Work intensification as missed care

Abstract

Work intensification is assumed to incorporate either longer working hours or a quickening of the pace or speed of work. In this paper, we argue that 'missed care' is a proxy for work intensification or work effort in nursing. Using Kalisch's MISSCARE survey tool, with modifications to suit the South Australian context we surveyed 354 registered and enrolled nurses between October and December 2012. Survey participants were recruited through the Australian Nursing and Midwifery Federation (SA Branch). The MISSCARE survey tool presents participants with a 5-point scale where 1 is never omitted care and 5 is always omitted care. Survey findings suggest that the tasks most often missed are ambulation of patients and mouth care. Tasks lest likely to be missed are blood glucose monitoring; hand washing; IV/central line care and providing PRN medication within 15 minutes. These findings suggest that when nurses are forced to ration care, priority is given to clinical tasks that will impact on immediate patient outcomes. In identifying the reasons why they missed care, nurses reported that while staffing often appeared adequate, sudden and unexpected rises in patient volume, heavy admissions and discharges, and inadequate numbers of staff or clerical support were key indicators of missed care. These unpredictable events resulted in an increase in work intensity and pace that was independent of extended working hours or overtime. We argue that one of the outcomes of work intensification is missed care.

Predicting variations to missed nursing care: A three-nation comparison

“…Lastly, cultural factors and habits in degree of compliance toward protocols or guidelines, as well as moral attitude, may have an influence here. Lower levels of missed care in Australia may reflect better staffing ratios due to greater protection from the global financial crisis than Italy or Cyprus, despite staffing levels consistently being identified as a factor in missed care in Australia (Blackman et al., ; Willis et al., ).…”

Nurses' perceptions of the impact of the aged care reform on services for residents in multi‐purpose services and residential aged care facilities in rural Australia

“…This study builds upon previous work identifying factors contributing to missed nursing care in South Australia . Nurses for this study came from two settings: MPS and RACF.…”

“…Rural aged care service providers are already known to experience challenges in the provision of aged care due to difficulties in recruiting staff, accessing resources for staff development, fewer general practitioners and limited access to specialist and allied health services . Further, a recent survey study on missed care revealed that lack of both physical and human resources for nursing care provision in rural care settings might be contributing factors for missed or delayed care activities . The movement towards marketisation of aged care is premised on increased consumer choice; however, residents and their families in rural regions experience limited choice of service providers and/or care packages, contributing to disparity between rural and metropolitan aged care service provision.…”

The evaluation of nurse navigators in chronic and complex care

“…Influences on the lack of continuity of care include increased pressure on staffing related to reduced human resource allocations and skills mix, and generalized cost constraints (Bergh, Friberg, Persson, & Dahlborg-Lyckhage, 2015;Chadban et al, 2010;Phelan & McCarthy, 2016). Additionally, in the work intensified environment, integrating care has been hampered by inadequate communication between departments/providers, poor or ineffective handover between services, and poor or absent discharge planning and patient education (Finlayson, Sheridan, Cumming, & Fowler, 2012;Harvey et al, 2016;Henderson, Willis, Toffoli, Hamilton, & Blackman, 2016;Willis et al, 2015). Often care gets missed, or misunderstood, and there are unnecessary duplications between services (Finlayson et al, 2012).…”