industry & reform
Accounting
for missed care
GFC aftershocks are still
being felt by nurses, a
new paper argues.
Eileen Willis interviewed
by Dallas Bastian
F
ollowing the global financial crisis of 2007, countries have
tightened their purse strings, but is this austerity making
patients sicker?
Researchers, led by emeritus professor Eileen Willis from
Flinders University, unpacked this question in a paper, published in
the Journal of Advanced Nursing, by exploring the link between
austerity and missed nursing care.
The authors said as nations continue to cut health budgets,
nursing services are seen as a major target and burden, rather than
a resource.
“There is a real danger that healthcare professionals, particularly
nurses, will be blamed for any sentinel or adverse events that
might occur as a result of missed care,” the paper said.
“What may not be admitted is that understaffing, casualisation,
long hours of work and overtime, along with unrealistic targets,
cannot be sustained over the long term and should only be seen
as temporary measures where governments wish to provide
quality healthcare.”
To evaluate the impact of budget cuts on missed care, the
research team drew from its own data from a survey of over 7000
registered nurses and midwives.
Nursing Review spoke with Willis about the findings of that
research and how they’re linked to a culture of austerity arising
from the GFC.
NR: To evaluate the impact of budget cuts and missed care,
your research team used its own data. What were some of the
key areas of missed care and the reasons participants gave as to
why care was missed?
EW: We did this survey in South Australia, NSW, Victoria and
Tasmania. We used and adapted the Kalisch MISSCARE Survey.
Kalisch has a number of items in the scale in which she asks
nurses: “Here’s a list of tasks. Have you missed them?” Or “Here’s a
list of cares”.
12 | nursingreview.com.au
The major things that are regularly missed are patient
ambulation, mouth care, responding to bells when patients wished
to go to the toilet, responding immediately for patient medication,
patient education and good discharge planning.
All 26 of the items that Kalisch lists are missed at some point, but
these ones tend to be at the top of the list.
When we asked nurses why these were missed, the sorts of
things they come up with are: “There weren’t the resources on my
ward and I had to go somewhere else to get them.” For example,
a patient is going to be discharged and their drugs haven’t come
up from the pharmacy and they had to go down and get them. Or
they didn’t have enough staff.
Now the staffing one is interesting. If you asked nurses if there’s
enough staff on the ward now, they would probably say yes. The
minute there is some sort of disruption – a patient is admitted or
you have to find a piece of missing equipment, or there’s an acute
event and you’ve got to attend to a very sick patient – then all of a
sudden there isn’t enough staff.
It’s as though public and private hospitals are being staffed at
that tipping point, and the minute something happens, the work
becomes so intensified that the nurse begins to make decisions
about what care will be missed.
That’s an important point to make, that nurses have always
prioritised care. They’ve always made decisions about the order of
care in the interests of the patient. What nurses are saying now is:
“I’m prioritising the care, but I’m actually having to miss some of
them or delay them or leave them to the next shift.”
If you’re leaving them to the next shift and their work is just as
intensified, it’s possible that certain care is not done at all.
How does austerity tie into it?
We argue that if you haven’t got enough staff to do the things that
need to be done, then clearly the hospital budget isn’t adequate.
We’ve used the framework of new public management in the
paper. What we’ve argued is that since the late 1970s we’ve had
what we would call ‘new public management’ – a neo-liberal
economic policy that says you can make the hospital system more
productive and efficient if internally you treat it as a competitive
private sector.
You get the sorts of things we’re seeing here in Australia in the
public sector, where they outsource non-core services like meals
and cleaning to a private company. Now, more readily you get:
“Let’s outsource pathology and radiology services and privatise