Beyond moral sensitivity: selected work-related factors associated with missed nursing care in intensive care units

Missed nursing care (MNC) in intensive care units (ICUs) threatens patient safety. While moral sensitivity (MS) is theorized as protective, its predictive value in high-pressure environments remains unclear. This study examined whether individual MS or selected work-related factors (specifically shift patterns and employment characteristics) better predict MNC among ICUs nurses. In this cross-sectional study conducted from June to September 2024, a total of 178 ICUs nurses were recruited via multistage cluster sampling from hospitals affiliated with Qom University of Medical Sciences, Iran. The response rate was 100%. Data were collected using the validated Missed Nursing Care Survey and Moral Sensitivity Questionnaire. Associations were analyzed using correlation coefficients and multiple linear regression with robust standard errors (HC3 estimator). The correlation between MS and MNC was weak and non-significant ( r = -0.055, p = 0.483). The final regression model explained 15.1% of the variance in MNC (R² = 0.151). Among the occupational characteristics examined, rotating shift work was significantly associated with higher MNC (B = 0.535, 95% CI: 0.314–0.756, P < 0.001), while female gender was associated with lower MNC (B = -0.664, 95% CI: -0.983 to -0.345, P < 0.001). MS was not significantly associated with MNC after adjustment for confounders. In the context of the Iranian healthcare system, where workforce shortages, demanding shift schedules, and nurse-to-patient ratios ranging from 1:2 to 1:5 are prevalent, rotating shift work was identified as a potentially modifiable factor associated with MNC. These observational findings warrant prospective evaluation in broader multicenter cohorts rather than assuming an established interventional benefit of shift redesign.