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Predictors of Nursing Care Rationing in Polish Healthcare Settings: A Cross-Sectional Study Using BERNCA-R
Stanisław Manulik1, Michał Czapla2,3,4, Ercole Vellone5
1Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland.
Journal of Clinical Nursing
|July 24, 2026
Summary
Nursing care rationing, including missed patient communication and documentation, is linked to organizational factors like shift work and high patient loads in Poland. Addressing these modifiable determinants can improve care quality and safety.
Area of Science:
- Nursing Research
- Healthcare Management
- Patient Safety
Background:
- Nursing care rationing, defined as the intentional omission of nursing care, is a growing concern in healthcare systems globally.
- Understanding its predictors is crucial for developing targeted interventions to improve patient outcomes and nurse well-being.
Purpose of the Study:
- To identify demographic, organizational, and psychological factors associated with nursing care rationing among Polish nurses.
- To examine the relationship between care rationing and burnout, coping strategies, and depressive symptoms.
Main Methods:
- A cross-sectional study involving 434 nurses in Poland.
- Data collected using validated instruments: Basel Extent of Rationing of Nursing Care-Revised (BERNCA-R), Maslach Burnout Inventory (MBI), Mini-COPE, and Beck Depression Inventory (BDI).
- Statistical analyses included descriptive statistics and multivariable linear regression.
Main Results:
- Moderate levels of nursing care rationing were observed.
- Higher care rationing was significantly associated with shift work, increased patient loads, union membership, and higher income.
- The coping strategy 'turning to religion' showed a positive association with rationing; specific rationed activities included patient conversations, emotional support, documentation, and handovers.
Conclusions:
- Organizational and workforce-related factors are significant drivers of nursing care rationing.
- Workload and shift organization are key modifiable determinants that, when addressed, can reduce rationing and enhance patient care quality and safety.
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