Nurses play a pivotal role to ensure adequate nutritional care for the patient at the bedside. Despite the increasing number of malnutrition cases in hospitals, the role of nurses in nutritional care is generally neglected in clinical practice [22]. Our study aimed to assess nurses’ nutritional care practice and associated factors in surgical patients at referral hospitals of Bahir Dar city.

Nearly one-third of nurses practiced good nutritional care for surgical patients. This suggests that most nurses provide less nutritional care service. This implies that surgical patients who require nutritional support may not obtain it, which increases the risk of malnourishment, poor recovery and complications. Furthermore, it can have a significant effect on the healthcare system, families, and caregivers.

The finding of this study was lower than the study conducted in Egypt [23] and Addis Ababa [14]. This could be explained by the difference that our study was conducted in all wards of the hospital, where nurses have the opportunity of annual ration to surgical ward. Whereas, the studies in Addis Ababa and Egypt were conducted only in critical care units (ICU) that might have better nutritional care practice. In fact, the ICU has a low nurse-to-patient ratio, which might have a lower workload to practice good nutritional care. Additionally, the Egyptian study was include nurses that have at least one year of experience who might have better skill in nutritional care. Furthermore, it could be due to the lack of knowledge, and shortage resources in our set up. Evidence found that lack of resources in clinical setting hinder nurses nutritional care practice for patients [17].

However, our finding is higher than the study done in Scandinavia [24]. This may be attributed to the difference in study period and data collection method. In contrast to our study, which employed a printed questionnaire and was conducted face-to-face, the Scandinavian study used mail to gather data, which may result in participants didn’t completely understand its’ purpose.

Female nurses had good nutritional practices for surgical patients compared to males. This might be due to cultural practice unlike males; females have better meal preparation and feeding experience. The order of nutrition intervention by staff category was found to be a factor in nutrition practices. Orders from doctors showed better implementation tendencies. This could be related to nurses’ personal attitudes to professional categories. This is supported by evidence that physicians’ lack of focus on nutritional care compromised nursing staff’s nutritional practices, resulting in suboptimal nutritional intervention [17]. It has its own limitation in helping patients that could lead poor clinical outcome. It is better that nurse to see both the order and patients’ condition to help them than consider a person who ordered the intervention.

Nurses who read nutrition guidelines were provide good nutritional care compared with the counterparts. This is consistent with the study done in Addis Ababa [14]. In addition, practice sharing experiences with colleagues have provided good nutritional care practice compared with the counterparts. It is true that if everyone reads updated guidelines and participates in experience sharing, they can update themselves and understand the adverse consequences of malnutrition. Thus, they may practice better nutritional care on their patients timely and be active participants in information sharing with other staffs.

In facilities or work units with a relatively low nurse-to-patient ratio, nutritional support for surgical patients was relatively appropriate. This is supported by the American Nurses Association that optimal nursing staff is crucial to improve the quality of patient care [25]. This might be related to nurses’ workload and inadequate time to read and perform nutritional care for patients. If nurses are busy with many tasks, they may not be effective in helping the patients as per the standard. They may not also read more on the program to update themselves [11].

Nurses with poor knowledge were unable to practice adequate nutritional care for hospitalized surgical patients which are supported by similar studies [26,27,28,29]. This implies that if less knowledgeable people are involved in nutrition care, the quality of services can be compromised which might result in poor patient outcome. In the same line, nurses’ with unfavorable attitude had negative effect on the practice of nutritional care. This is supported by similar study in Tanzania [30]. This implies that despite having good knowledge, the attitude of nurses is also important to provide good nutritional care practice.

As a limitation, this study was conducted in a single city and cannot be generalized to other parts of the country. There may be some bias in terms of recall and response. However, it is the first study in Ethiopia that provides new insights into nutritional care practice, which may be the strength of the study.

In this study, nurses’ nutritional care practices for surgical patients’ were found to be low. Gender, reading nutrition guidelines, orders from physicians, experience sharing with peers, and nurse to patient ratio, knowledge, and attitude had statistical association. Based on our findings, the following recommendations are forwarded:

It is better if hospital managers in collaboration with other concerned offices access information sources like nutrition guidelines in hospitals. It is also crucial to improve staffs awareness on nutritional support programs through short term training, peer education/experience sharing/, brushers, posters and mass media. Overcoming the nurses’ workload by increasing the number of nurses and mix-up more experienced and less experienced nurse can support program performance. Nurses need to help patients based on their dietary need and the request ordered. Researchers need to conduct qualitative study by include physicians and hospital managers.