Trends and variability of implicit rationing of care across time and shifts in an acute care hospital: A longitudinal study

Background Implicit rationing of nursing care is associated with work environment factors. Yet a deeper understanding of trends and variability is needed. Aims To explore the trends and variability of rationing of care per shift between individual nurses, services over time, and its relationship with work environment factors. Methods Longitudinal study including 1,329 responses from 90 nurses. Intraclass correlation coefficients (ICC) were computed to examine variability of rationing per shift between individual nurses, services, and data collection time; generalized linear mixed models were used to explore the relationship with work environment factors. Results Percentage of rationing of nursing activities exceeded 10% during day and night shifts. Significant variability in rationing items was observed between nurses, with ICCs ranging between 0.20 and 0.59 in day shifts, and between 0.35 and 0.85 in night shifts. Rationing of care was positively associated with nurses’ self-perceived workload in both shifts, but not with patient-to-nurse ratios. Conclusion Most variability in rationing over time was explained by the individual. Implications for Nursing Management Nurse managers and leaders need to develop and implement educational programs on implicit rationing of nursing care to strengthening nurses’ skills related to decision-making, prioritization and time management.