[Nursing tasks left undone in German acute care hospitals - results from the international study RN4Cast].

Background: Implicit rationing of nursing care - likewise as in medical care - has never been empirically measured in German hospitals. Thus, little is known about prevalence and patterns of nursing care left undone as well as its association with nurse work environment and staffing.

Methodology: We surveyed 1,511 registered nurses from 49 German acute hospitals participating in the multi-country cross-sectional study RN4CAST. Analyses were made by descriptive statistics as well as multilevel regression analysis to calculate predictors from the nurse work environment and staffing.

Results: On average 4.7 out of 13 nursing tasks were rationed. The range was between 82% for "comfort/talk with patients" and 15% for "treatments and procedures". The analysis revealed that hospital work environments and staffing ratios were significantly associated with the level of nursing care left undone. Further significant associations were found between poor leadership, inadequate organisation of nursing work as well as high emotional exhaustion and rationing.

Discussion: The phenomenon of nursing care left undone was prevalent in German hospitals. Those tasks which are most likely to have negative consequences for patients (e. g., pain management and medication on time) seem to receive higher priority than tasks whose potential effects are less immediate or direct (e. g., psychosocial care). With regard to the measured correlation with the nurse work environment, it is recommend to invest in a good environment before (or simultaneously) investing in nurse staffing.