To assess the views of RNs and nursing assistants (NAs) on missed nursing care (required but unmet patient care), the author administered a survey and conducted focus groups at one hospital. A total of 633 RNs and 121 NAs from 18 units took part in the study.

Findings showed that RNs reported more missed care than NAs did, RNs noted that NAs missed activities more often than NAs did, and RNs indicated that labor resources and lack of material resources were causes for missed care more often than NAs did. Also, RNs noted lack of communication from NAs as a reason for missed care more often than NAs did, and NAs felt that communication breakdowns were responsible for missed care more than RNs did.

Reasons for these findings, as discussed in the RN focus groups, included not enough RN or NA staff, NAs lacking the knowledge needed to value certain care, NAs refusing to follow RNs' instructions, and lack of motivation among NAs. In addition, RNs said they were too busy to ensure that activities were completed and that NAs should be able to fulfill their work independently. The NA focus group participants said RNs doubted they had completed tasks and didn't listen to or respect them. Lack of communication about patient care was also discussed.

The author concluded that several elements of teamwork between these nurses were missing: closed-loop communication (there was no discussion before or during a shift), mutual trust, team leadership, team orientation (RNs and NAs worked separately), and shared mental models (team members saw their work differently). The author proposed four actions to improve patient care: increasing communication before, during, and after shifts; providing education on being an effective team member; using communication boards to convey important patient care information; and ensuring effective communication between an NA and all the RNs she or he works with.