NZNO believes every patient has the right to receive quality care, every shift, every day. Nurses, midwives and health-care assistants also have the right to work in safe, supportive environments and be enabled to provide quality care.
The Safe staffing healthy workplaces unit defines care rationing as: “Any occasion when an aspect of a patient’s required care is either missed altogether, unduly delayed, performed to a suboptimal standard or inappropriately delegated to someone not qualified to perform the activity.”
Is care rationing the “new normal” in patient care? Are failing to take observations and administer medications on time, inability to turn bedridden patients two hourly, skipping hygiene cares, inability to mobilise patients regularly, failing to provide comprehensive patient education, not answering call bells, all too familiar aspects of too many nurses’ shifts, too often?
Care rationing is unacceptable because it means patients do not receive all the care they require, it exposes patients to unacceptable risks, it can have serious consequences, it increases patient morbidity and mortality, and contravenes people’s rights to health services of an appropriate standard.
Drawing on national and international research, NZNO’s newly-released position statement attributes care rationing to a systems failure due to inadequate staffing or inappropriate skill mix or insufficient time or a combination of these factors.
The position statement was developed to articulate that care rationing is a systems failure, not a failure of individual nurses. We have chosen the term ‘care rationing’ because terms such as ‘missed care’ or ‘care left undone’ imply that an individual nurse is to blame.
Care rationing is not just another form of prioritisation. Prioritisation occurs at the start of a shift when nurses consider the work that has to be done over their shift and what needs to be done first. Care rationing happens in a chaotic way when there are simply not enough staff to do the work and nurses have no control over the situation.”
It doesn’t have to be this way. NZNO has a plan to eliminate care rationing. What we need is:
- increased funding for DHBs;
- nursing care made a priority in decision-making;
- nursing seen as an investment, not a cost;
- patient-centred models of care;
- a focus on early intervention and prevention, and nurses working to the full extent of their scope;
- full implementation of the care capacity demand management programme in all DHBs;
- effective workforce planning;
- transparency about staffing levels;
- funding to address its cultural impacts;
- immediate action when staffing requirements are not met to ensure patients get the care they need; and
- patients who are empowered to complain when their needs are not met because of inadequate staffing.
To find out more about care rationing and what NZNO is doing to eliminate it, go to www.nzno.org.nz/carerationing
This blog post was developed from an article first published in Kai Taiki Nursing NZ, vol 20, no 6, July 2014.