These Australian findings not only contribute to other international studies that identify why nursing care is omitted, it provides a framework for why reported episodes of missed care can be predicted and subsequently addressed.

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour.

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.

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The incidences, types, and reasons behind missed care are a multidimensional construct which can be predicted when known significant factors behind missed care are simultaneously accounted for.