No abstract

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues - missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone - suggesting that nurses, in certain contexts, are actively engaged in rationing care - in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care - despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.

No abstract

Introduction and questions of exploration: In a first step this paper outlines the global context of and international influences on nurse migration. Liberalization of health markets is identified as a trigger point steering movements of nurses globally. Facts and figures concerning nurse migration are highlighted in a second section focusing on developments in the USA and UK, which are recruiting nurses from Europe and overseas on a large scale, and adding the latest European approaches and policies concerning this issue. Projections are presented that highlight growing demands for the next 2 decades. The third part explores the impact of nurse migration on nursing care and professional standards. Methods: The article is based on an extensive literature review and the analysis of quality issues in the nursing field. Results: The number of nurse migrations in the last decades show that the issue of nurse migration is already of high importance for many countries. This will be enhanced by future accelerated development of nursing shortages in many countries. Boosted global recruitment of nurses will be the consequence.The paper concludes that the recruitment of international nurses has not yet taken quality issues and indicators in health-care settings profoundly into consideration. Economical gains by not training nurses and recruiting them from abroad might have a severe impact on already existing problems concerning patient safety issues and nurse-sensitive outcomes in health-care settings

Aim Nurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses. Subject and methods The cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/ 2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods. Results High workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose "workload" and "interruptions" while nursing home nurses more often ranked "lack of knowledge" and "lack of motivation" as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses' perception. Conclusion The findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management.