It was also demonstrated that the level of satisfaction with job affects the level of satisfaction with provided services among the patients.

Each patient has a right to the high quality of care provided by a competent nursing team regardless of its clinical condition (New Zealand Nurses Organisation, 2014), Numerous studies (Chegini et al., 2020; Dhaini et al., 2020; Friganovic et al., 2020; Gurková et al., 2020; Jaworski et al., 2020; Kalánková et al., 2020; Uchmanowicz et al., 2020b; Zeleníková et al., 2020) performed throughout recent years demonstrated that, regrettably, the nurses fail to perform all activities planned in the nursing process when delivering care to the patient. This phenomenon was described for the first time by Kalisch (2006) while the literature is replete with many terms defining it, i.e., nursing care left undone (Aiken et al., 2001), unfinished nursing care (Sochalski, 2004), missed nursing care (Kalisch, 2006), implicit care rationing (Schubert et al., 2007, 2008), task incompletion (Al-Kandari and Thomas, 2009), unmet nursing care needs (Lucero et al., 2010), care left undone (Ausserhofer et al., 2014), work left undone (Leary et al., 2014), nursing tasks left undone (Bekker et al., 2015), failure to maintain (Bail, 2016), or the unfinished task of nursing care (Kebede et al., 2017). All these define the condition in which the patient is left without adequate nursing care. This may lead to many undesired events, i.e., falls (Schubert et al., 2008; Lucero et al., 2010; Kalisch et al., 2012), bedsores (Schubert et al., 2008), infections (Lucero et al., 2010), and even increased mortality (Schubert et al., 2012).

To prevent rationing, the studies were performed aiming at the identification of the determinants for the level of nursing tasks left undone. These determinants (factors) were divided into patient-related [i.e., age, type of disease, form (severe/chronic), concomitant diseases, diagnosing, and treatment plan], associated with the working environment (i.e., management, interdisciplinary cooperation, autonomy, and responsibility, as well as material resources and staff shortage), and nurse-related (i.e., experience, knowledge, and skills, as well as psychological factors, e.g., professional burnout, satisfaction with life, and satisfaction with job) (Kalisch et al., 2009; Schubert et al., 2013; Bragadóttir et al., 2017; Griffiths et al., 2018; Jaworski et al., 2020; Mandal et al., 2020; Uchmanowicz et al., 2020a).

Satisfaction with life is defined as the state of balance between the current situation and personal expectations. The more our needs are fulfilled, the more we are satisfied with life (Loewe et al., 2014). According to the studies performed to date, nurses are generally satisfied with life; however, there are some areas of life that could be improved (Piotrkowska et al., 2019; Bartosiewicz et al., 2020; Jaworski et al., 2020). The impact on the level of satisfaction with life in nurses is multifactorial and includes age and education level, among others (Piotrkowska et al., 2019; Bartosiewicz et al., 2020). It was also demonstrated that the nurses with a higher level of satisfaction with life tend to ration nursing care less frequently (Jaworski et al., 2020).

Also, the level of satisfaction with job depending on the attitudes and feelings of the employee toward the performed profession is a factor that affects the rationing of nursing care significantly (Jaworski et al., 2020; Uchmanowicz et al., 2020a). Satisfied employees are usually more productive and feel stronger attached to their workplace. It was also demonstrated that the level of satisfaction with job affects the level of satisfaction with provided services among the patients (Janicijevic et al., 2013).

The aim of this study was to assess the phenomenon of care rationing among the Polish nurses and the impact of nurse-related variables, i.e., satisfaction with life and satisfaction with job on the level of rationing of nursing care in the patients hospitalized at the medical treatment wards.

Care rationing seems to be both an increasingly recognized and relatively common practice in nursing care. Understanding the mechanisms of care rationing is very important (Scott et al., 2019). The purpose of this study was to assess the occurrence of care rationing among nurses working in surgical wards. An analysis of the obtained data demonstrated that the total mean BERNCA score is 1.53, which means that the frequency of care rationing by the respondents falls within the range between “never” and “rarely.” Similar results were also obtained by Jaworski et al. (2020), Schubert et al. (2013), and Uchmanowicz et al. during a validation study of the Polish version of the BERNCA questionnaire (Uchmanowicz et al., 2019a) and also the studies conducted among nurses working in a public hospital (Uchmanowicz et al., 2020a, 2021).

This study demonstrates that the activities most frequently rationed in patient care include analyzing the situation of individual patients and care plans at the beginning of the shift, assessment of the needs of newly admitted patients, administration of prescribed medication or infusion on time, setting up care plans for the patients, and providing emotional or psycho-social support to the patient, which is consistent with the results obtained by other authors (Schubert et al., 2013; Uchmanowicz et al., 2020a). In a study by Uchmanowicz et al. (2019a), the nurses declared that the most frequently rationed activities included activating or rehabilitating care, and due to inability to provide sufficient monitoring, they had to restrain confused patients or administer sedatives. Many authors also demonstrated that comfort talk with patients (Al-Kandari and Thomas, 2009; Ausserhofer et al., 2014; Bekker et al., 2015) and timelines of response to requests (Jones, 2014, 2015; Jarošová and Zeleníková, 2019; Gurková et al., 2020; Kalánková et al., 2020; Zeleníková et al., 2020) are the activities most frequently rationed when providing care to the patient.

