Resource allocation and rationing in nursing care: A discussion paper
Journal
Nursing Ethics
Date Issued
August 2019
DOI
10.1177/0969733018759831
Abstract
Driven by interests in workforce planning and patient safety, a growing body of literature has begun to
identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed
care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues
such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects
of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert
rationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged in
rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit
decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of
policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear
that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the
nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore
seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource
allocation and rationing as they relate to nursing care and the distribution of the nursing resource.
identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed
care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues
such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects
of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert
rationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged in
rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit
decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of
policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear
that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the
nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore
seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource
allocation and rationing as they relate to nursing care and the distribution of the nursing resource.
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