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Similarities and Differences in Nurse-Reported Care Rationing Between Critical Care, Surgical, and Medical Specialties

Higgs, Megan*; Fernandez, Ritin*†; Polis, Suzanne‡§; Manning, Vicki

doi: 10.1097/PTS.0000000000000295
Original Article: PDF Only

Objective The aim of this study was to determine the similarities and differences in elements of nursing care that are commonly rationed in the critical care, medical, and surgical specialties within an acute hospital environment.

Methods Registered nurses who provide bedside nursing care within the medical, surgical, and critical specialties at a single center were invited to anonymously complete the self-administered MISSCARE questionnaire. The frequency of rationing for each individual care element within the 4 broader care groups (assessment, intervention—individual needs, intervention—basic care, and planning) of the MISSCARE questionnaire was determined. A mean score for each care group was also determined, and multiple regression analysis was undertaken to determine the demographic predictors of care rationing.

Results Interventions related to basic care was the most frequently rationed care group in the critical care/emergency specialty (missed care mean of 50.1%), whereas planning was the most frequently rationed care group among both the medical (missed care mean of 43.6%) and surgical (missed care mean of 44.8%) specialties. Assessment was the least frequently rationed care group among all 3 specialties (missed care mean of 19.7%–26.7%). Length of time practicing as a registered nurse was an independent predictor of care rationing in the critical care/emergency specialty, and age older than 50 was an independent predictor in the medical specialty.

Conclusions There are numerous similarities and differences in care rationing between critical care, surgical, and medical nurses. The development and implementation of specialty-based strategies should be undertaken to reduce the incidence of nursing care rationing.

From the *St George Hospital, Centre for Research in Nursing and Health, Kogarah; †School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong; ‡University of Technology Sydney, Faculty of Health; §Sydney Children’s Hospital Network–Sydney Children’s Hospital; and ∥St George Hospital, Executive Unit, Kogarah, Sydney, New South Wales, Australia.

Correspondence: Megan Higgs, MN, RN, Centre for Research in Nursing and Health, Level 1 Research and Education Bldg, St George Hospital, Gray St, Kogarah, 2217, Sydney, New South Wales, Australia (e-mail:

The authors disclose no conflict of interest.

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