Introduction and Background: A widespread issue that is affecting patients and nurses alike is the ongoing prevalence of registered nurse shortages in the field of healthcare. This obstacle has jeopardized exceptional patient care for many years and research suggests there is a need for interventions to combat the growing shortage. Purpose Statement: This research aimed to investigate how the lack of acceptable nursing staff levels affected patients’ quality of care, safety, and outcomes in various healthcare settings. It also emphasizes the need for interventions that would focus on the supply and retention of nursing staff in order to combat the bleak outlook that nursing shortages have in relation to the goal of patient centered care. Literature Review: Journal articles were found utilizing subscription of the East Tennessee State University Library’s database to access peer reviewed articles using keywords such as shortage, missed care, safety, and registered nurse. The most used database was PubMed. A total of 5 articles were selected after excluding those conducted before 2018 to maintain relevancy. Findings: The findings of this research suggest that the nursing shortage negatively effects patients in hospitals, long term care facilities, and those requiring at-home nursing, resulting in care omissions, higher mortality rates, and increased negative perceptions of nurses. Conclusion: While there is more research needed to indicate the cause of nursing staff shortages, it is evidenced to be an international issue that jeopardizes patients and requires further attention in order to ensure that patient safety and satisfaction is invariably achieved.

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Crowding på akutmottagningar är ett problem som pågått under flera år och som kan leda till ökade omvårdnadsåtgärder till patienter som stannar kvar på akutmottagningen i väntan på en vårdplats. Många av dessa patienter är gamla och sköra och med ett stort omvårdnadsbehov. Efter en granskning av Inspektionen för Vård och Omsorg (IVO) på akutmottagningen på Huddinge sjukhus utarbetades omvårdnadsmål för att fungera som stöd i omvårdnadsarbetet. Syftet med denna studie var att sammanställa vilka omvårdnadsåtgärder som påverkas vid crowding på akutmottagningen och hur detta i sin tur påverkar patienten. Metod som använts är en litteraturöversikt med systematisk ansats och datasökningarna har utförts i Cinahl och PubMed där sökningarna genererade 25 originalartiklar med utgångspunkt i litteraturöversiktens syfte. Artiklarna är till största del med kvantitativ ansats och kvaliteten på artiklarna har genomgående bedömts som god. Analyseringen av artiklarna har gjorts med en integrerad analys. Omvårdnadsåtgärder har kategoriserats enligt Fundamentals of Care´s akuta vårdprocess. Den akuta vårdprocessen är uppdelad som initial bedömning, utförande av omvårdnadsåtgärder, övervakning och vidare bedömning och dokumentation. Resultatet i studien visar att crowding påverkar omvårdnaden av patienterna på akutmottagningen. Störst påverkan ses i omvårdnaden av patienten vid triagering, läkemedelshantering och följsamhet till riktlinjer för behandling av patienten på akutmottagningen. Slutsatsen är att en rad olika omvårdnadsåtgärder påverkas av crowding. Flertal risker har identifierats beträffande patientens omvårdnad på akutmottagningen då det råder crowding. Omvårdnadsåtgärder med störst påverkan vid crowding var den initiala bedömningen av patienten och läkemedelsadministreringen. Som patient att befinna sig på akutmottagningen då det råder crowding är en patientsäkerhetsrisk. Resultatet överensstämmer inte med de framtagna omvårdnadsmålen på akutmottagningen. / Crowding in emergency department is a problem that has been going on for several years, which in turn can lead to increased nursing measures for patients who remain in the emergency department while waiting for a care place. Many of these patients are old and fragile and in great need of care. After a review by Health and Social Care Inspectorate (IVO) the emergency department at Huddinge university hospital, nursing goals were developed to serve as a support tool in the nursing work. The aim of this study was to compile which nursing measures are affected by crowding in the emergency department and how this in turn affects the patient. The method used is a literature review with a systematic approach and the data searches have been performed in Cinahl and PubMed, where the searches generated 25 original articles based on the purpose of the literature review. The articles are mostly with a quantitative approach and the quality of the articles was consistently of good quality. The analysis of the articles has been done with an integrated analysis. Nursing measures were categorized according to the Fundamentals of Care´s acute care process. The acute care process is divided into initial assessment, execution of nursing measures, monitoring and further assessment and documentation. The results of the study show that crowding affects the care of patients in the emergency department, The greatest impact is seen in the care of the patient during triage, medication handling and compliance with guidelines for treatment of the patient in the emergency department. The conclusion is that a number of different nursing measures are affected by crowding. Several risks have been identified regarding the nursing of the patient in the emergency department as there is crowding. Nursing measures with the greatest impact from crowding were the initial assessment of the patient and drug administration. As a patient, being in the emergency department when there is crowding is a patient safety risk. The result does not correspond with the developed nursing goals at the emergency department.

Missed nursing care, according to Kalisch and Williams, is nursing care that is not completed to the highest quality of care, leading to an increase in hospital costs and poor patient outcomes. Missed nursing care can occur with any patient population; however, a survey by Kasich called the MISSCARE Survey has only been used in the adult and neonatal populations. Pediatric patients are a diverse and complex subset of the population, differing greatly from the adult and neonatal populations, thus identifying a need for a focused pediatric survey to effectively study missed nursing care in the pediatric setting. The purpose of this research, therefore, was to create and validate a pediatric nursing care survey A convenience sample of 10 pediatric experts completed the Expert Panel Survey to determine a content validity ratio (CVR) and content validity index (CVI) of a modified, MISSCARE Survey (Kalisch & Williams, 2009). Items determined to be essential by ninety percent or more of the participants (CVR> 0.78), were included in the MISSCARE-Pediatric Survey. Results showed that the CVI of the MISSCARE-Pediatric Survey determined by the Expert Panel was 0.9, meaning the items are essential to the pediatric population (Gilbert & Prion, 2016a). The created MISSCARE-Pediatric Survey includes 18 questions in section A (Types of Missed Nursing Care), 28 questions in section B (Reasons for Missed Nursing Care), and 9 questions in Demographics. Future research will determine content reliability of the MISSCARE-Pediatric Survey.