Linking patient satisfaction with nursing care: the case of care rationing - a correlational study

Abstract

BackgroundImplicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses’ perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were:a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses’ perceptions of their practice environment while adjusting for patient and nurse characteristics.b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels.MethodsA descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses’ perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall’s correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction.ResultsThe mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0–3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 – 3.69) and the two scales were significantly correlated (τ = −0.234, p < 0.001). The regression analysis showed that care rationing and work environment were related to patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction.ConclusionsThe results support the relationships between organizational and environmental variables, care rationing and patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a negative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient safety is not jeopardized.

Association between workload of the nursing staff and patient safety outcomes

“…Likewise, the inverse significant association (p<0.01) found between the workload and the level of satisfaction of the patients with the care received by the nursing team is consistent with the results of other studies, which indicated that higher numbers of patients assigned to the nursing team decrease patient satisfaction and that the restriction or reduction of nursing staff has a negative repercussion on patients' and professionals' perception of safety in care environments (4)(5)(23)(24) . Despite the differences in context, working hours, professional training and others, studies in different countries indicated that the increase in the number of nurses and nursing hours in patient care, as well as a higher proportion of nurses in teams composed also by professionals with a vocational education can improve quality and safety outcomes for patients in hospitals.…”

What impact does nursing care left undone have on patient outcomes? Review of the literature

“…Responses were collected on a four‐point Likert‐type scale, and a “rationing score” was derived from the average sum of all items. A high degree of rationing was negatively associated with all five dimensions of patient satisfaction (Papastavrou, Andreou, Tsangari, et al., 2014). Schubert et al.…”

United Family Healthcare (Chindex International)

“…UFH invests in nurse training on the principle that quality nursing care has been shown to correlate positively with clinical outcomes and patient satisfaction. 12 Competitors have also realized the effectiveness of UFH's training programs and made the retention of junior nurses challenging for the company, particularly in Beijing, where nurses have received offers of up to double their UFH salaries.…”