The mediating effect of job satisfaction and occupational fatigue on the relationship between Nursing practice environment and missed nursing Care among Critical Care Nurses in Saudi Arabia

Background: Missed nursing care (MNC)—defined as any required patient care that is omitted or delayed—poses significant risks to patient safety, especially in critical care units (CCUs) where patient acuity is high. The nursing practice environment is increasingly recognized as a key organizational determinant of care quality. However, the pathways through which it influences MNC, particularly the mediating roles of occupational fatigue and job satisfaction, remain underexplored. Aim This study aimed to examine the direct and indirect effects of the nursing practice environment on MNC among critical care nurses in governmental hospitals in Hail City, Saudi Arabia, with job satisfaction and occupational fatigue as mediating variables. Methods A cross-sectional correlational design was employed. Data were collected from 211 registered critical care nurses using validated instruments: the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Minnesota Satisfaction Questionnaire (MSQ), the Occupational Fatigue Exhaustion Recovery (OFER-15) scale, and the MISSCARE Survey. Structural equation modeling (SEM) was conducted using AMOS 24.0 to test hypothesized relationships, and bootstrapping was used to assess mediation. Results The nursing practice environment was significantly associated with increased job satisfaction (β = 0.305, p < 0.001) and decreased occupational fatigue (β = -0.541, p < 0.001). Both job satisfaction (β = -0.289, p < 0.001) and occupational fatigue (β = 0.230, p = 0.004) were significantly associated with MNC. The practice environment had a significant direct negative effect on MNC (β = -0.160, p < 0.001) and also exerted significant indirect effects via job satisfaction (β = -0.090, p = 0.003) and fatigue (β = -0.124, p < 0.001), confirming their mediating roles. The total effect of the practice environment on MNC was substantial (β = -0.374, p < 0.001). Model fit indices indicated excellent fit (CFI = 0.997, TLI = 0.984, RMSEA = 0.044). Conclusion A supportive nursing practice environment significantly reduces MNC in critical care settings, both directly and indirectly through increased job satisfaction and reduced occupational fatigue. These findings support the integration of the Job Demands–Resources model and Kalisch’s Missed Nursing Care model, underscoring the importance of organizational strategies that improve the work environment to enhance nurse well-being and patient care quality. Interventions targeting staffing adequacy, managerial support, and fatigue mitigation are recommended to minimize MNC and ensure safe, complete care delivery in high-acuity units. Clinical trial number : Not applicable.