Less money, less care: How nurses in long‐term care allocate hours of needed care in a context of chronic shortage

Abstract

The average funding of long-term care in Quebec, Canada, currently covers < 70% of the care hours required, which means that 30% of needs are unmet. The aims of this study were to understand how nurses, when they are in a position to do so, assign care hours, which needs are unmet by care dimensions and whether dimensions with unmet needs vary with client profiles. One-hundred-and-four nurses working in long-term care facilities participated in the study. They filled out individual questionnaires containing three case studies in the form of vignettes. When obliged to cut 30% of the care hours, the nurses ensured that treatment and diagnostic methods were done as prescribed and that vital feeding and elimination functions were preserved. However, they made the choice to cut some mobility and personal-care activities and, especially, communication with patients, families and other professionals. In this, they partly follow the theoretical care prioritization approach of Lefebvre and Dupuis, who take into account the degree of discomfort caused by the situation, the problem's place in Maslow's hierarchy of needs and the availability of a solution. Thus, although the choices made by the nurses follow a logical pattern, they could result in medium-term deterioration in the functional autonomy of their older patients. The overall consequences of these decisions are discussed.

Rationing of nursing care and nurse–patient outcomes: a systematic review of quantitative studies

“…It is plausible that the different time frames provide some explanation of the differences in missed care or rationing level between the North American (Kalisch et al ., ; Gravlin and Bittner, ) and European studies (Schubert et al ., , ), as self‐reported rationing in the latter group was lower. Eight studies reported elements of care being rationed and the causes of rationing (Morin and Leblanc, ; Al‐Kandari and Thomas, ; Kalisch et al ., ; Lucero et al ., ; Gravlin and Bittner, ; Rochefort and Clarke, ; Kalisch et al ., ), six studies reported significant correlations between nursing care rationing and patient outcomes (Sochalski, , Schubert et al ., ; Schubert et al ., ; Lucero et al ., ; Kalisch et al ., ; Schubert et al ., ) and three studies have correlated nursing care rationing with nurse job outcomes (Lucero et al ., ; Tschannen et al ., ; Kalisch et al ., ).…”

“…Morin and Leblanc () also found that very few hours were cut from the treatment and diagnostic dimensions of care because these are usually ordered by medical staff at the expense of the social and relational aspects of patient care. Thus, part of the explanation regarding choices provided by nurses, when asked to prioritize the treatment and diagnostic dimensions of care, may lie within the amount of decisional autonomy that the nurses have in assigning care hours (Morin and Leblanc, ). The factors influencing rationing …”

Nurses' Perceptions of Their Relationships with Informal Carers in Institutional Respite Care for Older People

“…As a result they also developed no caring relationship with the family.

“…We also get these fast-track types in, quite clearly. The client is admitted, they leave in a fortnight's time and absolutely nothing at all happens during this period… [22]”

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“…The client is admitted, they leave in a fortnight's time and absolutely nothing at all happens during this period… [22]” …”

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross-sectional study

“…In acute care hospitals, nursing activities related to vital medical needs and the safety of patients, treatments and procedures, and delegated tasks from medical staff were less often left undone, while activities such as communication and support of patients, documentation, patient education and discharge planning, skin care, ambulation, and hygiene were rationed more often (Aiken et al, 2001;Ausserhofer et al, 2014;Kalisch et al, 2009;Papastavrou et al, 2014;Zander et al, 2014). Two nursing home studies provide initial evidence for a similar pattern: care workers lacked time for comforting and talking to residents, personal care, mobilization, hygiene, and monitoring, while they seldom rationed treatment and diagnostic procedures, ensured feeding and elimination functions, and cared for their patients' safety (Kü nzi and Schä r Moser, 2002; Morin and Leblanc, 2005).…”