Does Rationing of Nursing Care Presuppose an Acceptance of Missed Care? Philosophical and Legal Aspects

This chapter discusses the concept of missed care, both from a theoretical point of view and from a practical one, mentioning philosophical and legal distinctions, and in relation to the concept of rationing in nursing care. The central question of this chapter is whether missed nursing care constitutes an unavoidable presumption within the context of rationing discussions. To answer this question, it begins by examining the concept of omission. At first glance, an omission is not equally bad as an action, but this has been contested, and it has important implications in the delivery of health care. Omissions have different meanings in nursing and medical contexts as the scope of practice of these professions is also different. Moreover, nursing care does not have as clear limits as medical care does; this creates difficulties in defining missed nursing care, and coupled with limited resources, that is nursing time combined with low staffing, renders rationing of nursing care inevitable. Therefore, attention is shifted to the question of whether missed nursing care should be seen as an error, and of what kind of error it is. In conclusion, a somewhat idealistic approach of nursing care and its missing elements is adopted, which nevertheless lies in the core of the nursing profession.