Systems, economics, and neoliberal politics: theories to understand missed nursing care

Terry Jones, Anat Drach-Zahavy, Mário Amorim-Lopes, Eileen Willis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


The phenomenon of missed nursing care is endemic across all sectors. Nurse leaders have drawn attention to the implications of missed care for patient outcomes, with calls to develop clear political, methodological, and theoretical approaches. As part of this call, we describe three structural theories that inform frameworks of missed care: systems theory, economic theory, and neoliberal politics. The final section provides commentary on the strengths and limitations of these three theories, in the light of structuration theory and calls to balance this research agenda by reinstating nurse agency and examining the interactions between nurses as agents and the health systems as structures. The paper argues that a better understanding of variations in structure–agency interaction across the healthcare system might lead to more effective interventions at strategic leverage points.

Original languageEnglish
Pages (from-to)586-592
Number of pages7
JournalNursing and Health Sciences
Issue number3
Publication statusPublished - 1 Sept 2020


  • Economic
  • Missed care
  • Structuration theory
  • Systems
  • Political economy
  • Nursing


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