Concept of Rationing in PMHCN Services Provision


A concept analysis is designed to make the student as familiar with a concept as possible. A concept is usually one or two words that convey meaning, understanding or feelings between or among individuals within a same discipline. Some concepts relevant to mental health are stigma and recidivism Concept of Rationing in PMHCN Services Provision.

Activities and Directions

To begin the process, choose a concept you are interested in, a term you encounter with your work or one with which you would like to research. Look for the measurable quality in your topic of interest, problem or question.

– Write down all of the words you can think of which relate to or express your concept.

– Search the literature for journal articles and books related to the concept to get a sense of the beliefs and thoughts of others in the discipline regarding the concept.

– Begin the analysis paper with a introductory paragraph expressing what the concept is and why it is significant to you and mental health Concept of Rationing in PMHCN Services Provision.


– Develop the Model Case. The model case is a brief situational description validating the concept including all of the characteristics you have listed which describe or make up the concept. The model case should be able to

reflect that If this is not an example of (concept), then nothing is.

– Close with a summary.

Psychiatric and Mental Health Clinical Nurse Specialists (PMHCN) are concerned with funds distribution to include reaching a balance between meeting the patients’ clinical needs, offering the best possible care based on available research evidence, and the health facility’s fiscal sustainability. This is based on the awareness that as leaders, PMHCN play a role in addressing the financial challenges facing medical organizations, while at the same time submitting practical opportunities (Tietelbaim & Wilensky, 2013). In addition, their primary duty is to meet the medical needs of their patients to include offering accessible and affordable nursing services that ensure the healthy development of the next generation (Getzen, 2013). Part of the balance must be the acknowledgment that the US medical landscape is dynamic and subject to change. In fact, the enactment of the Patient Protection and Affordable Care Act (PPACA) has seen amplified medical care access with an additional 30 million people offered access to affordable and equitable medical care, to include PMHCN care. The new reality is that the increasing number of patients is matched by skyrocketing health care costs, thereby compelling the revision of health care delivery models to improve the balance between patients’ clinical needs and health care facilities’ fiscal sustainability (Allen & Spitzer, 2015). As a result, the need to ration PMHCN services is explained by differential availability, needs and other qualifying factors.

Definition of Concept
The awareness about rationing PMHCN services accounts for the conceptualization, development and delivery of accountable care organization (ACO) based budgeting systems. Applying ACO entails budget and expenditure consultation with healthcare stakeholders (to include nurses and patients representatives), and forming partnerships with other healthcare teams who assent to sharing the mutual obligation for managing health care quality and fees as they are offered to patients (Gourdreau & Smolenski, 2014). In this case, ACO rewards the PMHCN by setting cost saving and quality targets with the results that the PMHCN is offered bonuses (to include financial bonuses) as rewards for meeting earmarked targets. For that matter, it would be expected that the PMHCN would work closely with other health personnel. Given their exclusive spot within the healthcare team, PMHCNs are expected to use the occasion presented by ACO to offer significant bearing for the care process. This implies that nurses employed at the facility will be able to work within the ACO model to reduce care costs and improve quality (Saba & McCormick, 2011). As such, applying the ACO model would allow a nursing leader to improve the balance the clinical needs of the patients and the fiscal sustainability of the healthcare facility.

III. List of defining characteristics

The key defining characteristic of ethical leadership among PMHCN is self-awareness. Marquis and Huston (2014) define self-awareness as the ability to correctly identify personal emotions and remain cognizant of them even as they change. In this case, a self-aware person is expected to have a good understanding of his or her limitations. This implies that a self-aware PMHCN would be expected to offer effective management to facilitate the provision of psychiatric care. This occurs through the development of a collaborative working environment to allow medical personnel to be effective in providing medical care (Marquis & Huston, 2014). In this respect, an individual with strong self-awareness would demonstrate unique leadership behaviors, even among PMHCN.

Firstly, persons with strong self-awareness have the capacity to form the right teams. This is useful to PMHCN who work in a hospital environment comprised of different individuals with divergent professions that include physicians, nurses, anesthetists, administrators, accountants, and so on. Having a good team will require working well with others, understanding the need for compromise, and flexibility in work strategies so as to avoid conflicts and strife that are likely to reduce productivity. Secondly, they can provide appropriate direction that trickles down to include presenting the group with comprehensive instructions concerning the goals that are to be met in a specified timeline, and how they will be measured for completion. This comprises building on the strengths of each group member and linking these strengths to common goals (Cherry & Jacob, 2016).

