Nursing prioritization and rationing decisions in acute care hospitals during the Covid-19 pandemic: A qualitative study

Abstract

Background: The Covid-19 pandemic has put decisions regarding prioritization and rationing of care resources on the health policy agenda. The effects on the allocation of nursing resources in clinical practice are unclear. Aim: In order to derive implications for future pandemic situations, we analyzed the extent to which decisions were made about the distribution of resources in acute inpatient care and how bottlenecks were dealt with. Methods: We conducted semi-structured interviews with nursing staff (n = 16) and nursing team leaders (n = 10) in five acute-care clinics in Germany and analyzed them inductively using thematic framework analysis. Results: In acute inpatient care under pandemic conditions, prioritization and rationing decisions were made, such as the postponement or reduction of nursing measures, in order to overcome pandemicspecific challenges. These decisions affected certain patient groups and certain near-and distant-patient services, in particular fundamental care measures, such as support with personal hygiene and nutrition, as well as access to acute inpatient care. The decisions were made implicitly rather than according to evidence-based criteria. Conclusions: Nursing prioritization and rationing decisions were made during the pandemic. These decisions are similar to comparable decisions outside of the pandemic, particularly in terms of insufficient evidence base, and emphasize the need for empirically based decision criteria.