Resource allocation and rationing in nursing care

Public discussion of resourcing in health care tend to compound ideas of resource allocation and rationing. Public debate also tends to focus on situations of scarcity such as lack of kidneys or hearts for transplantation, or heated arguments regarding whether the latest very expensive new drug should be made available, regardless of cost, to treat certain condition such as Cystic Fibrosis or a particular type of cancer. The idea that nursing or medical time is an important health care resource that needs to be allocated with care rarely gets an effective airing in public debate. I argue in this chapter that it is important in the healthcare context to differentiate resource allocation from rationing, on the basis that if we assume we are rationing health care as our starting point we may miss opportunities to examine more and less effective ways of allocating the health care resource. This is particularly important in nursing care where failure to examine carefully how the nursing resource is allocated, and supported, is leading to covert rationing of nursing time and sub-optimal patient care in hospitals across Europe.