Implicit rationing of nursing care in Turkish public nursing homes and rehabilitation centres: a cross-sectional analysis

BACKGROUND: Implicit rationing of nursing care refers to situations in which healthcare workers must delay, postpone, or omit required nursing activities due to limited resources. İmplicit rationing of nursing care is particularly important in nursing homes, where it is associated with poorer resident outcomes, increased adverse events, preventable hospitalisations, and negative consequences for care providers such as emotional exhaustion and job dissatisfaction. This study aimed to describe the prevalence and types of implicit rationing of nursing care in public nursing homes and rehabilitation centers (NHRC) in Türkiye, and to analyse its associations with nurses' and geriatric care workers' professional experience, work experience in the institution, and geriatric care training level. METHODS: This cross-sectional study was conducted in six NHRCs across different provinces in Türkiye. The Basel Extent of Rationing of Nursing Care for Nursing Homes (BERNCA-NH) instrument was used to assess the frequency of implicit rationing of nursing care. Categorical variables were summarised with frequencies and percentages, continuous variables with means and standard deviations, and responses to the open-ended question were analysed using qualitative content analysis. RESULTS: Of the 489 eligible nurses and geriatric care workers, 280 (57%) participated in the study. Rationing of nursing care rates ranged from 9.3% to 51.9% across different activities. Assisting with eating or drinking was the least rationed activity, while social care activities, such as "cultural activity for residents with contact outside of the nursing home", were rationed the most. Significant associations were found between implicit rationing of activities and characteristics such as total professional experience, working experience at the same institution, and level of geriatric care training. The main reasons for implicit rationing included tasks out of professional scope, heavy workloads, insufficient staffing, and low motivation. CONCLUSIONS: Implicit rationing of nursing care remains a challenge in NHRCs in Türkiye. To reduce the implicit rationing of nursing care, the roles and responsibilities of care workers with different training levels may need clearer definition in nursing homes, and their competencies can be enhanced through in-service training programs.