Thesis
The inpatient nurse as a street-level bureaucrat: rationing care at the bedside
Washington State University
Master of Public Affairs (MPA), Washington State University
2011
Handle:
https://hdl.handle.net/2376/103709
Abstract
Aim. This thesis reports a study conducted to determine if public policy intended to provide emergency care to all people presenting to U.S. hospitals, regardless of their ability to pay, is associated with nurses rationing care for patients on the inpatient nursing units of the hospital. Background. Public policy designed to ensure the availability of health care for anyone presenting to a hospital accepting Medicare funding has contributed to overcrowding in U.S. emergency departments (ED). Ambulances are turned away from overwhelmed EDs. It was not apparent in the literature whether a hospital policy to accept every ambulance patient had any impact on the inpatient nurse’s street-level bureaucrat decision to ration care. Method. A factorial survey of nurses on inpatient units at a non-profit, tertiary care medical center was used to collect data to determine if any association exists. The factorial survey consists of a vignette, which is a scenario that is a partial description of a real life situation used to obtain a decision from a survey respondent. The voluntary surveys were distributed to the nurses on the nursing units by an objective third party. The data was entered into SPSS and analyzed using logistic regression since the dependent variables were dichotomous. Results. There is no significant association between a nurse on an inpatient unit facing a situation where he or she must rapidly discharge or transfer one patient in order to accept another patient from an overwhelmed ED and rationing care by omitting an assessment (p=.269) or by omitting education (p=.457). However, there are other common patient- or organization-related situations that are significantly associated with rationing. Conclusion. Overcrowding in the ED resulting in rapid transfer of patients to hospital inpatient units does not result in care being rationed to existing patients. As a street-level bureaucrat, there are situations where nurses must ration care. It is in the interest of safe patient care, for organizations to monitor circumstances that result in rationing and mitigate those circumstances whenever possible.
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Details
- Title
- The inpatient nurse as a street-level bureaucrat
- Creators
- Lucinda Lorraine Eling
- Contributors
- Dana Lee Baker (Degree Supervisor)
- Awarding Institution
- Washington State University
- Academic Unit
- Politics, Philosophy and Public Affairs, School of
- Theses and Dissertations
- Master of Public Affairs (MPA), Washington State University
- Publisher
- Washington State University; Pullman, Wash. :
- Identifiers
- 99900525174301842
- Language
- English
- Resource Type
- Thesis