Rounding, work intensification and new public management

Abstract

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour.

Intentional rounding – An integrative literature review

“…Evidence suggests that the introduction, education and leadership of nursing staff around the concept of IR are important for the success of IR (Morgan et al., ; Neville et al., ). A lack of communication and understanding of the benefits of IR had a negative impact on the implementation (Deitrick et al., ; Fabry, ) and active role modelling, adequate education, staff involvement and ownership had a positive impact on implementation of IR (Rondinelli et al., ; Willis et al., ).…”

“…The willingness of nurses to accept IR was found to be critical for engagement and success (Fabry, ; Neville et al., ). The findings of these studies have implications for health services, suggesting the need for thorough preparation prior to implementation, including education and training and the importance of involving stakeholders to facilitate engagement (Deitrick et al., ; Rondinelli et al., ; Willis et al., ). The review provided evidence that IR was considered advantageous for staff satisfaction, workload, ward dynamics and time management, creating a better, more productive work environment (Edwardson et al., ; Meade et al., ; Neville et al., ).…”

“…The introduction, education and leadership of nursing staff around the concept of IR were reported as very important in the success of IR in three studies. A lack of communication and understanding had a negative impact on the implementation of IR (Deitrick, Baker, Paxton, Flores, & Swavely, 2012) and active role modelling, adequate education and staff involvement and ownership had a positive impact on IR (Rondinelli, Ecker, Crawford, Seelinger, & Omery, 2012;Willis et al, 2016). Delegation practices and accountability confusion were mentioned in three studies (Deitrick et al, 2012;Flowers et al, 2016;Rondinelli et al, 2012), as well as documentation and how this occurs (Deitrick et al, 2012;Flowers et al, 2016).…”

Missed nursing care as an ‘art form’: The contradictions of nurses as carers

“…Examples of this in Australia are the mandated handover in SA, where the Minister of Health directed standardised shift handover of patients (South Australian Health, ). It has also evident in the activity known as ‘rounding’ that mandates nurses record that they have checked their patients every hour (Willis et al., ), ‘Inpatient dashboards’ available to the public on the Internet that record real time bed states in hospitals are another example as are national access targets linked to incentive funding (Commonwealth of Australia, 2010).…”

Patient satisfaction surveys and care quality: a continuum conundrum

“…Without further substantive work in this field, there is a risk efforts to improve patient satisfaction may result in work intensification for nurses or other unintended consequences (Willis et al . (early view)).…”