This study reveals that nurses most frequently ration the activities related to the first and second stage of the caring process (diagnosing the bio-psycho-social condition of the patient and planning activities aimed at solving the problems of patients), which finally translates into lower quality of provided care and worse treatment outcomes for patients (Campagna et al., 2020). In contrast, the positive aspect is that, as has been demonstrated, the least frequently rationed activities include applying necessary disinfection measures and preparation of patients for planned tests or therapies, which is also confirmed by other authors (Schubert et al., 2013; Uchmanowicz et al., 2019a). The due performance of these activities enables the prevention of hospital-acquired infections and minimizes the risk of adverse events related to medical procedures or treatment.

Analysis of the obtained data demonstrated that the frequency of care rationing is significantly higher in persons working <5 years compared with nurses with seniority exceeding 20 years and among younger nurses (aged below 50 years) compared with persons aged above 50 years, which complies with the results obtained by Jarošová and Zeleníková (2019) and Al-Kandari et al. (Al-Kandari and Thomas, 2009).

It was also demonstrated that the factor of the patient-to-nurse ratio during a shift has a significant impact on the level of care rationing. Increasing the patient-to-nurse ratio results in more frequent non-completion of tasks planned during nursing care. Many authors (Schubert et al., 2013; Ausserhofer et al., 2014; Zhu et al., 2019) indicated that lower patient-to-nurse ratios are connected with lower levels of nursing care left undone.

An analysis of the obtained data revealed that the vast majority of the respondents (42.34%) declared a moderate level of satisfaction with life, which complies with the results achieved by other authors (Marilaf Caro et al., 2017; Kupcewicz et al., 2018; Piotrkowska et al., 2019; Lorber et al., 2020). While the study by Uchmanowicz et al. (2019b) demonstrated that nurses and midwives most frequently assess their level of life satisfaction as high. The difference in the results may be due to the characteristics of the study group, as the average age of the respondents in this study was significantly lower. While in the Iranian study, the vast majority of the respondents were definitely not satisfied with life (Yazdanshenas Ghazwin et al., 2016), which was affected by work-related factors (no satisfaction with remuneration and work environment) and associated with everyday emotions and stress. Practicing the profession of nurse is associated with experiencing strong stress and chronic fatigue, which clearly affects the perception and assessment of life satisfaction (Uchmanowicz et al., 2021).

In this study, no significant impact of the level of life satisfaction was on the level of rationing of nursing care (despite the result was borderline statistically significant), while a study by Uchmanowicz et al. (2021) demonstrated that nurses with a low or medium level of life satisfaction tend to leave nursing care unfinished more frequently compared with nurses who assess their level of life satisfaction as high.

Job satisfaction had a significant positive effect on the nurse-assessed quality of care (Boamah et al., 2017). An analysis of the material also demonstrated that the level of job satisfaction among the nurses in the study group was 18.5 points, which means that the nurses are neither satisfied nor unsatisfied with their job, which is consistent with the results obtained by other authors (Uchmanowicz et al., 2019b, 2020a; Jaworski et al., 2020). Aiken et al. (2013) revealed that the proportion of nurses unsatisfied with their job dramatically differ depending on the country of their work—in the Netherlands, only 11% of surveyed nurses reported no satisfaction with work, compared with 56% in Greece. The level of satisfaction with job should be continuously monitored by the management, since it was demonstrated that nurses unsatisfied with job ration the nursing care from 2.6 (White et al., 2019) to 3.4 (Clark and Lake, 2020) times more frequently compared with nurses reporting satisfaction with job, which was proved in studies conducted by other authors (Jones, 2014; Clark and Lake, 2020; Friganovic et al., 2020; Gurková et al., 2020; Uchmanowicz et al., 2020a,b; Zeleníková et al., 2020), as well as in this study. A low level of satisfaction with job also translates into a greater willingness to resign from work, and consequently, into staff shortages. Insufficient staff resources are a factor significantly affecting the level of rationing of nursing care (Alsubhi et al., 2020).

The most frequently rationed care interventions identified in the implicit rationing approach were activities related to care plans. The assessment of the level of satisfaction with work and identification of affecting factors will enable reducing the occurrence of care rationing among the nurses working at the surgical wards in Polish hospitals.

This study has some limitations. Care workers might not report the actual level of care rationing. Also, the results are based on the self-reported measure of satisfaction with job and satisfaction with life. The final limitation is the use of a cross-sectional study design, which did not allow us to arrive at firm conclusions regarding the causality of predictors.

The datasets presented in this article are not readily available because personal data in the data set. Requests to access the datasets should be directed to aleksandra.koltuniuk@umed.wroc.pl.

The study was carried out following the guidelines of the Declaration of Helsinki and Good Clinical Practice. Participation in the study was voluntary and anonymous. The study protocol was approved by the Bioethics Committee of Wrocław Medical University in Poland (permission no. KB-41/2019).

AK, IW, AM, KC, and IU: conceptualization, methodology, investigation, and writing—original draft preparation. AK and IW: formal analysis. AK: resources, data curation, writing—review and editing, and funding acquisition. IU: visualization. AK and IU: supervision. All authors have read and agreed to the published version of the manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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