Navigating missed nursing care in surgical wards: Nurses' experiences and strategies for improvement – A focus group study

Missed nursing care (MNC), the omission or delay of required nursing activities,is closely linked to patient safety, strained work environments and nurse burnout. Although contributing factors such as staffing shortages, workload pressures and teamwork deficits are well established, emerging research shows that MNC also involves intentional prioritization by nurses under constrained conditions. However, less is known about how nurses experience and manage these competing demands in everyday practice, particularly in surgical inpatient settings. This study explores nurses' experiences of MNC and the strategies they employ to maintain and improve nursing care. A qualitative descriptive design was used, based on focus group interviews. Six focus groups were conducted with a convenience sample of 20 nurses from three inpatient wards at one surgical clinic. Transcribed data were analyzed using thematic analysis. Three themes were identified: “ Caught in a tug of war ”, “ Bridging the gap ” and “ Active patients with a seat at the table ”, along with seven sub-themes describing nurses' experiences of MNC and their strategies to reduce it. These strategies involved drawing on clinical experience, providing patient education and helping patients to actively participate in their care. Leadership also emerged as essential, particularly in prioritizing and allocating resources to patients with the greatest care needs to ensure equitable and effective care delivery. This study identified key strategies to reduce MNC and its implications for patient safety and the work environment. Addressing MNC requires adequate staffing, effective teamwork, supportive leadership and active patient involvement. • Nurses experience missed nursing care due to time pressure and competing demands. • Education and effective use of clinical experience are key strategies to reduce missed nursing care. • Active patient participation can support the completion of essential nursing care. • Leadership and resource prioritization are critical for equitable care delivery.