Abstract
This paper focuses on the problem of nursing rationing and its impact on the quality of patient care delivery. Care rationing, i.e., the reduction of nursing resources in relation to demand, poses a serious challenge to the healthcare sector. The purpose of this paper is to identify the causes and factors influencing care rationing, analyze the effects of this phenomenon, and propose solutions to improve the quality of nursing care.References
Schubert M, Glass TR, Clarke SP, et al. Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study. Int J Qual Health Care 2008; 20(4): 227–237.
Aiken LH, Sloane DM, Cimiotti JP, et al. Implications of the California Nurse Staffing Mandate for Other States. Health Serv Res 2010; 45(4): 904–921.
West E, Barron DN, Reeves R. Overcoming the barriers to patientcentred care: time, tools and training. J Clin Nurs 2005; 14(4): 435–443.
Aiken LH, Clarke SP, Sloane DM. Hospital staffing, organization, and quality of care: cross-national findings. Nurs Outlook 2002; 50(5): 187–194.
Papastavrou E, Andreou P, Vryonides S. The hidden ethical element of nursing care rationing. Nurs Ethics 2014; 21(5): 583–593.
Vryonides S, Papastavrou E, Charalambous A, et al. The ethical dimension of nursing care rationing: a thematic synthesis of qualitative studies. Nurs Ethics 2015; 22(8): 881–900.
Bae S-H, Fabry D. Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes: systematic literature review. Nurs Outlook 2014; 62(2): 138–156.
Brennan CW, Daly BJ, Jones KR. State of the science: the relationship between nurse staffing and patient outcomes. West J Nurs Res 2013; 35(6): 760–794.
Gahan M, Kucharski G, Coyer F. Winner ACCCN Best Nursing Review Paper 2011 sponsored by Elsevier. Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit: a literature review. Aust Crit Care 2012; 25(2): 64–77.
Stalpers D, Brouwer BJM, de, Kaljouw MJ, et al. Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of literature. Int J Nurs Stud 2015; 52(4): 817–835.
Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: state of the science review. Int J Nurs Stud 2015; 52(6): 1121–1137.
Kalisch BJ, Landstrom GL, Hinshaw AS. Missed nursing care: a concept analysis. J Adv Nurs 2009; 65(7): 1509–1517.
Papastavrou E, Andreou P, Efstathiou G. Rationing of nursing care and nurse-patient outcomes: a systematic review of quantitative studies. Int J Health Plann Manage 2014; 29(1): 3–25.
Schubert M, Glass TR, Clarke SP, et al. Validation of the Basel Extent of Rationing of Nursing Care instrument. Nurs Res 2007; 56(6): 416–424.
Donabedian A. An Introduction to Quality Assurance in Health Care. New York: Oxford University Press; 2002.
Schubert M, Clarke SP, Glass TR, et al. Identifying thresholds for relationships between impacts of rationing of nursing care and nurseand patient-reported outcomes in Swiss hospitals: a correlational study. Int J Nurs Stud 2009; 46(7): 884–893.
Kalisch BJ, Xie B. Errors of Omission: Missed Nursing Care. West J Nurs Res 2014; 36(7): 875–890.
Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: state of the science review. Int J Nurs Stud 2015; 52(6): 1121–1137.
Schubert M, Glass TR, Clarke SP, et al. Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study. Int J Qual Health Care 2008; 20(4): 227–237.
Ausserhofer D, Zander B, Busse R, et al. Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study. BMJ Qual Saf 2014; 23(2): 126–135.
Lucero RJ, Lake ET, Aiken LH. Variations in nursing care quality across hospitals. J Adv Nurs 2009; 65(11): 2299–2310.
Sochalski J. Is more better?: the relationship between nurse staffing and the quality of nursing care in hospitals. Med Care 2004; 42(2 Suppl.): II67–II73.
Kalisch BJ. Missed nursing care: a qualitative study. J Nurs Care Qual 2006; 21(4): 306–315.
Uchmanowicz I. Missed nursing care – what went wrong? Cent Eur J Nurs Midwifery 2017; 8(2): 609.
Schubert M, Glass TR, Clarke SP, et al. Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study. Int J Qual Health Care 2008; 20(4): 227–237.
Aiken L, Clarke S, Sloane D. Hospital staffing, organization, and quality of care: cross-national findings. Nurs Outlook 2002; 50: 187–194.
Aiken LH, Clarke SP, Sloane DM, et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288(16): 1987–1993.
Rafferty AM, Clarke SP, Coles J, et al. Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records. Int J Nurs Stud 2007; 44(2): 175–182.
Piscotty R, Kalisch B. Lost opportunities... the challenges of ‘missed nursing care’. Nurs Manag (Harrow) 2014; 45(10): 40–44.
Griffiths P, Dall’Ora C, Simon M, et al. Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Med Care 2014; 52(11): 975–981.
Griffiths P, Ball J, Drennan J, et al. The association between patient safety outcomes and nurse/healthcare assistant skill mix and staffing levels and factors that may influence staffing requirements [Internet]. University of Southampton; 2014 Available from URL: https://eprints.soton.ac.uk/367526/ (cited 17.03.2021).
Andersson A-K, Omberg M, Svedlund M. Triage in the emergency department – a qualitative study of the factors which nurses consider when making decisions. Nurs Crit Care 2006; 11(3): 136–145.
Keogh B. Review into the quality of care and treatment provided by 14 Hospital trusts in England: overview report. England: National Health Service; 2013.
Hugonnet S, Chevrolet J-C, Pittet D. The effect of workload on infection risk in critically ill patients. Crit Care Med 2007; 35(1): 76–81.
Hegney DG, Rees CS, Osseiran-Moisson R, et al. Perceptions of nursing workloads and contributing factors, and their impact on implicit care rationing: a Queensland, Australia study. J Nurs Manag 2019; 27(2): 371–380.
Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 2002; 346(22): 1715–1722.
Aiken LH. Educational Levels of Hospital Nurses and Surgical Patient Mortality. JAMA 2003; 290(12): 1617–1623.
Kuenzi K, Schaer-Moser M. Die Arbeitssituation im Pflegebereich im Kanton Bern. Bern: Büro Bass, Büro & Co; 2002: 1–81.
Recio-Saucedo A, Dall’Ora C, Maruotti A, et al. What impact does nursing care left undone have on patient outcomes? Review of the literature. J Clin Nurs 2018; 27(11–12): 2248–2259.