Nursing students’ perspectives on implicit rationing of nursing care: Cross-sectional and cross-cultural analysis

Background: Scarce or insufficient nursing resources are an important reason that nurses have to ration necessary nursing tasks implicitly. Implicit rationing of nursing care is associated with negative patient and nurse outcomes, such as poor patient safety and low job satisfaction. The frequency at which nursing students implicitly ration nursing tasks during their clinical placements and the prioritisation strategies they use remain unclear. Aim: To describe the levels of implicit rationing of nursing care, prioritisation strategies used by Swiss and Turkish nursing students during their clinical placements, and characteristics of their nursing work environment. Methods: This descriptive, cross-sectional observational study included 506 Swiss and 750 Turkish eligible students from four universities, with a final sample size of 81 and 205 students, respectively. Implicit rationing of nursing care was measured using the Basel Extent of Rationing of Nursing Care-Revised (BERNCA-R) version on a scale of 0 ('never') to 3 ('often'). The prioritisation strategies were assessed with a single item. In addition, data on workplace characteristics and demographics were collected. Data were analysed using descriptive statistical methods. Results: Among the 23 BERNCA-R items compared in this study, the reported rationing levels in the Swiss sample ranged from 0.52 ('change of wound dressings') to 1.83 ('emotional and psychological support'), and in the Turkish sample, the levels ranged from 0.74 ('necessary disinfection measures') to 1.63 ('sponge bath'). The Swiss students prioritised nursing tasks primarily based on 'their necessity' and/or 'associated consequences for patient safety', whereas the Turkish students prioritised them mainly based on 'their necessity'. The Swiss students rated the staffing and resource adequacy, overall quality of the work environment, quality of care, and patient safety at their most recent clinical placement workplace slightly higher than that rated by the Turkish students. Conclusions: This study demonstrates the importance of teaching resource scarcity management and care prioritisation strategies to reduce students' implicit care rationing during clinical placements. Tweetable abstract: Implicit rationing and associated factors from the perspective of nursing students: a cross-sectional and cross-cultural comparative observational study, from Switzerland and Türkiye.