What underlying priority criteria influence which nursing activities get left unfinished? Findings from a national mixed methods study

Background: Priority setting is the act of classifying immediate actions versus what can be delayed until a later time; thus, some activities get left unfinished. Although several factors that increase or minimize the occurrence of unfinished nursing care (UNC) have been documented, the reasons why nurses decide to provide one intervention instead of another are still under-investigated. Expanding the knowledge regarding priority criteria adopted by nurses may help nurse managers provide support to clinical nurses and address and develop their competencies to set priorities, with the ultimate intent to minimize UNC episodes. Methods: A mixed methods sequential explanatory design according to the Good Reporting of A Mixed Methods Study was conducted. The quantitative phase consisted of a national survey of 15 hospitals, 110 units, and 1,977 nurses invited to fill in the Unfinished Nursing Care Survey (from 1 ‘never unfinished’ to 5 ‘always unfinished’). A subsequent qualitative phase involved focus groups with nurses identified from hospitals with high, medium, and low UNC occurrence, which were revealed in the quantitative phase. A joint technique displayed where qualitative findings were used to explain which UNC patterns were adopted. Results: A total of 1,400 nurses (70.8%) reported UNC ranging from 1.92 out of 5 (SD = 0.31) to 2.48 (SD = 0.32). Four priority criteria emerged: (1) “addressing biomedical needs”; (2) “physician expectations come first”; (3) “signing for/audited activities”; and (4) “it depends; there are absolute and relative priorities”. Data integration showed a thematic association that confirmed prioritization criteria underlying the pattern of UNC coherent with the elements of care mostly withheld in daily practice by nurses. Conclusions: Overall, two priority criteria were based on biomedical patient needs and physician-centric workflow expectations: one pertained to organizational expectations and rules, and only one pertained to nursing as a discipline. Nurse managers are in the best position to foster organizational excellence not only by addressing the underlying causes of time scarcity and UNC, but also by creating supportive work environments that empower nurses to prioritize activities linked with the scope of their discipline.