Understanding Missed Nursing Care Using Institutional Ethnography: The Ruling Relations of Post New Public Management

The emergence of New Public Management (NPM) strategies for curtailing the spiraling cost of public spending in the 1980s resulted in major reforms and restructuring of services within Western democracies, particularly the Anglo countries of New Zealand, Australia, the United States, Canada and the United Kingdom. While some commentators argue that NPM has run its course, in this paper we suggest that risk management is now central to the neo-liberal reform agenda of new public management, particularly within the public health care sector in Australia. In making this claim the paper draws on qualitative interviews with twelve nurse managers who worked late and night shifts in one large tertiary public hospital in South Australia. Participants self-selected following an open invitation through the major nurses' union. The focus of the interviews was on missed care, specifically reasons for missed care, using the methodological approach of Institutional Ethnography. In providing an analysis of the interviews we demonstrate the way new scientific approaches to risk management, including digital surveillance, sits alongside NPM to create novel regimes of governance and control over nurse's work.