{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:59:05Z","timestamp":1792533545085,"version":"4.5.0"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["sigmapubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Nursing Scholarship"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Missed nursing care threatens quality and safety, but patient counts may not capture shift\u2010level demands. We examined associations of patient\u2010count and perceived workload indicators with missed care, separating within\u2010 and between\u2010nurse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multicenter observational study using repeated shift\u2010level measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study included 502 shift records from 213 nurses in 16 medical\u2013surgical units across six Italian hospitals; the primary analysis included 480 records from 196 nurses. Patient\u2010count indicators were nurse\u2010reported numbers of assigned, isolated, and specialist\u2010care patients; perceived workload included work rhythm\/quantity, mental workload, emotional workload, and work organization. Grouped\u2010binomial generalized estimating equations modeled the proportion of applicable activities missed, with nurse clustering, robust standard errors, exchangeable correlation, and hospital fixed effects. Workloads were decomposed into within\u2010 and between\u2010nurse components, and four missed\u2010care domains were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nurses reported a mean of 6.5 missed activities per shift; 29.9% of shifts had no missed care. The seven workload indicators were jointly associated with missed care (robust Wald\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      [7]\u2009=\u200922.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Work rhythm\/quantity was the only individual indicator with a nominal\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value below 0.05 (OR 1.24 per SD, 95% CI 1.03\u20131.49;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023), but it did not remain significant after Benjamini\u2013Hochberg correction (\n                      <jats:italic>q<\/jats:italic>\n                      \u2009=\u20090.159). Assigned patient count was not clearly associated (OR 1.14, 95% CI 0.94\u20131.40;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.192). In exploratory within\u2013between analyses, the between\u2010nurse work rhythm\/quantity component was associated with missed care (OR 1.42, 95% CI 1.11\u20131.82;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), whereas the within\u2010nurse component was not (OR 1.03, 95% CI 0.90\u20131.17;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.649). Domain\u2010specific associations did not remain significant after multiplicity adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The workload indicators were jointly associated with missed nursing care, with secondary analyses indicating that the global signal was evident in the perceived\u2010workload block. However, no individual workload indicator remained statistically significant after multiplicity adjustment. Work rhythm\/quantity and its between\u2010nurse component should therefore be regarded as exploratory signals requiring confirmation in studies with denser repeated measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Workload surveillance research should evaluate patient\u2010count and multidimensional perceived\u2010workload indicators together. The present coefficient\u2010specific findings are insufficient to support the operational use of work rhythm\/quantity as a stand\u2010alone workload indicator.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jnu.70135","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:53:27Z","timestamp":1788861207000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patient\u2010Count and Perceived Workload Associations With Missed Nursing Care: A Multicenter Repeated\u2010Measures Study"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0091-7524","authenticated-orcid":false,"given":"Dhurata","family":"Ivziku","sequence":"first","affiliation":[{"name":"Department of Health Professions Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"},{"name":"Faculty of Health Sciences AAB College  Pristina Kosovo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Tartaglini","sequence":"additional","affiliation":[{"name":"Department of Health Professions Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"},{"name":"Research Unit in Nursing Science, Faculty of Medicine and Surgery Campus Bio\u2010Medico University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica Maria Pia","family":"Ferramosca","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Reanimation ASL Lecce  Lecce Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Lanzara","sequence":"additional","affiliation":[{"name":"Department of Health Professions Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3547-7454","authenticated-orcid":false,"given":"Francesca","family":"Reato","sequence":"additional","affiliation":[{"name":"Bachelor's Degree Program in Nursing University of Insubria  Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iliriana","family":"Bajrami","sequence":"additional","affiliation":[{"name":"Department of Stomatology Alma Mater Europaea, Campus College Resonanca  Pristina Kosovo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5904-1032","authenticated-orcid":false,"given":"Marzia","family":"Lommi","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention University of Rome Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7736-6209","authenticated-orcid":false,"given":"Rosario","family":"Caruso","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health Universit\u00e0 degli Studi di Milano  Milan Italy"},{"name":"Health Professions Research and Evidence Transfer Unit IRCCS MultiMedica  Sesto San Giovanni 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