Thirdly, they are able to implement an accountability system that holds each group member individually responsible for the group’s results to include implementing internal checks and balances for optimal and equitable performance. This is particularly useful for PMHCN whose patients include mentally ill patients with compromised cognitive processing who may not understand what danger constitutes and would be a risk to others in their environment. Finally, they ensure that the group supports its members to improve productivity. This means that should the PMHCN make a decision that threatens colleagues or patients, then a justification should be provided to explain why the decision was made from among the available options and what it implies (Catalano, 2015). As a result, an individual with strong self-awareness would demonstrate unique leadership behaviors to include facilitating formation of the right team, providing appropriate directions, accountability, and group support for improved productivity Concept of Rationing in PMHCN Services Provision.

Even as PMHCN are forced to be self-awareness they must also accept the reality of limited resources. Nursing leaders cope with the realities of limited resources. In fact, they face this reality on a regular basis within a healthcare rationing environment where difficult decisions must be made while considering prioritized options and opportunities. In essence, ethical concerns form the base of the distribution and use of medical resources since resources are limited in nature. The subject garners greater debate when it concerns populations that are often considered unproductive but require a large proportion of the health resources to maintain a high-quality life, health education and long-term care plans (Harlew, 2013). As a result, the debate on how to allocate PMHCN services within a rationing environment typically takes on an ethical perspective.

There are four ethical issues that affect the provision of PMHCN services within the rationing environment. These issues include PMHCN resources being limited, providers being scarce, financial limitations, and cultural barriers and biases. These four ethical issues stand out since they require input from multiple stakeholders before any change can be affected in nursing care. So far, it is undeniable that there has been an increase in the need to address nursing needs, even in the face of fiscal obligation and budgetary need. In fact, it is recognized that these costs will quickly become unmanageable if meaningful response is not mounted. Conversely, any acceptable decision would focus on reducing costs thus raising ethical concerns about the suitability and satisfaction of PMHCN services offered to patients. What becomes evident in this debate is that the snowballing cost of caring for patients introducing a cost issue that is accompanied by the need to increasingly spend more towards ensuring that patients receive high-quality nursing attention (Harlew, 2013). As a result, the ethical concerns that PMHCN personnel face when offering professional services within a rationed environment would revolve around cost realities and limitations that must be managed at realistic levels without compromising nursing care quality.

In addition, PMHCN must consider the fact that care decisions should ideally be supported by tangible evidence that improves the possibility of positive outcomes. Bojeun (2014) mentions that efficient and effective decisions must be secured by acceptable backing in the form of pertinent information management that presents the most relevant and current evidence. It is essential to comprehend that the nursing environment continuously experiences progress, activity, and change even as new management strategies and protocols are developed to question established ideas. In this case, nursing leaders are motivated to succeed by applying research skills to improve performance and commitment to reach those goals successfully (Bojeun, 2014).

The Model Case
The reality of rationing nursing services is one that no PMHCN can escape from despite an inherent need to offer the best possible medical services to any patient requiring psychiatric care. In such cases, the decision to offering PMHCN services would be affected by both internal and external forces as well as available evidence. The internal and external forces that impact PMHCN decision making refer to the nursing care stakeholders who include any institution, individual, or group who are either affected or affect the delivery of nursing services. These forces are identified by the nature of their relationships with the medical facility, and how that relationship has been shaped and managed over time. This is based on the understanding that the relationship is critical in ensuring that there is collaboration to facilitate the development and support of relevant and definite nursing goals, principled leadership, excellence standards, recognition, and support, unified commitment, results orientation, and competence. It is essential for a nursing system to know its stakeholders (internal and external forces) and understanding the nature of their relationship, as well as how to manage the relationship and shape it over time so as to ensure that the positive benefits are maximized while the adverse effects are minimized. This is because engaging the forces in a persuasive way can leverage the nurses’ capacity to gain support for their activities, thereby greatly enhancing the ability to report success in PMHCN activities and programs (Weiss, 2014)Concept of Rationing in PMHCN Services Provision .


Typically, these stakeholders are divided into two groups to include internal and external forces. The internal forces are the stakeholders who engage with the nursing system on a daily basis, and are directly affected by any decision that is made thereby requiring that they be involved in all decision-making so as to ensure their support and increase the possibility of that decision resulting in the desired effect. These internal forces include the associations representing the nursing personnel, the administrators who manage the daily operations and strategic decisions at the medical facility, nursing personnel, and patients. On the other hand, the external forces are the stakeholders who are indirectly affected by the decisions made within the nursing system. They include competing medical facilities, the patients’ families, American Nurses Association (ANA), the government and its agencies, community groups who offer support, the local community, private sector, special interest groups such as faith-based groups, suppliers, media, elected representatives, legislators, advisory boards, and board of directors (Weiss, 2014).

