Sleep quality, quality of work life, and missed perioperative nursing care among operating room technologists: a multicenter cross-sectional study

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BACKGROUND: Missed perioperative nursing care is an important patient safety concern in operating room settings. Sleep quality and quality of work life may represent complementary workforce conditions associated with the completion of required care; however, their independent associations with missed perioperative nursing care remain insufficiently understood. This study examined the associations of sleep quality and quality of work life with missed perioperative nursing care among operating room technologists. METHODS: This multicenter cross-sectional study was conducted between May and August 2025 in nine public referral hospitals across three cities in Southern Iran. Using proportionate stratified random sampling, 332 operating room technologists were recruited. Data were collected using a demographic and occupational questionnaire, the Pittsburgh Sleep Quality Index, Walton's Quality of Work Life Scale, and the Missed Perioperative Nursing Care Questionnaire. Bivariate analyses and multiple linear regression with 5,000 bias-corrected and accelerated bootstrap resamples were performed. Sensitivity analyses examined the influence of outcome skewness and hospital-level clustering. RESULTS: The mean corrected score for missed perioperative nursing care was 9.46 ± 9.67. Poorer sleep quality was associated with greater missed care (rₛ = 0.220, p < 0.001), whereas higher quality of work life was associated with less missed care (rₛ = -0.286, p < 0.001). The final regression model (n = 331) explained 33.8% of the variance in missed care (R² = 0.338; adjusted R² = 0.309). Poorer sleep quality (B = 0.85, β = 0.14, p = 0.012) and higher quality of work life (B = - 0.12, β = -0.15, p = 0.021) remained independently associated with the outcome. Greater work experience was associated with less missed care (B = - 0.45, β = -0.26, p < 0.001), whereas employment status, working night or rotating shifts, greater monthly shift load, and overtime hours were also independently associated with missed care. The principal findings remained substantively unchanged in sensitivity analyses. CONCLUSIONS: Poorer sleep quality and lower quality of work life were independently associated with greater missed perioperative nursing care after accounting for relevant demographic and occupational characteristics. Professional experience, employment arrangements, shift patterns, and workload indicators were also relevant. These findings suggest that strategies addressing missed perioperative nursing care should consider both workforce well-being and modifiable occupational conditions. Because of the cross-sectional design, the observed associations should not be interpreted as causal. TRIAL REGISTRATION: Not applicable.

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