ICU Nurses Split Into Three Distinct Profiles of Missed Care, Study Finds

In the high-stakes world of intensive care, the care a patient never receives can matter as much as the care they do. A new study from China has now revealed that missed nursing care in intensive care units is not a uniform problem but a heterogeneous one, with nurses falling into three sharply different subgroups whose omissions range from relatively benign lapses in supportive tasks to dangerous gaps in core clinical activities such as sedation and analgesia management. The findings, published in BMC Nursing, suggest that one-size-fits-all interventions may be doomed to fail, and that the path to safer ICUs runs through a more nuanced understanding of which nurses are missing which tasks, and why.

The research team, led by Xiangyue Liu and Xue Deng of Chengdu Medical College and The General Hospital of the Western Theater Command of the People’s Liberation Army, set out to challenge a long-standing assumption in the patient safety literature. Most previous studies have treated intensive care nurses as a single, homogeneous group, averaging their experiences and thereby obscuring the fact that some nurses may be quietly skipping essential care while others rarely do. To unpack this hidden structure, the researchers turned to latent profile analysis, a statistical technique that identifies unobserved subgroups within a population based on patterns in their responses. Rather than asking how much missed care exists on average, the method asks whether distinct types of nurses exist at all.

The study was conducted as a cross-sectional survey between November 30, 2025, and March 31, 2026. Using convenience sampling, the team recruited 332 intensive care nurses from five tertiary Grade A hospitals in Sichuan province, China. Tertiary Grade A hospitals represent the top tier of the Chinese hospital classification system, facilities that handle the most complex and acutely ill patients, making them precisely the environments where missed care carries the gravest consequences. Participants completed the Missed Nursing Care Scale, the Moral Sensitivity Questionnaire, and the Perceived Organizational Support Questionnaire, instruments designed to capture both the extent of care omissions and the psychological and organizational factors that might shape them.

The overall picture was sobering. The mean missed nursing care score across the sample was 67.54 with a standard deviation of 21.33, indicating that care omissions are a routine feature of intensive care work rather than an occasional anomaly. But the latent profile analysis revealed that this average concealed three fundamentally different worlds of practice. The largest subgroup, comprising 56.63 percent of the nurses, showed low levels of missed care. A second group, 28.31 percent of the sample, fell into a moderate profile, while a third group of 15.06 percent reported high levels of missed care. In other words, roughly one in seven intensive care nurses in the sample belonged to a profile in which essential care was being missed at substantially elevated rates.

What makes the study particularly valuable is that the three profiles were distinguished not merely by how much care was missed but by which care was missed. The low-missed-care group mainly reported omissions in supportive nursing activities, tasks such as comfort measures, communication, and emotional support that, while important, sit somewhat outside the immediate clinical core. The moderate group showed additional deficits in care planning, suggesting a gradual erosion of the organizational and anticipatory dimensions of nursing work. The high-missed-care group, by contrast, demonstrated omissions in core clinical care activities, including the management of sedation and analgesia. This escalation from peripheral to central tasks represents a clinically meaningful gradient of risk, because failures in sedation and analgesia management in critically ill patients can translate directly into pain, agitation, delirium, and adverse physiological outcomes.

The researchers framed their investigation using the Job Demands-Resources model, an influential framework in occupational health psychology that holds that employee outcomes depend on the balance between the demands placed on workers and the resources available to meet them. In this model, heavy workloads, overtime, and understaffing act as demands, while organizational support and professional competence act as resources. When demands chronically outweigh resources, performance degrades, and in nursing, that degradation manifests as care that is delayed, incomplete, or simply never delivered. The study’s findings map closely onto this framework, but with an important twist: the protective factors did not operate uniformly across all subgroups.

Moral sensitivity, measured with the Moral Sensitivity Questionnaire, emerged as a key psychological variable. The total moral sensitivity score was negatively associated with missed nursing care overall, meaning that nurses who reported greater awareness of the ethical dimensions of their decisions tended to miss less care. Yet when the researchers examined this association within each latent profile, a striking pattern appeared: the negative association was significant only in the low-missed-care subgroup. In other words, moral sensitivity appears to act as a protective factor primarily among nurses who are already performing well, while among those in the moderate and high profiles, its influence was not statistically detectable. This context-dependence is a critical insight, because it suggests that simply exhorting nurses to be more ethically attuned may accomplish little in the settings where the problem is most severe.

Perceived organizational support told a complementary story. The high-missed-care group had the lowest levels of perceived organizational support, and multinomial logistic regression showed that lower perceived organizational support was associated with membership in the high-missed-care group relative to the moderate group. Meanwhile, the low-missed-care group combined the highest moral sensitivity with the highest proportion of ICU specialist nurses, credentialed professionals with advanced qualification in critical care. The high group’s combination of low support and high omissions in core care paints a portrait of nurses who feel abandoned by their institutions and whose practice has consequently eroded at its foundations.

Hierarchical regression analysis rounded out the picture by identifying the broader set of factors associated with missed nursing care across the sample. Monthly overtime, dissatisfaction with human resource allocation, and dissatisfaction with the communication climate all emerged as demand-side factors linked to more missed care, while ICU specialist nurse qualification, moral sensitivity, and perceived organizational support functioned as resource-side factors associated with less. This constellation of predictors reinforces the Job Demands-Resources interpretation: intensive care nurses who work excessive overtime in understaffed units with poor communication are systematically more likely to leave care undone, especially when they lack specialist training and feel unsupported by their organizations.

The authors are careful to note the limitations inherent in their design. The study is cross-sectional, capturing a single moment in time, which means it can identify associations but cannot establish causal direction; it remains possible, for example, that nurses who miss more care subsequently perceive less organizational support rather than the reverse. The convenience sampling from a single Chinese province also limits generalizability, and the reliance on self-reported questionnaires introduces the possibility of bias, since nurses may underreport omissions in their own practice. The researchers accordingly call for stratified interventions tailored to the characteristics of each subgroup, while emphasizing that the effectiveness of such tailored approaches requires testing in future studies, ideally longitudinal and interventional in design.

Even with those caveats, the study’s central message carries considerable weight for hospital administrators and patient safety advocates worldwide. Missed nursing care is not an amorphous quality problem to be addressed with generic exhortations; it is a structured phenomenon with identifiable subtypes, each demanding a different remedy. For the majority of nurses in the low profile, preserving supportive activities may require modest adjustments to workload and team communication. For the moderate group, strengthening care planning processes could prevent further slippage. For the fifteen percent in the high profile, the priority is more fundamental: restoring organizational support, ensuring adequate staffing, expanding specialist credentialing, and protecting nurses from chronic overtime before core clinical care itself begins to unravel. In intensive care, where patients cannot advocate for themselves and the margin between recovery and deterioration is measured in hours, understanding who is missing what care, and why, may prove to be one of the most consequential questions in modern patient safety research.

Subject of Research: Latent profiles of missed nursing care and their influencing factors among intensive care unit nurses in China

Article Title: Latent profiles and influencing factors of missed nursing care among ICU nurses

Article References: Liu, X., Deng, X., He, B., Tian, W., Cui, L., Liao, D., Li, D., Cui, J., Bi, Y., & Tan, Q. (2026). Latent profiles and influencing factors of missed nursing care among ICU nurses. BMC Nursing. https://doi.org/10.1186/s12912-026-05308-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05308-1

Keywords: missed nursing care, intensive care unit, ICU nurses, latent profile analysis, moral sensitivity, perceived organizational support, Job Demands-Resources model, patient safety, nursing workforce, cross-sectional study, BMC Nursing, China