The hidden ethical element of nursing care rationing

Evridiki Papastavrou, Panayiota Andreou, Stavros Vryonides
  • Nursing Ethics, January 2014, SAGE Publishing
  • DOI: 10.1177/0969733013513210

The ethical element of nursing care rationing

What is it about?

Objective: To explore nurses’ experiences and perceptions about prioritizations, omissions, and rationing of bedside nursing care, via focus groups discussions. Four themes were developed based on the data: (a) priorities in the delivery of care; (b) professional roles, responsibilities, and role conflicts; (c) environmental factors influencing care omissions; and (d) perceived outcomes of rationing. Discussion: The delivery of nursing care is framed by the biomedical ethos and inter-professional role conflict while the standards of basic care are jeopardized. Organizational and environmental factors appear to exert significant influence on prioritization. Failure to carry out necessary nursing tasks may lead to adverse patient outcomes, role conflict, and an ethical burden on nurses.

Why is it important?

The aim of this study was to explore the perceptions and experiences of nurses concerning prioritizations, omissions, and rationing of bedside nursing care through focus groups. Based on the findings of an earlier survey with nurses, the intention was to explore rationing in more depth and to gain a better understanding of the pressures and influences guiding nurses’ decisions to ration and give priority to certain care tasks over others. This is one of the only few studies internationally have examined this phenomenon in its ethical context perspective


Cyprus University of Technology

Considering rationing within the ethical reasoning and behavior framework, it is clear that nurses experience various difficulties, including opposing values and norms that hamper their personal decision-making process. In several instances, nurses admitted that they were unable to act according to their own professional standards because of practical circumstances, time limitations, rules and routines, or the expectations of others. This inconsistency between what nurses wanted to do and what they were actually able to offer to patients created a lot of negative feelings that might have resulted in ethical burden and moral distress that is evident in the findings of our study.

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