Original Article

The relationship between missed nursing care and teamwork in emergency nurses: A predictive correlational study


Background & Aim: Missed nursing care can reduce nursing care quality by eliminating or delaying any aspect of the patient’s necessary nursing care. Teamwork has been a solution to improve the quality of care and safety of patients. The present study was conducted to determine the relationship between missed nursing care and emergency nurses’ teamwork in the educational-medical centers affiliated to Iran University of Medical Sciences in 2019.
Methods & Materials: This cross-sectional study is predictive correlational in nature. It was conducted on 213 nurses working in the emergency department who were selected based on the census method from March 2018 to December 2019. The self-report data were collected using Nursing Teamwork Survey and Missed Nursing Care questionnaires. The data were analyzed through conducting ANOVA, t-test, Pearson correlation, and multiple regression analysis in SPSS version 16.
Results: The mean score of missed nursing care in the emergency nurses was 2.25±0.65, and the nurses’ average teamwork was 3.53±0.55. There was a statistically significant yet inverse correlation between teamwork and missed nursing care (p<0.001) (r= -0.29). The determination coefficient of the multiple linear regression modeling was used to predict the missed nursing care based on the total teamwork score indicated that 14% of the missed nursing care was explained under the influence of independent variables.
Conclusion: Due to the inverse relationship between teamwork and missed nursing care, it is necessary to design and plan training courses to further enhance the nurses’ ability to perform teamwork and collaborative work.

