Abstract
Nurses have an essential role to play in ongoing patient surveillance. The quality of nursing care patients receive has implications for both their recovery and long term health outcomes. Currently, due to a number of factors, nurses are facing increasing challenges to meeting the care needs of hospital patients. These include fluctuations in nursing skill mix and staffing levels, inconsistent availability of equipment and supplies, and higher patient acuity. The additional impact of healthcare restructuring on nursing has been reflected in the demand to do more with less. Consequently nurses are constantly forced to prioritise certain aspects of nursing care as being less important than others, resulting in some nursing cares being delayed or missed.

In this study the concept of “missed care” was explored using a qualitative descriptive approach. Five registered nurses working within a New Zealand hospital were interviewed and the data obtained analysed using a general inductive approach. Two of the main categories were identified: ‘the types of care that were regularly delayed or missed’, and ‘the reasons for regularly delaying or missing care’. The third main category identified was ‘moral distress’. This related to the feelings of guilt and frustration experienced by the nurses as a result of delaying or missing care.

It is argued that by understanding issues affecting direct care delivery to patients, registered nurses will be more able to effect constructive change in their work environments. This will have the benefit of enhancing both the quality of the nurses’ work environment and the quality of care delivered to patients.

Keywords
missed care, rationing nursing care, patient care outcomes, patient safety.

Introduction
In many health care organisations, both in New Zealand and internationally, the delivery of a high quality, safe and cost effective health care service that is responsive to patient care needs presents a challenge. This situation is exacerbated by an ageing population, the greater expectations of the general public regarding healthcare interventions, and the rising costs of health service delivery (Aiken, Clarke & Sloane, 2002; Finlayson & Gower, 2002). Unfortunately many healthcare organisations have had to reorganise and restructure their services in attempts to contain burgeoning expenditure. The impact of healthcare restructuring on nursing is reflected in the demand for nurses to do more with less and to care for patients “sicker and quicker” (IOM, 2004, p. 39). These pressures have implications for the ability of nurses to meet all the care requirements of individual patients.   .....cont.