Professional, social, and demographic correlates of nursing care rationing: insights from hospital nurses in the Czech Republic, Poland and Slovakia

Introduction: Nursing care rationing is an increasingly common problem in healthcare systems. It results in reduced quality of care, decreased patient satisfaction, and an increased risk of medical errors. The aim of this study was to assess the level and patterns of nursing care rationing and to examine associations between rationing and selected demographic and professional characteristics of hospital nurses in the Czech Republic, Poland and Slovakia. Materials and methods: A cross-sectional study was conducted between March 2024 and March 2025. The study included 610 licensed nurses working in hospitals in Zlín, Czech Republic (151), Białystok, Poland (245) and Ružomberok, Slovakia (214). The study was conducted using the standardized BERNCA-R scale. The frequency of omitting 32 nursing activities was assessed, and correlations with demographic and professional factors were analyzed. Data were examined using descriptive statistics, Kruskal-Wallis tests, and Spearman's rank correlations. Results: The mean overall BERNCA-R score differed slightly between the hospital samples. Demographic and professional characteristics-including age, marital status, parenthood, education, and years of experience-were not significantly associated with the overall level of rationing. In contrast, the type of hospital ward showed a stronger association with rationing patterns, with emergency departments reporting the highest frequency of omitted nursing activities. Analysis of individual BERNCA-R items indicated that activities requiring extended patient communication, assessment, or monitoring were more likely to be rationed, whereas basic hygiene-related tasks were rarely omitted. Conclusion: The findings suggest that nursing care rationing in hospital settings is more strongly associated with organizational and workload-related factors than with individual nurse characteristics. Efforts to reduce rationing should therefore focus on improving staffing structures, workflow organization, and working conditions, particularly in high-intensity clinical environments.