The quality of hospital work environments and missed nursing care is linked to XXXX readmissions: a cross-sectional study of US hospitals.

@entity1 @entity712
INTRODUCTION: Threats to quality and @entity1 safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with @entity1 outcomes. AIM: The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. METHODS: Cross-sectional examination, using three linked data sources-(1) nurse survey, (2) @entity1 discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data- from 2005 to 2006. We explored the incidence of 30-day readmission for 160   930 @entity1 with @entity712 in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for @entity1 and hospital characteristics. RESULTS: The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting @entity1 (42.0%), developing and updating care plans (35.8%) and educating @entity1 and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2-8% after adjusting for @entity1 and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). CONCLUSIONS: Missed care is an independent predictor of @entity712 readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses' working conditions may be one strategy to reduce care omissions and improve @entity1 outcomes.