Other than the internal and external stakeholders, there is a need for PMHCN to consider evidence from research when making practice decisions. Evidence-based practice (EBP) in nursing care refers to the phenomenon of applying the conclusions of peer-reviewed publications to direct professional practice and recommend any changes. Even as the material is published, it has been deemed appropriate – by experts – as a reference material for application in nursing practice. Understandably, peer-reviewed publications serve the function of spreading knowledge and associated practice interventions through evidence use. In this respect, EBP refers to the action of increasing access to tangible professional evidence, motivating nursing leaders to use and apply evidence, and providing an avenue through which the evidence can be implemented (Rubin, 2013).

The prevailing psychiatric care environment is highlighted by increased patients’ acuity that demands the best possible PMHCN care. This cognition is supplemented by the awareness that the psychiatric environment is multifaceted and requires more than PMHCN care. As such, it is not surprising that PMHCN often finds it difficult to offer care that is patient-centered. In addition, alterations to the economic and social environments have demanded alterations health care provision, prioritizing management of workflows and PMHCN costs. This is based on the understanding that patients satisfaction while managing PMHCN costs is best achieved through effective communication with a focus on providing high-quality care (Melnyk & Fineout-Overholt, 2011)Concept of Rationing in PMHCN Services Provision .

Besides that, the broad information that is obtainable by nursing stakeholders has made them well-informed and cognizant of the status of nursing care, in so doing raising the desire for involvement in care planning, as well as participation in fiscal decisions. This indicates that nursing leaders must increasingly depend on peer-reviewed publications as evidence to justify and support their decisions for accountability purposes (Harris, 2015). As a result, today’s medical environment is one that has forced PMHCN personnel to adapt and increasingly consult available sources in making decisions thereby relying on evidence-based care to make fiscal decisions.

Although nursing evidence from peer-reviewed publications and practice is presumed to have a shared objective (of realizing a healthy community with costs that can sustainably be managed) that necessitate working with periodic reviews and regular consultations in decision-making, which is not always the case. This is for the reason that each publication must follow the scientific process that is true to the research results. Although these differences may hinder the nursing decisions and activities, that is not always true. This is because the variances presented in the publications’ material, formation and structure can have an influence since they offer a reference point to justify decisions (Bowerman & Van Wart, 2015). As a result, there is a need for PMHCN to consider both internal and external force even as they adopt an evidence-based approach in making decisions to ensure that the best possible outcomes are achieved in all instances, as well as being justified. In this respect, the concept of rationing in the provision of PMHCN services is reliant on differential availability, needs, financial reality, and EBP as justifications for practice decisions made.


Allen, K. & Spitzer, W. (2015). Social work practice in healthcare: advanced approaches and emerging trends. Thousand Oaks, CA: SAGE Publications.

Bojeun, M. (2014). Program management leadership: creating successful team dynamics. Boca Raton, FL: CRC Press.

Bowerman, K. & Van Wart, M. (2015). The business of leadership: an introduction. New York, NY: Routledge.

Catalano, J. (2015). Nursing now! today’s issues, tomorrow’s trends. (7th ed.). Philadelphia, PA: FA Davis Company.

Cherry, B. & Jacob, S. (2016). Contemporary nursing: issues, trends, & management (7th ed.). Amsterdam: Elsevier Health Sciences.

Getzen, T. (2013). Health economics and financing (5th ed.). Hoboken, NJ: John Wiley & Sons.

Gourdreau, K. & Smolenski, M. (2014). Health policy and advanced practice nursing: impact and implications. New York, NY: Springer Publishing Company.

Harlew, G. (2013). Ethics in clinical practice: an inter-professional approach. New York, NY: Routledge.

Harris, M. (2015). Handbook of home health care administration (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Marquis, B. & Huston, C. (2014). Leadership roles and management functions in nursing: theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: a guide to best practice (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Rubin, A. (2013). Statistics for evidence-based practice and evaluation (3rd ed.). Belmont, CA: Brooks/Cole.

Saba, V. & McCormick, K. (2011). Essentials of nursing informatics (5th ed.). New York, NY: McGraw-Hill Professional.

Teitelbaum, J. & Wilensky, S. (2013). Essentials of health policy and law (2nd ed.). Sunbury, MA: Jones & Bartlett Learning.

Weiss, J. (2014). Business ethics: a stakeholder and issues management approach (6th ed.). San Francisco, CA: Berrett-Koehler Publishers Concept of Rationing in PMHCN Services Provision.

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