title: The impact of rationing of health resources on capacity of Australian public sector nurses to deliver nursing care after-hours: a qualitative study.
abstract: Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care.
authors.affiliation: School of Health Sciences, Flinders University, Adelaide, SA, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Henderson
authors.affiliation: School of Health Sciences, Flinders University, Adelaide, SA, Australia.
authors.forename: Eileen
authors.initials: E
authors.lastname: Willis
authors.affiliation: School of Nursing & Midwifery, University of South Australia, Adelaide, SA, Australia.
authors.forename: Luisa
authors.initials: L
authors.lastname: Toffoli
authors.affiliation: College of Nursing, Texas Women's University, Denton, Dallas, TX, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hamilton
authors.affiliation: School of Nursing & Midwifery, Flinders University, Adelaide, SA, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Blackman
mesh_terms: D001315:Australia; D057191:Capacity Building; D006295:Health Resources; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D009732:Nursing Care / Q000379:methods*; D009741:Nursing Staff, Hospital / Q000600:supply & distribution; D010561:Personnel Staffing and Scheduling; D017150:Public Sector; D036301:Qualitative Research; D000078329:Workforce; D016526:Workload / Q000523:psychology / Q000592:standards
keywords: missed care; new public management; nurse staffing; nursing care; qualitative research; rationing