How Rationing of Care Impacts Nursing

Nurses are a fundamental part of a hospital, responsible for many of the daily tasks associated with the patients. When there is a nursing shortage or hospitals must make budgetary cuts that affect nurses, hospitals must ration the care their nurses can give. To avoid stretching the nurses too thin, their responsibilities are reduced and the overall impact on patient care changes.

Patient Care

• When care is rationed among the available nurses, patients receive less care than if the hospital is fully staffed. If a patient requires the help of a nurse, he must often wait for a nurse to be available to help him. Depending on the level of need, some hospitals rush help to some patients over others. However, in some situations, this does not happen. Some patients go without something they need for a longer period of time than necessary. In some cases, this wait can have a negative impact on the patient's condition.

Patient Prioritizing

• In some nurse rationing practices, younger, healthier patients are given priority over those who are elderly or very sick. Patients who are given lower priorities have higher incidents of infections, bed sores and increased mortality rates. Some nurses, though, feel that health care rationing based on age is a violation of a patient's right to choose whether or not to receive treatment. However, nurses often have little say over the hospital policy without putting their jobs at risk.

Outcomes for Patients

• Because a patient's needs are not always met in a timely manner, her condition may become worse. If it does not become worse, she may take longer to get better, resulting in a higher cost of care. A study in Switzerland that addressed nurse rationing showed that the percentage of negative incidents increased when rationing occurred. This study was conducted over the course of 11 months in 2003 and 2004 and was the collaborative work of the University of Basel in Switzerland and the University of Pennsylvania in the United States. The more the nurses were rationed with care, the greater the number of incidents. For instance, in this study, medication errors occurred at least once 85 percent of the time. Falls happened with about 89 percent of patients in the study.

Effects on Nurses

• The nurses who work in hospitals that ration health care are often overworked. Because this rationing contributes to nursing shortages within the hospital, administration often requires that nurses work overtime, which can add to the already high stress that many nurses experience in the field. Those nurses who have issues with the prioritization of patients may find that nursing no longer feels fulfilling as it once did. In addition, those who want to be nurses may change their minds and choose a different field because they do not want to deal with the long hours and added stress.