Hospital Transfers of Nursing Home Residents: A Vignette Experiment on Nurses' Decision Making

Nursing home (NH) nurses play a key role in hospital transfer decisions. In case of unavailability of physicians, they have to decide alone. In doing so, they consider potential threats to residents' quality of life (QoL), but they also fear the consequences of wrong decisions. The present study examines the causal influence of these deliberations on nurses' transfer decisions and emotional strain. In all, 241 NH nurses participated in the experiment. The vignette describing a resident with deteriorating health state elicited either thoughts on residents' QoL, on legal consequences, or on QoL and legal consequences. In the QoL condition, the likelihood of a hospital transfer was lower compared with all other conditions. Emotional strain was stable across experimental conditions. When thoughts on QoL and legal consequences were induced at the same time, strain was positively correlated with the inclination to transfer the resident. Promoting QoL considerations can help to reduce avoidable transfers.