The double‑edged sword of calling: mediating nursing practice environment and missed care – a cross‑sectional study

Aim and objectives To investigate the status of missed nursing care and examine the mediating role of calling between nursing work environment and missed nursing care. Background Missed nursing care (MNC) critically affects patient safety and care quality and is closely linked to the nursing work environment. However, the role of career calling—a key psychological resource for nurses—in this process remains unclear. Design Cross-sectional study. Methods We recruited 535 clinical nurses from a tertiary hospital in Nanjing, China, using convenience sampling. Participants completed the Nursing Work Environment Scale, Career Calling Scale, and the Missed Nursing Care Scale. Data were analyzed using descriptive statistics, Pearson’s correlation, and the PROCESS macro in SPSS 26.0. Statistical significance was set at p < 0.05. Results The mean score for missed nursing care was 34.75 (SD = 12.15), indicating a moderate level. Mediation analysis revealed that nursing work environment significantly and negatively predicted career calling (β = −0.352, p < 0.001), whereas career calling significantly and positively predicted missed nursing care (β = 0.138, p = 0.034). Furthermore, career calling partially mediated the relationship between nursing work environment and missed nursing care, accounting for 18.1% of the total effect. Conclusion Career calling partially mediates the link between the nursing work environment and MNC: a poor environment strengthens calling, which in turn is linked to more MNC, revealing a paradoxical effect. Relevance to clinical practice To reduce MNC, nurse managers should improve the practice environment—particularly nurse–physician collaboration and staffing—while fostering a balanced sense of career calling to prevent over-commitment, which is critical for patient safety and care quality. Patient or public contribution No patient or public contribution was involved in this study, as the research focused on clinical nurses as the study population.