Missed nursing care in the critical care unit, before and during the COVID-19 pandemic: A comparative cross-sectional study

OBJECTIVES: To describe and evaluate reported missed nursing care in the critical care context during different phases of the COVID-19 pandemic in Sweden. RESEARCH METHODOLOGY: A comparative cross-sectional design was used, comparing missed nursing care in three samples: before the COVID-19 pandemic in 2019, during the second wave of the pandemic in spring 2020, and during the third wave of the pandemic in fall 2021. SETTING: The study was conducted at critical care units at a university hospital, Sweden. MAIN OUTCOME MEASURES: The MISSCARE Survey-Swedish version was used to collect data along with two study-specific questions concerning perception of patient safety and quality of care. RESULTS: Significantly more overtime hours and number of days absent due to illness were reported during the pandemic. The nurse/patient ratio was above the recommended level at all data collection time points. Most missed nursing care was reported in items concerning basic care. The most reported reasons for missed nursing care in all samples concerned inadequate staffing, urgent situations, and a rise in patient volume. Most nurses in all samples perceived the level of patient safety and quality of care as good, and the majority had no intention to leave their current position. CONCLUSION: The pandemic had a great impact on the critical care workforce but few elements of missed nursing care were affected. To measure and use missed nursing care as a quality indicator could be valuable for nursing managers, to inform them and improve their ability to meet changes in patient needs with different workforce approaches in critical care settings.