[Nursing tasks left undone in German acute care hospitals - results from the international study RN4Cast].
BACKGROUND
Implicit rationing of nursing care - likewise as in medical care - has never been empirically measured in German hospitals. Thus, little is known about prevalence and patterns of nursing care left undone as well as its association with nurse work environment and staffing.


METHODS
We surveyed 1,511 registered nurses from 49 German acute hospitals participating in the multi-country cross-sectional study RN4CAST. Analyses were made by descriptive statistics as well as multilevel regression analysis to calculate predictors from the nurse work environment and staffing.


RESULTS
On average 4.7 out of 13 nursing tasks were rationed. The range was between 82% for "comfort/talk with patients" and 15% for "treatments and procedures". The analysis revealed that hospital work environments and staffing ratios were significantly associated with the level of nursing care left undone. Further significant associations were found between poor leadership, inadequate organisation of nursing work as well as high emotional exhaustion and rationing.


CONCLUSIONS
The phenomenon of nursing care left undone was prevalent in German hospitals. Those tasks which are most likely to have negative consequences for patients (e. g., pain management and medication on time) seem to receive higher priority than tasks whose potential effects are less immediate or direct (e. g., psychosocial care). With regard to the measured correlation with the nurse work environment, it is recommend to invest in a good environment before (or simultaneously) investing in nurse staffing.
Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin.
Britta
B
Zander
Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin.
L
L
Dobler
Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin.
M
M
Bäumler
Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin.
R
R
Busse
D000328:Adult; D002055:Burnout, Professional / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D007857:Leadership; D008297:Male; D009726:Nurses / Q000706:statistics & numerical data*; D009732:Nursing Care / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data; D015995:Prevalence; D011361:Professional Competence / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data*