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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.
Aims:
To identify demographic, organisational and psychological predictors of nursing care rationing among nurses working in Polish healthcare settings and to examine its associations with burnout, coping strategies and depressive symptoms.
Design:
A cross-sectional study.
Methods:
The study was conducted between February and September 2025 among 434 nurses employed in various healthcare settings in Poland. Data were collected using the Basel Extent of Rationing of Nursing Care-Revised (BERNCA-R), the Maslach Burnout Inventory (MBI), the Mini-COPE and the Beck Depression Inventory (BDI). Descriptive statistics and univariate and multivariable linear regression analyses were performed.
Reporting Method:
This study adhered to the STROBE guidelines for cross-sectional studies.
Results:
The mean BERNCA-R score indicated moderate levels of care rationing. In the multivariable model, higher care rationing was associated with shift work, higher patient loads, employment in professional unions and higher income levels. Living in medium-sized cities was associated with lower rationing levels. Additionally, the coping strategy 'turning to religion' showed a small but significant positive association with care rationing. The most frequently rationed activities included patient conversations, emotional support, patient education, proper documentation and shift handovers.
Conclusions:
Nursing care rationing is influenced by organisational and workforce-related factors. Workload and shift organisation emerged as key modifiable determinants. Addressing these may reduce care rationing and improve care quality and safety.
Implications For The Profession And/Or Patient Care:
Rationing is strongly influenced by modifiable organisational factors, including staffing and shift organisation. High patient loads and shift work increase the risk of missed care, particularly in communication, documentation and patient support. Optimising staffing and work organisation may enhance patient safety.
Impact:
This study highlights organisational drivers of missed care in a Central European context and provides evidence to inform staffing strategies and healthcare policy.
Patient Or Public Contribution:
None.
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