Co-occurrence of missed nursing care, abusive supervision, and leader-member exchange: a latent profile analysis

Abstract Background Missed nursing care is a pervasive patient safety threat, yet its complex interplay with leadership dynamics, particularly abusive supervision and leader-member exchange, remains poorly understood. This study aimed to: (1) to identify the co-occurrence of nurses’ missed nursing care behaviors, nurse leaders’ abusive supervision, and leader-member exchange among nurses using Latent Profile Analysis; and (2) to identify the underlying sociodemographic factors that predict these patterns. Methods This cross-sectional study was conducted across all municipal-level maternal and child health hospitals in Hunan Province. Data were collected between March 28 and July 8, 2024. A questionnaire incorporating sociodemographic factors, the Leader-Member Exchange-7 Scale, the Abusive Supervision Questionnaire, and the Missed Nursing Care Survey was used to gather data. Latent profile analysis was employed to identify distinct subgroups. The three-Step Approach to Auxiliary Variable Selection method was used to examine factors related to different profiles. Results All staff nurses ( n = 2,839) were invited to participate, and 1,593 nurses (55.1%) completed the questionnaire. Three profiles were identified: the “out-group” (characterized by low leader-member exchange, occasional abusive supervision, and fewer missed nursing care behaviors; n = 142, 11.8%), the “in-group” (defined by high leader-member exchange, fewer abusive supervision, and occasional missed nursing care behaviors; n = 866, 72.1%), and the “middle-group” (marked by moderate leader-member exchange, frequent abusive supervision, and frequent missed nursing care behaviors; n = 193, 16.1%). Education level and average daily overtime hours were statistically significant factors associated with these profiles. Conclusion The study sheds new light on the interdependencies among missed nursing care, abusive supervision, and leader-member exchange in clinical settings. These findings suggest that future intervention research may benefit from targeting nurses in the “middle group” and their leaders as a potentially strategic focus for reducing missed nursing care. Additionally, directing resources such as mentoring programs toward nurses with higher formal education, and flexible schedules toward those working extended shifts, may help reduce care omissions. Further research is needed to investigate whether this profile structure and its factors remain consistent across different healthcare settings. Reporting method This article follows the STROBE guidelines for the reporting of cross-sectional studies.