A longitudinal study on implicit rationing of nursing care among Lebanese patients- study protocol.

Aim To gain an in-depth understanding of the variations and trends of implicit rationing of nursing care, of its associated factors and of its relation to with nurse and patient outcomes. Background Maintaining and improving the quality of nursing care and patient safety have been the focus of health services researchers over the last decade. Cross-sectional studies have showed the magnitude of implicit rationing of nursing care and its associations with negative patient and nurse outcomes. Design Observational longitudinal study. Method Two-year funded study (between 2018-2020), including a sample of 317 Registered Nurses working on 19 units in two large Lebanese urban hospitals. The study included a cross-sectional baseline survey followed by multiple follow-up assessments over 90 days. The repeated measurements on each of the units include repeated surveys on nurses' rationing of care, hospital administration reported nurse-sensitive indicators, nurse staffing levels, and patient mortality data. Discussion The study results will describe variations and trends of implicit rationing of nursing care in hospital units over time and whether and which elements of the nurses' work environment are associated with these variations. Data will inform on the impact of implicit rationing of care on patient and nurse outcomes. These data are needed to advance future planning and interventional research to efficiently reduce rationing of nursing care and improve the quality of care. Impact Generating new knowledge (variations and trends) on the association between rationing of care and other element of nurses' work environment and nurse and patient outcomes.