Linking Patient Safety Climate With Missed Nursing Care in Labor and Delivery Units: Findings From the LaborRNs Survey


Jie Zhong, Kathleen Rice Simpson, Joanne Spetz, Caryl L. Gay, Jason Fletcher, Gay L. Landstrom, and Audrey Lyndon

January 13, 2023

This study aimed to explore the association of nurses’ perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units. We recruited nurse respondents via email distribution of an electronic survey between February 2018 and July 2019. Hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data in the United States. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. We estimated the relationship between safety climate and missed care using Kruskal-Wallis tests and mixed-effects linear regression.

The analytic sample included 3,429 L&D registered nurses from 253 hospitals (response rate, 35%). A majority of respondents (65.7%) reported a perception of good safety climate in their units, with a mean score of 4.12 (±0.73) out of 5. The mean number of aspects of care occasionally, frequently, or always missed on respondents’ units was 11.04 (±6.99) out of 25. Tests showed that six mostly commonly missed aspects of care (e.g., timely documentation) and three reasons for missed care (communications, material resources, and labor resources) were associated with safety climate groups (P < 0.001). The adjusted mixed-effects model identified a significant association between better nurse-perceived safety climate and less missed care after controlling for years of experience and highest nursing education.

Our findings suggest that improving safety climate — for example, through better teamwork and communication — may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care — such as staffing improvements — may improve safety climate.