265 Prevalence of low-value nursing care in Dutch hospitals: a basis for developing implementation strategies

Introduction Healthcare is under pressure due to rising care demands and a declining workforce. Increasing treatment options drive up costs, making efficient use of nurses’ time crucial for maintaining quality care. This forces choices to be made to keep healthcare accessible to everyone. Despite striving for high standards, nurses often perform low-value nursing care (LVNC) interventions. LVNC is defined as care that: a) provides minimal or no benefit to the patient; b) wastes limited resources; and c) can cause physical, psychological or financial harm to patients. Reducing low-value nursing care contributes to keeping healthcare future-proof. Currently, there is no good insight into the frequency of LVNC performance by nurses in hospitals, therefore it is important to determine the current prevalence of LVNC.

The aim of this study was to assess the prevalence of low-value nursing care using a recently revised questionnaire among Dutch nurses working in general hospital wards.

Methods A multicenter cross-sectional study was conducted among registered nurses working on general hospital wards across the Netherlands using convenience sampling approach. The Nursing Care Questionnaire (NCQ) was developed based on Choosing Wisely and ‘do-not-do recommendations for nursing care list’. Nurses received an online survey via email or QR-code posters. The questionnaire, taking five minutes to complete, measured LVNC prevalence through frequency and sum scores of low-value tasks performed. Personal characteristics were collected, and multiple regression analysis identified potential influencing factors.

Results A total of 1598 nurses participated, with most being female (91.4%) and an average of 27 years (IQR 24-36). They had a median of five years of work experience (IQR 2-12) and performed an average of nine LVNC task in their last seven shifts. The most common LVNC tasks were:

1. Let older adults lie in bed or only get up to a chair (56.1%)

2. Medication to prevent delirium (54.9%)

3. Use physical restraints in case of a delirium (54.9%)

4. Doing a urine sediment or dip slide to diagnose urinary tract infection in frail elderly people (48.7%)

5. Wake a sleeping patient for unnecessary routine care (48.2%)

Night shifts and higher nursing education levels were associated with more unfinished tasks and LVNC. Additionally, a greater workload of non-nursing tasks correlated with increased LVNC.

Reducing LVNC is essential for improving patient safety and ensuring sustainability healthcare. The widespread presence of LVNC highlights the need for targeted de-implementation strategies, which are now being explored in collaboration with nurses across multiple hospitals. The absence of demographic or ward-specific influencing factors suggests that these tasks are deeply embedded in nursing routines and institutional structures, making change complex. Future research should focus on understanding the underlying drivers of LVNC and developing effective, evidence-based de-implementation strategies. Ultimately, self-reflection among nurses is essential to optimizing care delivery and improving patient outcomes.