title: Linking patient satisfaction with nursing care: the case of care rationing - a correlational study.
abstract: BACKGROUND
  Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses' perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses' perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels.
  
  
  METHODS
  A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses' perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall's correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction.
  
  
  RESULTS
  The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0-3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 - 3.69) and the two scales were significantly correlated (τ = -0.234, p < 0.001). The regression analysis showed that care rationing and work environment were related to patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction.
  
  
  CONCLUSIONS
  The results support the relationships between organizational and environmental variables, care rationing and patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a negative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient safety is not jeopardized.
authors.affiliation: Department of Nursing, School of Health Sciences, Cyprus University of Technology, Vragadinos street 15, Limassol, Cyprus.
authors.forename: Evridiki
authors.initials: E
authors.lastname: Papastavrou
authors.affiliation: Department of Nursing, School of Health Sciences, Cyprus University of Technology, Vragadinos street 15, Limassol, Cyprus.
authors.forename: Panayiota
authors.initials: P
authors.lastname: Andreou
authors.affiliation: Department of Economics and Finance, School of Business, University of Nicosia, Nicosia, Cyprus.
authors.forename: Haritini
authors.initials: H
authors.lastname: Tsangari
authors.affiliation: Department of Nursing, School of Health Sciences, Cyprus University of Technology, Vragadinos street 15, Limassol, Cyprus.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Merkouris
keywords: Nursing care; Patient satisfaction; Professional environment; Rationing