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Int J Nurs Stud. 2018 Dec;88:25-42. doi: 10.1016/j.ijnurstu.2018.08.006. Epub 2018 Aug 17.

Ethical elements in priority setting in nursing care: A scoping review.

Author information

University of Turku, Department of Nursing Science, Turku University Hospital, and City of Turku, Welfare Division, Turku, Finland. Electronic address:
University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland. Electronic address:
Hochschule Bremen Neustadtswall 30, 28199 Bremen, Germany. Electronic address:
University of Iceland, Clinical Nurse Specialist, University Hospital of Iceland, Iceland. Electronic address:
Cyprus University of Technology, School of Health Sciences, Department of Nursing, Limassol, Cyprus. Electronic address:
University of Southeast Norway, Vestfold, Norway. Electronic address:
Oslo Metropolitan University, Oslo, Norway. Electronic address:
Central Queensland University Australia, School of Nursing, Midwifery and Social Sciences, Tertiary Education Division, Mackay, Australia. Electronic address:
School of Nursing and Midwifery, University of South Australia, Australia. Electronic address:
National University of Ireland Galway, Galway, Ireland. Electronic address:



Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses' professional and moral values.


To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses.


A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis.


Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients' daily care needs, prioritising work by essential tasks and participating in priority setting for patients' access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient's situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses' moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise.


Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.


Ethics; Nurse; Nursing care; Prioritisation; Priority setting; Rationing; Scoping review

[Indexed for MEDLINE]

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