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.