Rationing of nursing care and its relationship to patient outcomes: The Swiss extension of the International Hospital Outcomes Study

Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
International Journal for Quality in Health Care (Impact Factor: 1.76). 08/2008; 20(4):227-37. DOI: 10.1093/intqhc/mzn017
Source: PubMed


To explore the association between implicit rationing of nursing care and selected patient outcomes in Swiss hospitals, adjusting for major organizational variables, including the quality of the nurse practice environment and the level of nurse staffing. Rationing was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Additional data were collected using an adapted version of the International Hospital Outcomes Study questionnaire.
Multi-hospital cross-sectional surveys of patients and nurses.
Eight Swiss acute care hospitals
Nurses (1338) and patients (779) on 118 medical, surgical and gynecological units.
Patient satisfaction, nurse-reported medication errors, patient falls, nosocomial infections, pressure ulcers and critical incidents involving patients over the previous year.
Generally, nurses reported rarely having omitted any of the 20 nursing tasks listed in the BERNCA over their last 7 working days. However, despite relatively low levels, implicit rationing of nursing care was a significant predictor of all six patient outcomes studied. Although the adequacy of nursing resources was a significant predictor for most of the patient outcomes in unadjusted models, it was not an independent predictor in the adjusted models. Low nursing resource adequacy ratings were a significant predictor for five of the six patient outcomes in the unadjusted models, but not in the adjusted ones.
As a system factor in acute general hospitals, implicit rationing of nursing care is an important new predictor of patient outcomes and merits further study.

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Available from: Douglas M Sloane, Oct 10, 2015
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    • "Current research suggests as nurses' work intensifies, they have less time to care for individual patients. In 2008, Schubert et al. 2008, reported results of a multi-hospital, international project studying the association between implicit rationing of nursing care and patient outcomes. They found that implicit rationing of nursing care was a significant predictor of six negative patient outcomes studied. "
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    • "These results support the relationship suggested between organizational and environmental variables, plus care rationing and patient outcomes as described in the theoretical model of implicit rationing of nursing [6]. Although the average rationing levels were not high, in line with similar studies [4,12] the related analyses provided estimates of the effect of implicit rationing of nursing care and nurses’ perceptions of their professional practice environment after controlling for patient and nurse covariates, confirming previous findings [6,51]. "
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    ABSTRACT: 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. 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. A 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. The 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. The 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.
    BMC Nursing 09/2014; 13(1):26. DOI:10.1186/1472-6955-13-26
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