Authors: Terry Jones, Patti Hamilton, Jenny Carryer, Susan Sportsman and Gretchen Gemeinhardt
Abstract: Rationalised economic cultures are characterized by a preoccupation with production efficiency and control of business practices through scientific management techniques. Nursing practice is profoundly affected by these techniques and rationalised nurse work environments threaten the well-being of nurses and patients. Healthcare managers pursue cost reduction by increasing productivity while employing the fewest nurses possible. As a result, nurses experience situations throughout their work day in which they lack sufficient time resources to meet all work demands. During these situations, decisions must be made regarding which activities will be completed and which will be left undone. In economic terms this decision making process is called ‘implicit rationing of nursing care’. In quality and safety terms the end result of these decisions is called “missed care”. Evidence suggests that implicit rationing may play an important role linking inadequate nurse staffing to adverse nurse and patient outcomes. What follows is a description of a network of researchers who have come together to pool ideas and resources to examine relationships between rationalized management practices, nursing care processes (staffing and implicit rationing), nurse sensitive outcomes, and a nations’ ability to address the health of their citizens.
Keywords: error; missed nursing care; quality; rationalisation; safety