The juxtaposition of nursing autonomy and health care policy in nursing care delivery

This paper presents the findings of a survey that was conducted in New Zealand examining the perceptions of nurses in regard to missed care opportunities. The study replicated the work of Kalisch et al (2009) using their Missed Care Survey undertaken in the USA and the Adelaide study (Hamilton et al). The survey used an 8-step method of concept analysis which found that missed care conceptualised within the Missed Nursing Care Model, is defined as “any aspect of required patient care that is omitted (either in part or in whole) or delayed” (Kalisch et al 2009; 1509). Overall findings support the Kalisch study indicating that much of the missed care related to systemic issues in three main areas; ineffective methods for determining staffing levels; competing demands that reduce time for patient care, and skill mix. More specifically this paper examines three themes within the areas identified and these are; the age of nurses in relation to care that is missed; overtime and the working of ‘extra’ shifts that are seen as part of the business as usual within normal working allocations, and concurrent with that, the he analysis of data suggesting that overtime and illness are closely correlated; and finally the element of ‘no longer caring’ manifested in significant care being missed.