The Reality of Providing Nursing Services in a Healthcare Rationing System


The notion of healthcare has always been one of the most sophisticated phenomena as far as ethics and morality issues are concerned. For centuries, healthcare as a social endeavor has been a marker of social status and affiliation to a particular social group. Thus, the ones having a more substantial financial advantage were entitled to be properly diagnosed and treated. The following pattern is also visible today, even though its manifestation has become rather implicit. That is, with the rapid development of a capitalistic form of social hierarchy, the healthcare costs have also been increasing. As a result, a severe gap between the healthcare costs and profit of average US residents has been created (Bauchner, 2019). To take control of the situation, the process of rationing services, such as an attempt to equally distribute scarce resources among the population, was introduced to the US society.

Nursing leaders play one of the most crucial roles in terms of healthcare resource rationing and fiscal sustainability management. The importance of their engagement in the process is related to the fact that nurses are the ones who communicate directly with the patient. That is, it is the nurse’s responsibility to provide patients with the utmost care while accounting for the service available for an individual. To dwell on the issue of nursing services in the paradigm of the healthcare rationing system, the following paper is aimed at looking into both practical and ethical aspects of healthcare and rationing.

Balance Between Patients’ Clinical Needs and Fiscal Sustainability

Unquestionably, the main task of every nursing leader who starts their career is to provide the patients with high-quality service. However, according to the statistical data, since the introduction of healthcare insurance as a major means of health management and help provision, the cost of healthcare has been steadily rising (Bauchner, 2019). As a result, it is now barely possible for a nursing leader to ensure a full-scale treatment for each individual due to the scarcity of available resources. Today’s healthcare model has now put the question of choice in terms of treatment provision, as the government claims to have no physical ability to cover the healthcare expenses of the US residents. However, according to the local researchers, such inability is rather a choice than a nationwide necessity, implying that the US government does not have a functional framework for the finance allocation (Rosoff, 2017). As a result, the major responsibility is placed on the nursing leaders who tend to address the issue of healthcare rationing in the workplaces daily.

Having considered the aforementioned information, it would be safe to assume that the notion of fiscal sustainability within the facility should be of primary importance for a nursing leader. Thus, when speaking of such sustainability, the first step towards finding a balance between rationing and patient supply would be to reconsider the finances allocated for administrative and patient-oriented expenses. The notion of administrative costs, which tends to cover the process of scheduling appointments, medical billing, and other back-end expenses, now accounts for almost 10% of the overall healthcare industry (Bauchner, 2019). Although such a number seems relatively small compared to 90% of the direct patient-oriented costs, the minimization of administrative expenses might save almost $175 billion (Bauchner, 2019). Hence, reconsidering the allocation of local financial resources would be the most efficient step in the way to finding a balance between satisfying the needs of patients without abusing the facility’s fiscal sustainability. However, the ethical challenge related to the patient treatment and nursing leadership is frequently more devastating for the healthcare workers than the administrative issues encountered in the workplace.

Ethical Issues in a Healthcare Rationing Environment

Every day a nursing leader is faced with at least one ethical dilemma when it comes to the healthcare provision, medical support of the patients, and communication with individuals. However, one of the central challenges in healthcare is the necessity to decide whether a certain choice should be made in favor of society as a group or a single patient. The former ethical framework, in which the outcome of action plays the most important role, is known as utilitarianism (Mandal et al., 2016). According to the following ethical consideration, the final impact on society matters more than a health condition of a person, as the scopes of social benefit are more important for a group of individuals.

Another theory, known as deontology, is an opposite, more individualistic approach to the process of treatment, which emphasizes every separate patient. When speaking of the modern American model of healthcare, it may be noted that such social system as capitalism implicitly promotes the idea of individualism (Mandal et al., 2016). As a result, in the vast majority of situations, practitioners are left with little choice in terms of resource rationing. Still, when it comes to the ethical consideration of any healthcare rationing environment, nursing leaders feel mentally pressured to reach a consensus in terms of both theories. As of now, the solution to this ethical dilemma has not been found.

Internal and External Forces Impacting Decision Making

Today’s major tendencies are focused on the development of a healthcare framework that prevents potential increases in the disease rate. In the following scenario, nurses play one of the most significant roles, as they serve as social advocates for a healthy lifestyle, regular check-ups, and community education. Thus, to successfully implement this framework, nursing leaders are to identify the proportion of employees who dedicate themselves to healthcare promotion. In such a way, they will be able to calculate the patterns of resource rationing in the scenario where some of the major health risks are eliminated. However, such a decision-making process is predetermined by a variety of external and internal factors.

The external factors in terms of the rationing environment are related to the legislative and public initiatives implemented in healthcare. For example, the fiscal sustainability of the national system was greatly modified by the Affordable Care Act that made access to healthcare real for some US residents (Salmond & Echevarria, 2017). As a result, the elimination of some restrictions on public procurement allowed nursing leaders to make decisions in favor of more middle-class Americans. Internal factors, on the other hand, have an impact on the given healthcare facility, which makes it generally easier to resolve. The examples of such a force are the framework of organizational factors such as working conditions, relationships in the nursing team, and access to the resources allocated to a facility (Salmond & Echevarria, 2017). Hence, it may be concluded that the process of decision making in terms of rationing healthcare is a sophisticated endeavor predetermined by both public and governmental interventions and individual relationships within the facility staff.

Evidence-Based Care and Leadership in Fiscal Decision Making

When deciding resource allocation and service rationing, nursing leaders cannot rely exclusively on their ethical considerations or personal perception of the situation. Thus, to make sure that every option is considered while making a decision, it is of crucial importance for the practitioners to analyze the empirical data on the specific matter (Bowers, 2018). Such an approach is known as the evidence-based care framework, which encourages an individual to analyze the information from various resources to define the best possible option. As far as fiscal decisions are concerned, evidence-based care may help the nursing leaders to identify the patterns of procurement for the facility and the allocation of direct and administrative healthcare costs. When the organization uses such a strategic model, the notion of evidence-based leadership is implemented into practice to make sure that everyone on the team is aware of the precedents leading to a certain strategic choice (Bowers, 2018). Thus, evidence-based leadership may be used in the decision-making process for the sake of better internal communication within the facility, which leads to a productivity increase.


Rationing and fiscal sustainability in healthcare have always been some of the central discussion points in the social paradigm. However, despite various discussions, suggestions, and disputes, no practical solution was found to the issue of the relationship between nursing leadership and rationing healthcare. The primary aim of the following paper was to identify some of the ethical and practical challenges faced by nursing leaders. As a result, it was estimated that the absence of balance between both financial allocation and ethical approach to healthcare made it almost impossible for the practitioners to find the middle ground. The future implication of the research might be related to the notion of the authorities’ role in the issue, as their decisions remain the most relevant to US healthcare realities.


Bauchner, H. (2019). Rationing of health care in the United States: An inevitable consequence of increasing health care costs. JAMA, 321(8), 751-752. Web.

Bowers, B. (2018). Evidence-based practice in community nursing. British Journal of Community Nursing, 23(7), 336-337. Web.

Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5–7. Web.

Rosoff, P. M. (2017). Drawing the line: Healthcare rationing and the cutoff problem. Oxford University Press.

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12–25. Web.

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NursingBird. (2022) 'The Reality of Providing Nursing Services in a Healthcare Rationing System'. 10 May.


NursingBird. 2022. "The Reality of Providing Nursing Services in a Healthcare Rationing System." May 10, 2022.

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NursingBird. "The Reality of Providing Nursing Services in a Healthcare Rationing System." May 10, 2022.