Rulings convicting nurses for care omissions in the Italian supreme court: A qualitative document analysis

Background: The phenomenon of Unfinished Nursing Care raises important questions from theoretical and empirical perspectives, as well as legal and forensic implications that have not been considered in the available literature to date. The analysis of rulings issued in a given country may expand available knowledge by introducing a legal-forensic lens into this field of research, enabling the identification of unlawful behaviors attributed to nurses, the types of omissions recognized by judges, and the judicial reasoning underlying the attribution of individual criminal responsibility. Objective: To analyze and synthesize criminal rulings issued by the Italian Supreme Court of Cassation in which registered nurses were convicted for omissions or delays in the provision of nursing care. Methods: A qualitative document analysis was conducted. Supreme Court of Cassation rulings involving nurses held responsible for adverse outcomes in patients due to episodes of poor care attributable to Unfinished Nursing Care were considered. The DeJure database was searched. Extracted data were synthesized in narrative form, focusing on the main characteristics of the rulings, their consequences for patients, nurses, and the health care system, the omitted or delayed interventions sanctioned, and the concurrent reasons underlying such omissions. Results: Between December 2004 and October 2022, the Italian Supreme Court of Cassation issued 10 rulings. In eight cases, the patients died; in the remaining cases, the patients suffered permanent consequences. The most reported omissions included failure to monitor vital signs and postoperative care, inadequate patient monitoring, failure to document notes and allergies, neglect of basic care, failure to check surgical sites, and delays in response time. The rulings identified reasons ranging from a single cause to multiple concurrent factors at the individual nurse, unit, and system-wide levels. Conclusions: This is the first document analysis of Italian case law on Unfinished Nursing Care, offering a forensic perspective based on legally documented omissions rather than self-reported data. Omissions leading to criminal convictions most often concerned patient monitoring, postoperative surveillance, documentation, and basic nursing care. Omissions or delays in nursing care may lead to severe patient harm while also exposing individual nurses to criminal liability, despite the inherently multidisciplinary and system-based nature of care delivery.