The Normalization of Missed Nursing Care

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Many aspects of routine nursing care were skipped during the COVID-19 pandemic. Nurse leaders are now trying to do a reset on care as they look at declining quality and safety measures. Consider the story a nurse manager recently shared on a webinar:

I have been shocked recently at how much care we now routinely miss. Patients are not being ambulated or sometimes even turned. Giving baths is considered a nice to do but not essential. Patient education is not happening. Linens are not changed. Meal trays sit in rooms and are then removed without patients ever eating. Even routine documentation is often missed. I am working to get things back on track, but I am somewhat frustrated by the response I get when I give feedback about this. A nurse recently told me that it is not her responsibility if she works on an understaffed unit.

This nurse leader is not alone in finding that when she stops for a moment from fighting the fires of staffing and scheduling, she learns basic policies and practices are not followed. It is a classic example of the normalization of deviance – a growing challenge in many organizations and a significant safety issue. The normalization of deviance can be defined as a gradual process in which unacceptable practices or standards become acceptable. When the deviant practices are repeated and taught to new nurses, they become the social norm for the team. In today’s environment, deviance can arise from a lack of knowledge and close supervision of nursing care.

Nurse leaders must be committed to patient safety and communicate this to staff to counter deviant behavior. In the current environment with so many inexperienced staff, nurse leaders must stay especially vigilant about what is happening in nursing practice. Missed nursing care is widespread, but I may need help understanding what can and can’t be omitted as a new nurse. My preceptor and charge nurse may need to learn, too.

A nurse educator recently said she had developed a course for her hospital on basic nursing care – things that should have been taught in school but were not. She raises a good point about rebuilding best practices moving forward after three years of turmoil on teams. One important strategy is to have skill fairs, perhaps evenly quarterly, to reinforce policies and practices in high-risk/problem-prone areas. Findings from these skill fairs and deficits in practice discovered can provide a foundation on what to do next and how to hardwire safety and quality back into our practice more effectively. Like the manager in the above situation, we need to be brutally honest about the toll that COVID has had on our workforce and nursing practice.

© emergingrnleader.com 2023

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