Factors Influencing the Rationing of Nursing Care in Selected Polish Hospitals

Impact of Nursing Practice Environments in Work Engagement and Burnout: A Systematic Review

Background/Objectives: Work environment greatly affects nursing activities. This study aimed to explore the impact of the professional nursing environment on the risk of burnout symptomatology and work engagement (a burnout-moderating variable). Methods: A systematic review has been carried out. Selection criteria included cross-sectional studies that evaluated the professional nursing environment with the PES-NWI scale and also evaluated the levels of burnout and/or engagement in nurses. The PubMed, Scopus, Cinahl and WoS databases have been reviewed until November 2024, and potential articles manually selected by two researchers independently. Results: Eighty-four articles were selected, and after applying selection and exclusion criteria, 14 papers were finally included. Most studies were conducted in Europe. The quality evaluation was carried out using the JBI critical appraisal checklist. All retrieved studies focused on burnout, and only two works also evaluated work engagement. Conclusions: Overall, the trend indicates that a favorable professional environment was related to lower burnout symptoms, lower intentions to leave work and higher levels of work engagement. In addition, an adequate work environment was associated with less stress and higher quality of care, social support, professional development, leadership, nurse-doctor collaboration, nurse participation in hospital issues, staffing and job satisfaction.

From awareness to action: investigating the impact of big-five teamwork model awareness on rationing of nursing care and patient-centered care

BACKGROUND

Nurses are the cornerstone of healthcare delivery, playing a pivotal role in ensuring safe, high-quality, and patient-centered care. However, the significant demands on their time and resources often lead to the rationing or omission of essential nursing care activities, undermining patient outcomes. As frontline caregivers, nurses' ability to collaborate effectively within teams is critical to overcoming these challenges. The Big Five Teamwork Model, which emphasizes trust, communication, and leadership, offers a transformative approach to strengthening teamwork and addressing barriers to comprehensive nursing care.

AIM

This study aimed to assess the impact of the Big Five Teamwork Awareness Sessions (Big 5TWAS) on the rationing of nursing care and patient-centered care.

METHODS

A quasi-experimental pre-post-test design was conducted in critical care units at an Egyptian university hospital. A convenience sample of 60 nurses and 31 admitted patients participated in the study. Big 5TWAS interventions were implemented for nurses, and study variables were measured using nursing teamwork surveys, the Rationing of Nursing Care Observational Checklist (RONCO), and patient-centered care questionnaires before and after the intervention. Data were analyzed using descriptive and inferential statistics.

RESULTS

The Big 5 Teamwork Awareness Sessions (Big 5TWAS) demonstrated a significant impact on the study variables. Post-sessions, there was a significant decrease in rationing of nursing care scores and significant increases in nursing teamwork and patient-centered care scores (p ≤ 0.001). In addition to the significant correlation values, regression analysis revealed that overall teamwork accounted for approximately 22% of the variance in rationing of nursing care (R² = 0.224, p = 0.015), with trust as the significant predictor. Furthermore, teamwork explained approximately 80% of the variance in patient-centered care (R² = 0.801, p < 0.001), with trust, backup, and team leadership emerging as significant predictors.

CONCLUSION AND RECOMMENDATIONS

The study underscores the critical role of teamwork in reducing the rationing of nursing care and enhancing patient-centered care in critical care units. The Big 5TWAS was effective in fostering improved team dynamics, trust, and leadership, which translated into better care delivery. These findings highlight the need for ongoing inter-professional training and teamwork-enhancing strategies led by nurse managers to sustain and amplify these improvements. By focusing on teamwork, healthcare institutions can ensure high-quality patient outcomes and minimize missed nursing care practices.

Relationships between job satisfaction, occupational burnout and rationing of care among intensive care unit nurses

Introduction

Rationing of nursing care is referred to as overlooking aspects of required patient care. Its result is incomplete or delayed services provided to the patient. Anesthesia nurses employed in an intensive care unit are exposed to a significant workload. Particularly heavy is the psychological burden leading in many cases to the onset of burnout syndrome and a decrease in job satisfaction.

The aim of this paper

Was to determine the relationship between occupational burnout, job satisfaction and rationing of care among anesthesia nurses employed in intensive care units.

