Resource allocation and rationing in nursing care: A discussion paper

Driven by interests in workforce planning and patient safety, a growing body of literature has begun toidentify the reality and the prevalence of missed nursing care, also specified as care left undone, rationedcare or unfinished care. Empirical studies and conceptual considerations have focused on structural issuessuch as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspectsof unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covertrationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged inrationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicitdecision-making frameworks within which to consider rationing of nursing care. In reality, the assumption ofpolicy 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 appearthat rationing/missed care/nursing care left undone is a direct response to overwhelming demands on thenursing resource in specific contexts. A discussion of resource allocation and rationing in nursing thereforeseems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resourceallocation and rationing as they relate to nursing care and the distribution of the nursing resource.