Nurses and Healthcare Rationing

Nursing Management and Leadership An Analysis of Healthcare Rationing While nursing, and healthcare in general, often gets negative publicity for the idea of rationing care, in many cases it is a necessity. Hospitals and nurses only have so much time and so many resources available to them and have to decide where these resources are best invested in an ethical manner. Deciding where to ration care due to limited resources is a perplexing moral and ethical challenge in many situations, and one that is more common than most people think.

Nurses must make judgements, sometimes on the spot, about where best to allocate their time consistent with their professional values. This analysis will consider the role of rationing in healthcare and nursing as well as how this challenge can be approached from an ethical perspective.

Issue Recent studies into nursing care rationing indicate that nurses always ration their time and care, resulting to serious threats to the quality of care and patient safety; for example patient mobilization, hygiene, feeding, communication, patient support, teaching and discharge planning, surveillance and care documentation are regularly lacking or omitted (Papastavrou, 2013). Most of the rationing stems for the simple fact of scarcity in time or available resources and resources are inevitably either explicitly or implicitly rationed, sometimes without the realization that they are actually rationing care.

Healthcare rationing has been extensively discussed in the medical profession and is understood as withholding beneficial interventions, mainly for cost-effectiveness reasons that occur at all levels and in all healthcare systems around the world (Papastavrou, Andreou, & Vryonides, 2014). However, because the idea of healthcare rationing is often an emotional and/or politically charged issue in many circles, the frequency of patterns of implicit rationing are not well-understood.

One study conducted in Texas found that some degree of rationing on at least one of the nursing care activities was reported by almost all of the respondents and most rationed multiple activities; also rationing preference patterns favor completion of activities directed to meet immediate physiological needs over other activities (Jones, 2015).

Implicit 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 (Papastavrou, Panayiota, Hartini, & Anastasios, 2014). However, such rationing occurs on a nurse's individual decision making needs in most cases. There are also other levels of rationing that can be found in healthcare.

Decisions about health care are made at multiple levels within the system: (a) the macro level where policy is established by governments, health authorities, insurance plans, etc.; (b) the meso level where organizational budgets are established by organizational administrators; and (c) the micro level where care is delivered by clinician providers (Jones, 2015).

Thus there is a stark difference in a busy nurse making a judgement call about where to spend their time, and the forms of rationing that are based on decision making by executives, managers, and administrators who often face similar challenges on different scales. For example, a hospital may only be able to afford a limited number of healthcare workers and must determine the best way to allocate their resources based on a set of priorities.

Some researchers have attempted to identify possible measures that can help them determine the level of rationing that is present in a nursing care setting. Nurses' decisions to ration care may be influenced by hospital organizational attributes and the nurse practice environment, and researchers have developed a rationing measurement instrument, the Basel Extent of Rationing of Nursing Care (BERNCA), which has produced reports that rationing was significantly associated with staffing and work environment conditions (Schubert, Glass, Clarke, Aiken, & Sloan, 2008).

Such metrics can explore the association between implicit rationing of nursing care and selected patient outcomes in hospitals, adjusting for major organizational variables, including the quality of the nurse practice environment and the level of nurse staffing (Schubert, Glass, Clarke, Aiken, & Sloan, 2008). Conclusion In a perfect world, there would be plenty of resources available to meet all patients' needs at all times. However, in practice this rarely is the case. Nurses must decide, on a personal level, where to best devote.