1. Kalisch BJ, Xie B. Errors of omission: Missed nursing care. Western Journal of Nursing Research. 2014;36(7):875-90.
2. Alemdar DK, Aktaş YY. Medical error types and causes made by nurses in Turkey. TAF Preventive Medicine Bulletin. 2013;12(3):307-14.
3. MMakary MA, Daniel M. Medical error—the third leading cause of death in the US. Bmj. 2016 May 3;353.
4. Kalisch BJ, Williams RA. Development and psychometric testing of a tool to measure missed nursing care. JONA: The Journal of Nursing Administration. 2009 May 1;39(5):211-9.
5. McMullen SL, Kozik CA, Myers G, Keenan K, Wheelock M, Kalman M. Improving nursing care: examining errors of omission. Medsurg Nursing. 2017;26(1):9.
6. Griffiths P, Maruotti A, Saucedo AR, Redfern OC, Ball JE, Briggs J, Dall'Ora C, Schmidt PE, Smith GB. Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ quality & safety. 2019 Aug 1;28(8):609-17.
7. Schuur JD, Hsia RY, Burstin H, Schull MJ, Pines JM. Quality measurement in the emergency department: past and future. Health Affairs. 2013 Dec 1;32(12):2129-38.
8. Chapman R, Rahman A, Courtney M, Chalmers C. Impact of teamwork on missed care in four Australian hospitals. Journal of clinical nursing. 2017 Jan;26(1-2):170-81.
9. Kilner E, Sheppard LA. The role of teamwork and communication in the emergency department: a systematic review. International emergency nursing. 2010 Jul 1;18(3):127-37.
10. Soremekun OA, Takayesu JK, Bohan SJ. Framework for analyzing wait times and other factors that impact patient satisfaction in the emergency department. The Journal of emergency medicine. 2011 Dec 1;41(6):686-92.
11. Holden RJ. Lean thinking in emergency departments: a critical review. Annals of emergency medicine. 2011 Mar 1;57(3):265-78.
12. Bayrami R, Rezazadeh A, H E. Challenges in emergency departments in teaching hospitals of Mashhad University of Medical Sciences: A qualitative study. Journal of Hospital. 2017; 16 (1):63-72.
13. Tanha F, Mazloumi A, Faraji V, Kazemi Z, Shoghi M. Evaluation of human errors using standardized plant analysis risk human reliability analysis technique among delivery emergency nurses in a hospital affiliated to Tehran University of Medical Sciences. Journal of Hospital. 2015 Sep 10;14(3):57-66.
14. Ajeigbe D, McNeese-Smith D, Phillips L, Leach L. Effect of nurse-physician teamwork in the emergency department nurse and physician perception of job satisfaction. J Nurs Care. 2014 Jan 1;3(1):141.
15. Porter JE, Cant RP, Cooper SJ. Rating teams’ non-technical skills in the emergency department: A qualitative study of nurses’ experience. International emergency nursing. 2018 May 1;38:15-20.
16. Redley B, Botti M, Wood B, Bucknall T. Interprofessional communication supporting clinical handover in emergency departments: An observation study. Australasian Emergency Nursing Journal. 2017 Aug 1;20(3):122-30.
17. PS. Y-W. Leading and managing in nursing:. Canada.: Elsevier Health Sciences; Mosby 2014.
18. Porter JE, Cant RP, Cooper SJ. Rating teams’ non-technical skills in the emergency department: A qualitative study of nurses’ experience. International emergency nursing. 2018 May 1;38:15-20.
19. Kennedy HP, Lyndon A. Tensions and teamwork in nursing and midwifery relationships. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2008;37(4):426-35.
20. Attia NM, Abdeen MAA, El-sayed SH. Impact of Nursing Teamwork on Missed Nursing Care in Intensive Care Units at Zagazig University Hospitals. Zagazig Nursing Journal. 2014;10(2):201-17.
21. Souza GCD, Peduzzi M, Silva JAMD, Carvalho BG. Teamwork in nursing: restricted to nursing professionals or an interprofessional collaboration?. Revista da Escola de Enfermagem da USP. 2016;50(4):642-9.
22. Khademian Z, Neshat T. The relationship between interpersonal communication skills and nursing students’ attitudes toward teamwork. Sadra Medical Sciences Journal. 2017 Jan 1;5(2):99-110.
23. Li A-T. Teamwork climate and patient safety attitudes: associations among nurses and comparison with physicians in Taiwan. Journal of nursing care quality. 2013;28(1):60-7.
24. Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, et al. Care pathways lead to better teamwork: results of a systematic review. Social science & medicine. 2012;75(2):264-8.
25. Behnia O, HosseinPour M, Zarea K. The analysis of the team working facilitating factors among nurses working in training centers affiliated with the university of Jondi SHapour in Ahvaz. Scientific Journal of Hamadan Nursing & Midwifery Faculty. 2016;24(4):247-55.
26. Mohamed SA, Abed F. Perception of Teamwork and Missed Nursing Care among nurses in Intensive Care Units at South Valley University Hospitals. IOSR Journal of Nursing and Health Science, 2016; 5(6): 89-97.
27. Grover E, Porter JE, Morphet J. An exploration of emergency nurses’ perceptions, attitudes and experience of teamwork in the emergency department. Australasian emergency nursing journal. 2017;20(2):92-7.
28. Kalisch BJ, Lee H, Salas E. The development and testing of the nursing teamwork survey. Nursing research. 2010;59(1):42-50.
29. Yaghoubi M, Torki ME, Salesi M, Ehsani-Chimeh E, Bahadori M. The Relationship between Teamwork and Missed Nursing Care: Case Study in a Military Hospital in Tehran. Journal of Military Medicine. 2019;21(1):63-72.
30. Zúñiga F, Ausserhofer D, Hamers JP, Engberg S, Simon M, Schwendimann R. The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes–a cross-sectional study. International journal of nursing studies. 2015 Sep 1;52(9):1463-74.
31. Hajinabi K, Jahangiri K. The Relationship between the Patient's Safety and Nurses' Team Working in Surgical and Intensive Care Units in Gilan Province Selected Hospitals. Management Strategies in Health System. 2018;3(1):33-43.
32. Hossieni SF, Soltani F. The relationship between teamwork with job stress and job motivation in nurses. Journal of Clinical Nursing and Midwifery. 2017;4(3):82-90.
33. Gibbon B, Crane J. The impact of ‘missed care’on the professional socialisation of nursing students: A qualitative research study. Nurse education today. 2018;66:19-24.
34. Castner J, Wu Y-WB, Dean-Baar S. Multi-level model of missed nursing care in the context of hospital merger. Western journal of nursing research. 2015;37(4):441-61.
IssueVol 8 No 2 (2021): Spring QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v8i2.5121
missed nursing care; teamwork; emergency; safety

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Najafi Ghezeljeh T, Gharasoflo S, Haghani S. The relationship between missed nursing care and teamwork in emergency nurses: A predictive correlational study. NPT. 8(2):103-112.