Predictors of Nursing Care Activities Left Undone in Dialysis Units

There are few available data regarding the patterns and predictors of essential nursing care left undone in acute and chronic dialysis units, according to Charlotte Thomas-Hawkins, PhD, RN, FAAN, and Linda Flynn, PhD, RN, FAAN, of Rutgers University School of Nursing.

The researchers conducted a study designed to examine the patterns of nursing care left undone, RN staffing, workload, and practice environment support in acute and chronic dialysis units. The study also sought to examine the effects of RN staffing, workload, and practice environment support on nursing care left undone. Results of the study were reported during a virtual session at the 2020 ANNA National Symposium in a presentation titled Patterns and Predictors of Nursing Care Left Undone in Acute and Chronic Dialysis Units.

The study sample included 104 staff nurses working in acute and chronic dialysis units. The nurses completed a mailed survey. Based on responses to the survey staffing questions, patient-to-RN ratios were computed. The Individual Workload Perception Scale was used to measure RN workload. The Practice Environment Scale measured the practice environment support, and a Nursing Care Left Undone Inventory was used to measure nursing care activities left undone. The researchers conducted univariate, multivariate, and simple mediation analyses.

Nursing care activities left undone, high patient-to-RN ratios, and unsupportive practice environment ratings were significantly higher in chronic dialysis units compared with acute dialysis units. There was no statistically significant difference between the two unit types in RN workload.

In adjusted regression models, independent predictors of nursing care left undone were type of chronic dialysis unit (b=.293; P=.003, high patient-to-RN ratios (b=.461; P=.000), high RN workloads (b=.443; P=.000), and unsupportive practice environments (b=.434; P=.000). Following adjustment, only high patient-to-RN ratios (b=.230; P=.02) and high RN workloads  (b=.308; P=.001)  were independent predictors of undone nursing care activities. The effect of chronic dialysis unit type on nursing care left undone was mediated by practice environment support.

In conclusion, the authors said, “Improving RN staffing, reducing RN workloads, and improving practice environment support, particularly in chronic dialysis units, should be key initiatives to enhance the adequacy of nursing care processes in dialysis settings.”

Source: Thomas-Hawkins C, Flynn C. Patterns and predictors of nursing care left undone in acute and chronic dialysis units. Abstract of a presentation at the virtual 2020 American Nephrology Nurses Association National Symposium, August 29-31, 2020.