Abstract
There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation is unclear. Thus, both patients and nurses would benefit from the development of a minimum standard of nursing care. Clarity on this matter is also of ethical and legal concern. In this article, we explore the case for developing a minimum standard to ensure safe and competent nursing care services. Any such standard must encompass knowledge of basic principles of clinical nursing and preservation of moral values, as well as managerial issues, such as manpower planning, skill-mix, and time to care. In order for such standards to aid in providing safe and competent nursing care, they should be in compliance with accepted evidence-based nursing knowledge, based on patients’ needs and legal rights to healthcare and on nurses’ codes of ethics. That is, a minimum standard must uphold a satisfactory level of quality in terms of both professionalism and ethics. Rather than being fixed, the minimum standard should be adjusted according to patients’ needs in different settings and may thus be different in different contexts and countries.
Highlights
Today, nurses in all kinds of positions throughout healthcare organizations experience the impact of fiscal constraints, including pressure on staffing
Studies on nurses’ rationing report that nurses experience moral frustration and distress when facing the value conflict of having to choose between patients, including choices regarding which fundamental nursing care elements will be left undone, such as psychosocial and spiritual care, nutrition, or oral hygiene.[34]. These value conflicts result from complex situations where nurses have to take into account several aspects related to fundamental nursing care, such as consequences, benefits, urgency, effectiveness, and harm, to name a few. Facing such a conflict implies choosing between alternatives, none of which are satisfying:[36] for example, when district nurses have to choose between the older woman who needs help with her diabetes medication or the frail older man who has dementia and needs help to make it to day care in time
We suggest a framework of safe, competent nursing care that includes patients’ fundamental needs, values to preserve in provision of fundamental care, and a minimum standard of care adjusted according to setting and context and meeting the requirement of reliable and caring services
Summary
Schubert et al.[6] define rationing of nursing care as “the failure to carry out necessary nursing tasks due to inadequate time, staffing level and/or skill mix.” There is growing evidence that the elements of nursing care most frequently left undone or missed are the so-called “basic” and “softer” elements of care, such as patient hygiene, comfort care, patient education, and discharge planning.[7,8] These are elements of care that make the patient feel better, feel cared for. Not being able to provide care due to limited resources is a situation that entails difficult decision-making processes.[36] Studies on nurses’ rationing report that nurses experience moral frustration and distress when facing the value conflict of having to choose between patients, including choices regarding which fundamental nursing care elements will be left undone, such as psychosocial and spiritual care, nutrition, or oral hygiene.[34] These value conflicts result from complex situations where nurses have to take into account several aspects related to fundamental nursing care, such as consequences, benefits, urgency, effectiveness, and harm, to name a few Facing such a conflict implies choosing between alternatives, none of which are satisfying:[36] for example, when district nurses have to choose between the older woman who needs help with her diabetes medication or the frail older man who has dementia and needs help to make it to day care in time. Norwegian legislation sets minimum standards called the requirement of reliable and caring services, a responsibility of all healthcare personnel to provide safe, competent, and attentive healthcare services, which we elaborate of this article
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