Materials and methods

The study group consisted of 477 anesthesia nurses employed in intensive care units in Poland. The study was conducted between December 2022 and January 2023. The research tools were BERNCA-R questionnaire, Job Satisfaction Scale questionnaire and Maslach Burnout Inventory questionnaire, which were distributed to selected hospitals with a request to be forwarded to intensive care units and completed. In the statistical analysis, correlations were calculated using Spearman's rho coefficient, reporting the intensity of the relationship and its positive or negative direction. The analysis was performed using the IBM SPSS 26.0 package with the Exact Tests module.

Results

The mean score of the BERNCA questionnaire was 1.65 ± 0.82. The mean score of occupational burnout was 60.82 ± 10.46. The level of emotional exhaustion, which significantly affects occupational burnout, was 26.39 ± 6.07, depersonalization was 14.14 ± 3.21 and lack of personal achievement was 20.29 ± 4.70. All the scores obtained exceeded the threshold of 50% of total points, which indicates the presence of occupational burnout at a significant level. The job satisfaction of the nurses surveyed was above mean at 23.00 ± 5.2 out of 35 total points.

Conclusion

The results proved that there is a statistically significant, although with a weak strength of association, correlation between occupational burnout and rationing of care by anesthesia nurses. As the limitation of anesthesia nurses' ability to perform certain activities increases, their job satisfaction decreases. In a work environment that is conducive to nurses, there are fewer job responsibilities that are unfulfilled. Therefore, it is essential to create a friendly work environment for nursing staff that will promote the provision of services at the highest possible level.

Rationing of nursing care in Internal Medicine Departments-a cross-sectional study

BACKGROUND

Implicit rationing of nursing care refers to a situation in which necessary nursing care is not performed to meet all of the patients' needs.

PURPOSE

To examine the factors influencing the rationing of nursing care, nurses' assessment of the quality of patient care, and their job satisfaction in Internal Medicine Departments.

METHODS

A cross-sectional descriptive study was undertaken. The study included 1164 nurses working in the Internal Medicine Departments in 8 hospitals (Lower Silesia, Poland). The Perceived Implicit Rationing of Nursing Care instrument was used.

RESULTS

Respondents rarely ration nursing care, with a mean score of 1.12 (SD = 0.68). The mean score for quality of patient care was 6.99 (SD = 1.92). In contrast, the mean job satisfaction score was 6.07 points (SD = 2.22). The most important predictors of high rates of rationing of nursing care were work experience of 16-20 years (regression parameter: 0.387) and a Bachelor's degree in nursing (regression parameter: 0.139). Nurses' assessment of the quality of patient care ratings were increased by having a Master's degree in nursing (regression parameter: 0.41), and significantly decreased by work experience of 16-20 years (regression parameter: -1.332). Independent predictors of job satisfaction ratings in both univariate and multivariate analysis were Master's degree and long-shift working patterns.

CONCLUSION

The factors that influence an increased level of nursing care rationing on medical wards are nurse seniority, exceeding 16 years and female gender. Obtaining a Master's degree in nursing indicates improved nurses' assessment of the quality of patient care.

The Impact of Sociodemographic Factors on the Rationing of Nursing Care in Urology Wards

BACKGROUND

The problem of care rationing is widespread all over the world and results from many factors affecting nurses. These factors may result from the environment in which the nurses work, e.g., the atmosphere at work, or may not be related to work, e.g., place of residence. The aim of this study was to examine the impact of sociodemographic factors (place of residence, satisfaction with the financial situation, number of forms of postgraduate education, work system, number of patients per nurse, number of diseases) on care rationing, job satisfaction and quality of nursing care.

METHODS

The study is a cross-sectional study which includes 130 nurses from all over Poland who work in urology wards. The criteria for inclusion were consent to the examination, practicing the profession of a nurse, work in the urology department and work experience of at least 6 months, regardless of the number of hours worked (full-time/part-time). The study was conducted using the standardized PIRNCA (Perceived Implicit Rationing of Nursing Care) questionnaire.

RESULTS

The average rationing nursing care was 1.11/3 points which means nursing care was rarely rationed. The average job satisfaction was 5.95/10 points, and the assessment of the quality of patient care was 6.88/10 points, which means a medium level of the job satisfaction and the quality of patient care. The rationing of care was affected by the number of nurse illnesses; job satisfaction was influenced by the place of residence and satisfaction with the financial situation, while the quality of care was not influenced by any of the analyzed factors.

CONCLUSIONS

The result of care rationing is at a similar level as the results in Poland and abroad. Despite the rare rationing of care, employers should take corrective action, especially in terms of increasing the staff and health prevention of nurses.