Continuous Quality Improvement: Healthcare Professionals

Continuous Quality Improvement (CQI) initiatives necessitate the focus of healthcare professionals on the following dimensions of practice: overuse, underuse, and misuse (Sollecito & Johnson, 2013). The occurrence of any of these quality problems undermines the quality of delivered care, thereby creating the chance for the occurrence of medical errors. Under the essentials of master’s education in nursing, students are required to aspire to continuous improvement of quality in their practice, which necessitates the reduction of the prevalence of missed care (AACN, 2011). This paper aims to discuss missed care and connect the concept to nurse-sensitive indicators.

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Missed care refers to the failure to deliver relevant care services to a patient due to a lack of time (Jones, Hamilton, & Murry, 2015). The phenomenon is also associated with other terms such as unfinished care and nursing care left undone (Jones et al., 2015). Prevalence estimates for missed care are excessively high across different healthcare settings of the country. A recent report shows that as much as 86 percent of nursing practitioners reported on failing to conduct at least one care activity during their last shift (Ball, Murrells, Rafferty, & Morrow, 2013). Given the prevalence of missed care and the necessity to apply translational process to CQI initiatives, it is important to consider factors influencing its emergence.

Missed care can occur due to a wide-range or reasons that form a multidimensional context. According to Blackman et al. (2014), the following conditions are primary causal agents of care left undone: type of shift, resource allocation among staff, communication, predictability and intensity of workload, turnover intentions, and job satisfaction. It follows that alternative approaches are needed to improve patient safety, which can be substantially deteriorated by missed care (AHRQ, 2008). The theory of knowledge translation requires the implementation of evidence-based practices as a means of improving patient-and organizational-level outcomes (Watson, 2012). Although there is a considerable overlap between the theory and CQI, its directions are different. To better understand how missed care affects clinical practices, it is necessary to consider several related nurse-sensitive indicators (NSIs).

Heslop and Lu (2014) argue that missed care is closely associated with a large number of patient-related NSIs such as pressure ulcer, selective nosocomial infection, medication error, falls, pneumonia, sepsis, shock, and vein system complication. From the student’s area of expertise, it is clear that these outcomes can increase the length of stay, decrease patient and/or family satisfaction, and produce higher mortality rates. Furthermore, nurses who are not capable of delivering care because of the unmanageable workload intensity are much likely to have turnover intentions than their counterparts. From this vantage point, it is clear that missed care negatively impacts the CQI agenda; therefore, forward-looking organizations should develop effective strategies for ameliorating its effects.

To reduce the burden of missed care within a healthcare setting, it is necessary to ensure the adequacy of nursing resources (Heslop & Lu, 2014). Another approach to solving the problem is to relieve communication tensions with the help of the open door policy. The introduction of rounding, budget reforms, and rostering changes are other alternatives that should be considered in the attempt to reduce the harmful influence of missed care.


The paper discussed missed care and provided several reasons for its occurrence. It has been argued that insufficient staffing, a lack of communication, and limited predictability of workload are the primary reasons for nursing care left undone. The paper has also proposed several solutions for the amelioration of the missed care burden.


AACN. (2011). The essentials of master’s education in nursing. Web.

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AHRQ. (2008). Advances in patient safety: New directions and alternative approaches. Web.

Ball, J. E., Murrells, T., Rafferty, A. M., & Morrow, E. (2013). ‘Care left undone’ during nursing shifts: Associations with workload and perceived quality of care. BMJ Quality & Safety, 23(2), 116-125.

Blackman, I., Henderson, J., Willis, E., Hamilton, P., Toffoli, L., Verrall, C.,… Harvey, C. (2014). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24(1-2), 47-56.

Heslop, L., & Lu, S. (2014). Nursing-sensitive indicators: A concept analysis. JAN, 70(11), 2469-2482.

Jones, T. J., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International Journal of Nursing Studies, 52, 1121-1137.

Sollecito, W. A., & Johnson, J. K. (2013). Continuous quality improvement in health care (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Watson, J. (2012). Human caring science: A theory of nursing (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

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