Causes of missed nursing care: qualitative responses to a survey of Australian nurses

ABSTRACT

There is a growing nursing literature that views missed nursing care as an inevitable consequence of work intensification associated with the rationing of the human and material resources required to deliver care. A modified MISSCARE survey was administered to 4431 nurses and midwives in New South Wales in November 2014. This paper reports on 947 responses to an open question contained in the survey which asked respondents ‘Is there anything else you would like to tell us about missed care?’ Responses were analysed using qualitative content analysis and focused upon both the causes and impact of missed care. Analysis identified two major causes of missed care: the impact of work intensification and staffing issues. Participants associated work intensification with patient acuity and cost containment, while the staffing issues identified included: undermining prescribed staffing ratios; skill mix; changing workloads across shifts; and poor support from other staff. Respondents identified insufficient resources, albeit staffing or other resources, to meet patient care needs reflecting findings in similar studies. Missed or delayed nursing care in this context is associated with resource issues leading nurses to ration the care they can provide. While work intensification is not a new phenomenon, its increasing use in the public hospital sector across a number of OECD countries has become a major consequence of new public management (NPM) strategies aimed at cost containment.

KEYWORDS:

• Implicit rationing
• missed care
• new public management
• nursing
• staffing
• work intensification

Acknowledgements

The authors would like to thank the New South Wales Nurses’ and Midwives’ Association, in particular Mark Kearin, for facilitating data collection through advertising the survey and thank the Nurses and Midwives of New South Wales who completed the survey. We would also like to acknowledge the Faculty of Medicine, Nursing and Health Sciences at Flinders University who provided funding for this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Faculty of Medicine, Nursing and Health Sciences at Flinders University.

Notes on contributors

Julie Henderson

Julie Henderson, PhD, is a Health Sociologist working at Flinders University who has an interest in mental health and health workforce issues.

Eileen Willis

Eileen Willis, PhD, is a Professor in the School of Health Sciences at Flinders University. Her research interests include indigenous public health policy and the impact of health reform on working time.

Ian Blackman

Ian Blackman, EdD, is a lecturer in the School of Nursing & Midwifery at Flinders University. His research addresses measurement outcomes in health professional education and health workforce issues.

Luisa Toffoli

Luisa Toffoli, PhD, is a senior lecturer in the School of Nursing & Midwifery at the University of South Australia. Her research addresses nursing workforce issues particularly in the private sector.

Claire Verrall

Claire Verrall, MN, is a lecturer in the School of Nursing & Midwifery at Flinders University. Her primary research interest is the role of the nurse in primary care.