Impact of burnout, job and life satisfaction, and life orientation on rationing of nursing care: a cross-sectional observational study

Abstract

Background: Rationing of nursing care leads to a decline in the quality of nursing care. With the current shortage of nursing staff being a major cause of care rationing, there is still a need for research to identify the factors influencing the level of care rationing. The aim was to evaluate the level of nursing care rationing among nursing staff, considering the type of rationed activities. Methods: The study included 795 nurses employed in 2018 at the University Clinical Hospital in Wrocław, who were directly responsible for patient care. Five standardized questionnaires were used to investigate the main variables – the Basel Extent of Rationing of Nursing Care (BERNCA-R), the Maslach Burnout Inventory (MBI), the Job Satisfaction Scale (JSS), the Satisfaction with Life Scale (SWLS), and the Life Orientation Test (LOT-R). Results: The average BERNCA-R score was 1.65 points (SD = 0.81), indicating a frequency of rationing between “never” and “rarely.” The most rationed activity was the administration of prescribed medication or intravenous infusion at the appropriate time. Higher BERNCA-R scores (more frequent rationing) were statistically influenced by variables: lack of postgraduate education, working in closed healthcare, shift work, and a higher number of patients under care. The study showed an impact of life and job satisfaction, burnout on the BERNCA-R score. Independent predictors of a higher BERNCA-R score (more frequent rationing) were specialization, having 16–25, 26–35, or > 35 patients under care, a less pessimistic life orientation, higher emotional exhaustion, and greater depersonalization. Independent predictors of a lower BERNCA-R score (less frequent rationing) were professional experience of more than 20 years, open healthcare as the primary workplace, and “other” as the main workplace. Conclusions: Higher life and job satisfaction reduce the level of nursing care rationing. Conversely, rationing is more frequent with higher burnout levels, among those working in closed healthcare and shift work. An increase in the number of patients under care during shifts leads to increased burnout and more frequent rationing of nursing care. Clinical trial number: Not applicable.