Validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument

An inverse relationship between implicit rationing and quality patient outcomes has been demonstrated in European hospitals, but this relationship has not been explored in the United States.

To evaluate the psychometric properties of a new measure of implicit rationing, the Perceived Implicit Rationing of Nursing Care (PIRNCA).

A cross-sectional survey design with a stratified random sample of 226 medical surgical nurses was used to evaluate the PIRNCA. The internal structure was evaluated using exploratory factor analysis. Pearson correlations were used to assess the associations between implicit rationing and three related constructs: work environment, overall job satisfaction, and quality of care.

A single-factor solution explaining 55% of the total variance and excellent reliability, Cronbach's alpha = 0.97, was supported for the PIRNCA. Moderate inverse relationships with related constructs provided evidence of concurrent validity: work environment (-0.44), overall job satisfaction (-0.48), and quality of care (-0.56). The majority of nurses (97%) reported rationing at least one of the 30 care activities listed; however, mean scores reflected a low frequency ("rarely") of rationing overall.

The phenomenon of implicit rationing is experienced by nurses in U.S. hospitals, and the PIRNCA instrument is a valid and reliable measure of this phenomenon.