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

Abstract

Bedside rationing in nursing care refers to withholding or failure to carry out certain aspects of care because of limited resources such as time, staffing or skill mix. The absence of previous systematic reviews on nursing care rationing leads to a gap of synthesized knowledge on the factors and processes related to rationing and the potential negative consequences on both patients and nurses. The aim of this study was to gain an in-depth understanding of the factors and processes related to nursing care rationing. Selected papers were methodologically assessed based on their design, sampling, measurement and statistical analysis. Seventeen quantitative studies were reviewed, and findings were categorized into four themes: elements of nursing care being rationed, causes of rationing, nurse outcomes and patient outcomes. Results revealed that communication with patients and families, patient ambulation, and mouth care were common elements of rationed care. Nurse-patient workload and communication barriers were reported as potential causes of rationing. Patient-related outcomes included patient falls, nosocomial infections and low patient satisfaction levels. Nurse-related outcomes included low job and occupational satisfaction. In addition, rationing appears to be an important organizational variable linked with patient safety and quality of care. This review increases understanding of what is actually occurring at the point of care delivery so that managers will be able to improve processes that lead to high quality of care and better patient and nurse outcomes.

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

“…Patient outcomes reported in the missed care literature, which have been associated with quality of care delivered, include hospital‐acquired infections, discharge planning, mortality, falls, patient mobilisation, feeding, psychological and emotional support (Cho, Kim, Yeon, You, & Lee, 2015; Kalisch, 2006; Kalisch, Tschannen, & Lee, 2011, 2012; Papastavrou, Andreou, & Efstathiou, 2014; Schubert, Clarke, Aiken, & de Geest, 2012). Likely factors that influence care prioritisation and completion include the time that is required to complete a care task and the immediate effect that delaying or missing this task might have on patients (Kalisch, 2006).…”

Nurses and midwives perceptions of missed nursing care – A South Australian study

“…1509. Missed nursing care has been linked to negative patient outcomes (Schubert, Glass, Scaffert-Wiltvliet & De Geest., 2009) and attributed to a variety of causes from the work environment, to patient care demands and staffing issues (Kalisch, Doumit, Lee & Zein 2013;Papastavrou, Panayiota & Georgios, 2013;Aitken, Clarke & Sloane, 2002;Needleman, Buerhaus, Mattke, Srewart & Zelevinsky, 2002). Current research suggests that when a nurse's work load increases, there is less time to care for individual patients (Schubert, Glass, Schaffert-Witvliet & De Geest 2008).…”

“…When there are insufficient resources, nurses are forced to ration or omit care. It is this that impacts on negative patient outcomes and is a major challenge to quality assurance, risk management, nurse satisfaction and ultimately patient care (Papastavrou et al, 2013).…”

Health Care Service Quality and Availability of Skilled Health Workforce: A Panel Data Modelling of the UK, USA and Israel

“…Wagner and Bear (2009) argued that social influence, previous health care experience of nurses and organisational factors affect nurse's performance and healthcare service delivery. Papastavrou et al (2014), Tobiano et al (2015) and Hudgins (2016) argued that nurses are unable to carry out their tasks effectively because they are affected by limited resources. These resources include time, staffing and the ability of human resources department to recruit staff at the right place and at the right time.…”