteral nutrition, monitoring patient safety, and having important conversations with staff, family, or the patient. Only nursing care hours provided by float staff significantly predicted nurse estimates of UNC, [beta] = .008, p < .05, R² = .021. These results indicated that the prevalence and patterns of UNC were consistent with findings in previous studies of UNC. This was first study to describe variations in UNC over time and the first to measure UNC in the burn and military environments. Implications for practice, policy, education, and research were discussed.