Methods: A cross-sectional study that considered a theoretical model of first and second order, using the modeling of structural equations. In the first order analysis, was considered the relations between the domains of the Practice Environment Scale - PES (Nurse participation in hospital affairs’; Nursing foundations for quality of care; Nurse manager ability, leadership, and support of nurses; Staffing and resource adequacy; and Collegial nurse-physician relations) and the domains of the MISSCARE-Brazil (Labor resources; Material resources; Communication; Ethical dimension; and Management style). For the second-order analysis, the PES was considered as an independent variable, the MISSCARE-Brazil as a dependent variable and the job satisfaction and safety climate variables as possible moderators variables. The analyzes were carried out using structural equation models, considering Partial Least Squares (PLS) as the method of estimation using Smart PLS 3.2.1 software. The quality of fit of the structural model was evaluated by the calculation of Pearson's coefficient of determination (R²), the coefficient of predictive validity, or Stone-Geisser's indicator (Q²) and the Effect Size, or Cohen's Indicator (f²). It was considered a confidence interval (CI) of 95%. The sample was composed of 93 nursing professionals from the adult critical care units at a teaching hospital in the state of São Paulo, Brazil, from April to October 2017.
Results: The first-order model pointed out that a better perception of management's leadership and management skills resulted in a lower perception of reasons for missed nursing care related to labor resources (Path Coefficient -0.27; CI -0.48 to -0, 01); a better perception of the staffing and resource adequacy, lower perception of the reasons of missed care with regard to the management style (Path Coefficient -0,25, CI -0.46 to -0.02), labor resources (Path Coefficient -0.59, CI -0.74 to -0.42) and material resources (Path Coefficient -0.23, CI -0.42 to -0.03). The better perception of the nursing foundations for quality of care, the greater the reasons for missed care related to labor resources (Coef 0,32, CI 0.04 to 0.58). In the second-order model, the higher the job satisfaction, the lower the perception of reasons for missed care (Coef -0.38, IC-0.55 to -0.19), however, it has not been demonstrated a moderator effect of job satisfaction and safety climate in the relation between PES and MISSCARE-Brazil.
Conclusion: Work in a environments where the professional perceives nurse manager ability, leadership and support of nurses, resources and staff adequacy results in less reasons for missed nursing care. The nursing professionals satisfied with their job reported lesser reasons for omission of care. Providing a work environment with appropriate leadership style and management, as well as adeqaute resources and staffing leads to fewer reasons for missed care