Hospital malnutrition is a worldwide problem. A nutritional care policy was evaluated to determine whether nutrition was enhanced by improving patients' access and nurses' supervision of meals. Fourteen pre-audit wards (435 patients) and 20 postaudit wards (422 patients) across three hospitals participated in a pre–post audit and observation study with an examination of documentation. A food satisfaction survey was completed by 226 patients (pre) and 240 patients (post). A modest increase in the proportion of patients receiving supervision with meals (83% pre, 88% post, P = 0.058) was not associated with an increase in consumption (50% or more of meal). Patients report poor appetite in the presence of good to fair food quality. The nurse's role in nutritional care was defined. Protected mealtimes supported by nurse managers reorganizing staff mealtimes with assistance from carers, volunteers and other health professionals were endorsed. Nurses must ensure that patient's meal trays are accessible.