Labor and Delivery Nurse Perceptions of Patient Safety Linked to Missed Nursing Care

January 19, 2023

Researchers at NYU Rory Meyers College of Nursing have found a connection between labor and delivery nurses’ perceptions of patient safety on their units and missed nursing care, or tasks that are delayed or not completed. Their findings are published in the Journal of Patient Safety.


A growing body of research suggests that workplaces with strong organizational commitments to patient safety, including those that focus on adequate staffing, attention to workload, and open team communication, are associated with less missed nursing care. To explore the connection between nurses’ perceptions of patient safety with missed nursing care in labor and delivery units, the researchers surveyed 3,429 labor and delivery nurses from 253 U.S. hospitals between February 2018 and July 2019.


Nurses’ perceptions of patient safety were measured using items from the Safety Climate Subscale of the Safety Attitudes Questionnaire, including questions about how errors are handled and whether nurses would feel safe being treated on their units as patients. Missed nursing care was measured using the Perinatal Missed Care Survey, which asks about aspects of required basic nursing care during labor and birth that may be delayed or not completed and the reasons care might be missed.


The researchers found that, although nurses on labor and delivery units generally had positive perceptions of their unit’s safety climate (65.7% reported good safety climates), they reported that an average of 11 of 25 aspects of essential nursing care were occasionally, frequently, or always missed. The most commonly missed aspects of care included timely documentation, monitoring fluid intake and output, review of prenatal records, and assessment of pain. Labor and supply shortages were reported as the most significant reasons for why the nursing care is delayed, unfinished, or missed in maternity settings.


“Health systems can only provide good quality maternity care if facilities have sufficient and skilled staff who have access to functioning equipment, and sufficient drugs and supplies,” the authors write. “However, insufficient nurse staffing is commonly viewed as a major challenge in perinatal care because the fetus or the newborn is generally considered the invisible patient and the care required is often not understood or recognized by those making decisions about nurse staffing.”


In a further analysis, the researchers identified a significant association between better nurse-perceived safety climate and less missed nursing care. They note that safety strategies such as nurse staffing consistent with national standards, promoting open communication, encouraging errors to be reported, incorporating perinatal safety nurses, and ongoing learning from safety events may decrease missed care in daily nursing activities.


“Our findings suggest that improving safety climate—for example, through better teamwork and communication—may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care—such as staffing improvements—may improve safety climate,” the authors write.


The study’s authors are first author Jie Zhong, MSN, Jason Fletcher, PhD, and senior author Audrey Lyndon, PhD, of NYU Meyers; Kathleen Rice Simpson, PhD, of Mercy Hospital St. Louis; Joanne Spetz, PhD, and Caryl L. Gay, PhD, of UCSF, and Gay L. Landstrom, PhD, of Trinity Health.