DESEQUILÍBRIO NO RÁCIO ENFERMEIRO/UTENTE: IMPLICAÇÕES ÉTICAS, PROFISSIONAIS, IDENTITÁRIAS E NA QUALIDADE DOS CUIDADOS

• DOI: https://doi.org/10.22533/at.ed.3761226130211

• Palavras-chave: Rácio enfermeiro/utente. Dotações seguras. Segurança do doente. Sofrimento moral. Qualidade dos cuidados. Modelo de Donabedian.

• Keywords: Nurse-to-patient ratio. Safe staffing. Patient safety. Moral distress. Quality of care. Donabedian model.

• Abstract: The imbalance in nurse-to-patient ratios is a structural problem of growing relevance in contemporary healthcare systems, with direct implications for patient safety, quality of care, and nursing professionals' well-being. This chapter critically analyses this issue across four interrelated dimensions, framed within Donabedian's structure-process-outcome model — a widely used framework in nursing staffing research that organises the assessment of care quality into structure, process, and outcome dimensions: ethical and deontological, professional practice, career development and professional identity, and care quality. To illustrate the clinical reality under analysis, the authors present a fictional scenario constructed on the basis of situations documented in the scientific literature and Portuguese hospital practice, in compliance with Regulation (EU) 2016/679 (GDPR). Drawing on recent scientific evidence, the chapter discusses the ethical principles compromised by care rationing — beneficence, non-maleficence, justice, autonomy, veracity, and fidelity — and their implications for moral distress among nurses. The impacts of inadequate nurse-to-patient ratios on professional progression, nursing identity, adverse event incidence, and patient safety are examined, with reference to Portuguese data from the RN4CAST project. The chapter concludes with a structured action plan articulated with the dimensions analysed, and a limitations section acknowledging the constraints inherent to the approach adopted. Findings indicate that ensuring safe nurse staffing is not merely a managerial requirement but an ethical and organisational obligation, essential to the sustainability of the nursing profession and the quality of care provided.