Mrs Sarah Mills1
1Charles Darwin University, Brisbane, Australia
Biography:
Sarah Mills is a Senior Lecturer in Nursing at Charles Darwin University, with extensive experience in teaching, curriculum innovation, and simulation-based education. She is currently completing a PhD examining socio-political, personal, and organisational influences on missed nursing care in Australia. Trained in the United Kingdom, Sarah has clinical experience in intensive care and remote area nursing, having lived and worked across the Northern Territory. Her research focuses on improving patient safety and care quality while supporting nurses’ wellbeing, and sustainable workforce practices, particularly in rural and remote health settings.
Abstract:
Background
Registered nurses practicing in rural and remote settings are required to uphold professional standards within complex socio-political and organisational environments. These contexts shape how nurses exercise professional accountability, particularly when competing demands make it difficult to deliver all required care. Missed Nursing Care (MNC), defined as required nursing care that is delayed, incomplete, or omitted, provides a useful lens through which to examine how accountability is negotiated in practice. Understanding how socio-political and organisational factors influence nurses’ professional accountability in rural and remote contexts is essential to supporting the workforce and maintaining safe, high-quality care.
Methods
Preliminary findings summarise data from phase 1 (open-ended questionnaire) and Phase 2 semi-structured interviews). Data was obtained from 2024 to 2025. Yin’s case study design was used, and findings are presented through a micro-meso-macro lens (individual, organisational, system).
Results
Participants upheld high standards despite working in challenging practice environments. Individual (Micro): Rural and remote nurses mitigated MNC by prioritising care, bundling tasks, and with teamwork. However, personal accountability was often upheld through personal sacrifice rather than supportive systems, contributing to moral distress and burnout. Organisation (Meso): Participants identified Inadequate staffing, heavy workloads and increasing administrative demands as key contributors to MNC. In small rural and remote teams, these pressures were intensified, amplifying the risk of care being missed. System (Macro): Policy changes, inadequate funding and electronic medical records increased nurses’ workloads.