Background: Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing\nmeasures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nursesââ?¬â?¢\nperceptions of their professional environment, negative patient outcomes, and placing patient safety at risk.\nThe aims of the study were:\na) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nursesââ?¬â?¢\nperceptions of their practice environment while adjusting for patient and nurse characteristics.\nb) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across\nrationing levels.\nMethods: A descriptive, correlational design was employed. Participants in this study included 352 patients and\n318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were\nused: the BERNCA scale for rationing of care, the RPPE scale to explore nursesââ?¬â?¢ perceptions of their work\nenvironment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The\nstatistical analysis included the use of Kendallââ?¬â?¢s correlation coefficient to explore a possible relationship between\nthe variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together\nwith organizational characteristics on patient satisfaction.\nResults: The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0ââ?¬â??3), the overall mean\nof RPPE was 2.76 (SD = 0.32, range = 1.28 ââ?¬â?? 3.69) and the two scales were significantly correlated (? = ?0.234, p < 0.001).\nThe regression analysis showed that care rationing and work environment were related to patient satisfaction, even\nafter controlling for nurse and patient characteristics. The results from the adjusted regression models showed that\neven at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction.\nConclusions: The results support the relationships between organizational and environmental variables, care rationing\nand patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a\nnegative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient\nsafety is not jeopardized.
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