This is relevant to community nursing too.
Procedures (like wound care) have a time allowance - and those are perfectly adequate when the nurse knows her patient and the patient knows her. But when she is visiting a new patient, she may need to work out how to find the house, introduce herself to the patient and establish rapport, assess the living conditions and the ability of the person to comply with instructions after she has gone as well as do the actual procedure.
Nurses get frustrated at not having the time they need to care in the way they want to and leave the profession or cut back hours to only work part-time. This increases the scheduling problem, resulting in more people being seen by a different nurse each time. And that results in more new-patient procedures that require more time than is allowed. Nurses end up working through lunch times to get through their client list for the day.
The lack of continuity of care also means that nurses miss subtle changes in patient condition that might have helped them head off medical crises. And it makes it harder for nurses to educate their patients and followup so that some patients could take on more self-care and actually reduce the demands on community nursing (e.g. insulin administration).
I think it's an interesting topic - there's so much scope for improving the way primary medical care is done.
