Care Rationing

Care rationing is ‘the withholding or failure to carry out necessary nursing tasks due to inadequate time, staffing level, and/or skill mix’.

We are hearing more and more nurses say they don’t have time to deliver the care required to achieve a satisfactory outcome for patients because good systems are not in place.

Nursing staff are concerned about staffing levels; they are stressed, distressed and anxious about their ability to deliver safe and effective care in an environment that is not appropriately resourced.

This is care rationing and it is an ethical dilemma nurses face every day. The conscious decision of prioritising care provision and dropping off the nursing tasks that are deemed less of a risk is draining, demoralising and exposes nurses professionally.

Care rationing is both a service quality and patient safety issue; it is much more than patients not having their hair combed or being assisted with personal hygiene. Care rationing can result in falls, infections and pressure sores, longer recovery times and even serious harm or death.

NZNO has formulated a position statement about care rationing. It pulls together the evidence to show care rationing is happening and it puts forward the solutions needed to make sure every patient gets the right nursing care, in the right place, at the right time, by the appropriate member of the nursing team.

Its purpose is to make clear the importance of achieving safe staffing levels and healthy working places in all health sectors to ensure delivery of safe and effective nursing care and prevent care rationing.

How you can help

  • Help us make the position statement available to as many nurses as possible – print it and put it in the tea room/gathering places.
  • Put the position statement on the agenda for discussion at team meetings, meetings with peers, meetings with management.
  • Have you had to ration care? Tell your story on the NZNO Facebook page or email it to rob.zorn@nzno.org.nz
  • Find out more about our Safe Staffing campaign, that is working toward a health system where care rationing doesn't exist

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What NZNO members are saying

"We are not able to give quality time to patients. Hygiene and oral cares are routinely missed. On night shifts there is no health care assistant, so patients are not turned as often as they should be.” RN

“I feel frustrated, disappointed and heavy-hearted.” RN

"Encouraging breastfeeding and skin-to-skin contact between mother and baby is no longer considered essential.” Midwife

“Today I had to watch four psychiatric patients by myself. Two months ago, two of us were asked to watch five psych patients, three of whom were committed patients. We are not trained to do that. I have been attacked.” HCA 

“Inadequate assessments, limited or no documentation and missed district nursing visits are examples of care rationing I see.” RN

“Care rationing is insidious in aged care. People are not showered or toileted as frequently as they should be, they don't get the fluids they need.” RN

“If we are looking after a palliative care patient with no extra staff, then we can't give that dying person all the care we want to give.” RN

"I work in older people's health and we're at least one short a lot of the time. The staffing situation is really difficult. It's very hard going.” EN

“In a war zone where there are mass casualties, only life-preserving care is given and everything else is expendable - it's almost reaching that point in some parts of our health system." RN

“A bedridden patient, unable to be toileted in a timely manner, was trying to get out of bed to go to the toilet and fell out of bed and sustained a fracture." RN