Award Date


Degree Type

Doctoral Project

Degree Name

Doctor of Nursing (ND)



First Committee Member

Kayrn Holt

Second Committee Member

Paul Thomas Clements

Third Committee Member

Cecilia Maldonado

Number of Pages



Despite all the literature about missed care and its contributing factors, it is prevalent in most hospitals worldwide. Missed care is the result of care that is implicitly rationed. For this paper, implicit rationing is defined as how nurses decide what care is delivered based on the present work environment. Many factors influence implicit rationing. One such factor is the work environment. The association between the nursing work environment and implicit rationing is well described in the literature. The nursing leader is in a formal position responsible for patient outcomes and the nursing practice environment. Therefore, it is important to understand the relationship between the nursing practice environment and implicit rationing. This Doctor of Nursing practice project aimed to examine the awareness of nursing leaders regarding the influence of a positive work environment on implicit rationing. Online surveys were used to assess the work environment and presence of implicit rationing. Statistical tests were conducted to evaluate the relationship between work environments and implicit rationing. An assessment among nursing leaders was performed to examine knowledge concerning healthy work environments and implicit rationing before and after receiving education. This project contributes value to the nursing profession, specifically leaders, regarding the influence of a healthy work environment on implicit rationing.


healthy work environment; implicit rationing; Perceived Implicit Rationing Nursing


Health and Medical Administration | Nursing | Work, Economy and Organizations

File Format


File Size

2100 KB

Degree Grantor

University of Nevada, Las Vegas




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