Variations in nursing care quality across hospitals.

Title: Variations in nursing care quality across hospitals.

Aims: The aim of the study was to describe Registered Nurses' reports of unmet nursing care needs and examine the variation of nursing care quality across hospitals.

Background: Large proportions of Registered Nurses have reported leaving necessary care activities undone because they lacked the time to complete the activities. Nursing care left undone can be expected to adversely affect the quality of care. However, little is known about the degree of variation in the quality of nursing care across hospitals.

Methods: In 2008, a secondary analysis of a 1999 survey of Registered Nurses (n = 10,184) was conducted using descriptive and comparative statistics. Data were derived from inpatient staff nurses working in acute care hospital settings (n = 168). A hospital-level measure (i.e. unmet nursing care needs) of the quality of nursing care was developed from care needs left undone among all nurses.

Results: Across hospitals there was a wide range in the proportion of Registered Nurses who reported leaving each nursing care need undone. They reported leaving two of seven necessary nursing care activities undone during their last shift. After controlling for nurses' demographic information, we found statistically significant variations in the quality of nursing care across hospitals.

Conclusion: Differences in nursing care quality across hospitals appear to be closely associated with variations in the quality of care environments. Understanding the determinants of unmet nursing care needs can support policy decisions on systems and human resources management to enhance nurses' awareness of their care practices and the care environment.