Rationed – Missed Nursing Care: An International and Multidimensional Problem

Rationed – Missed Nursing Care: An International and Multidimensional Problem

Leader: Associate Professor Clare Harvey

Work intensification is becoming a widely-used term within the healthcare workforce, brought about by the ongoing (and escalating) cost constraints being imposed upon health services. In this milieu, there is an emerging awareness to the fact that health professionals are unable to manage care effectively, with a corresponding increase in the need to ration care and in some cases, miss the care that is required for effective, patient centred direction.

This research cluster focuses on examining quality and risk related to health professionals and their working conditions, which have a direct impact on clinical quality and patient outcomes. This approach aligns with Health Workforce New Zealand’s strategic intent of improved health and wellbeing of the population by improving delivery of health care. The cluster compliments the Heathy Communities research cluster by combining workforce development with models of care that support effective use of healthcare resource allocations. Additionally, our categories for research align with the international RANCARE project, which asserts that for care delivery to be effective in the face of increasing economic reform, dialogue needs to occur in social, economic and workforce policy, located within a multidisciplinary, multinational inquiry forum. The health of the workforce therefore, is reliant upon any facets of organisation that together create an effective environment within which healthcare is delivered. 

Rationed – Missed Nursing Care: An International and Multidimensional Problem

The Eastern Institute of Technology (EIT) is the institution representing New Zealand as an International Partner Country (IPC) on the project “Rationed – missed nursing care: An international and multidimensional problem” RANCARE CA15208 (European Co-operation in Science and Technology [COST]). RANCARE is a four-year project which is divided into four working groups that are far reaching in their exploration of all facets of the workforce affected by the act of rationing and missing care. Research members on the project come from 24 COST countries (Eurozone), 4 international partner countries, 8 inclusiveness countries and 1 co-operating state.

Whilst RANCARE focuses on nursing, the EIT position on missed and rationed care is that it affects all health professionals in all settings. In this location, research allows for multidisciplinary involvement where that work supports identifying solutions to issues related to workforce quality.

RANCARE Working Groups

The following EIT academics are named researchers on working groups:

Working Group 1: Conceptualisation of Rationing and Research Methodology – Prof Bob Marshall, Dr Eunice Fuchs

Working Group 2:  Evidence-Based Intervention and Intervention Design – Assoc Prof Clare Harvey, Assoc Prof Jonathan Sibley

Working Group 3: The Ethical Dimension of Rationing Nursing Care – Assoc Prof Clare Harvey

Working Group 4: Educational Issues and Training

Current Projects and Doctoral Studies


  • The effects of presenteeism in missed and rationed care – Ms Clare Buckley (PhD candidate, Flinders University)
  • Reducing health inequities for patients with long term conditions using a nurse-led model of care – Ass Prof Clare Harvey, Ms Janine Palmer, Ms Trish Freer, Ms Sue Ward, Prof Eileen Willis (IPC Australia), Dr Shona Thompson, Dr Jonathan Sibley, Prof Evridiki Papastavrou (Lead Researcher RANCARE), Prof Bob Marshall, Ass Prof Rachel Forrest, Ms Maria Pearson (in collaboration with Hawke’s Bay District Health Board)

2017 Projects

The following projects are underway/under development. 

  • Exploring the concepts of missing care in a multidisciplinary dimension.

Team members –  Prof Bob Marshall, Assoc Prof Clare Harvey

  • Exploring attrition in the workforce.

Team members – Dr Eunice Fuchs

  • Developing a conceptual model for measuring the financial cost of missed and rationed care.

Team members – Assoc Prof Clare Harvey, Assoc Prof Jonathan Sibley, Prof Bob Marshall, Dr Shona Thompson, Prof Eileen Willis

  • Examining the professional impact of missed and rationed care

Associate Professor Clare Harvey, Dr Shona Thompson, Professor Eileen Willis, Ms Alannah Meyer

For EIT academics: Opportunities exist to join existing research groups and projects, or if you have an idea/proposal that would fit within this cluster, please contact us.

For postgraduate students: If you are looking for a topic for study in this cluster, please contact us to find out what opportunities are available. 

For more information please contact:


Professor Bob Marshall

bob-marshallBob is the Research Director at EIT with a special interest in biomechanics of sport. He has previously taught and researched biomechanics at the Universities of Otago, Western Australia and Auckland. The sports he has particular biomechanics expertise in are cricket fast bowling, golf, tennis, cycling, athletics, kayaking, and sailing.

Professor Bob Marshall (Research Professor), email bmarshall@eit.ac.nz

Associate Professor Clare Harvey

Clare HarveyI have worked in Zimbabwe, South Africa, New Zealand and Australia, in clinical, management and education roles that have gone across settings from primary health and remote area nursing to intensive care.

Associate Professor Clare Harvey (Research Cluster leader), email charvey@eit.ac.nz