Intensive care units (ICUs) are designed to treat critically ill patients and those with life-threatening conditions. Such patients are usually diagnosed with a potentially reversible cause for their condition and require advanced monitoring of their vital signs. ICUs perform procedures and apply methods that are only available in the anaesthesiology and intensive care wards and not in any other hospital ward (Donovan et al., 2018). ICU nurses are responsible for providing comprehensive nursing care to patients and their families during critical periods (Danielis et al., 2022). They offer intensive care as a specialty in managing human reactions to actual or potentially life-threatening situations. The work of ICU nurses entails a high physical and mental load (Sardo et al., 2023).

Rationing of nursing care (Kalisch, 2006), refers to the required patient care that is omitted or delayed (Kalisch et al., 2009). Rationing of nursing care has a direct effect on patients’ clinical outcomes. A systematic review (Recio-Saucedo et al., 2018) demonstrated that the omission of nursing care had a negative impact on the incidence of bedsores, treatment errors, hospital-acquired infections, patient falls, critical incidents, 30-day rehospitalisation, and mortality. Other negative effects of rationing of nursing care include an increased number of falls, hospital-acquired infections, and deteriorated care quality (Aiken et al., 2002a, Aiken et al., 2002b, Needleman et al., 2002). Some researchers noted that the absence of care resulted in decreased patient satisfaction (Ambrosi et al., 2017, Bruyneel et al., 2015, Papastavrou et al., 2014). Additionally, other researchers demonstrated that even a low level of care rationing resulted in worse patient outcomes (Schubert et al., 2008). According to (Griffiths et al., 2014) a lower level of nursing care omission will contribute to an improvement in nursing oversight and patient treatment outcomes, such as the number of falls, incidence of bedsores, and pneumonia.

According to many studies, the most frequent causes of nursing care rationing include shortage of nursing staff, difficult work conditions, budget limitations, nurses’ level of knowledge, and adverse work environments (Bail and Grealish, 2016, Cho et al., 2015, Schubert et al., 2013). Moreover, the study by (Sochalski, 2004) suggested that an increase in the number of nurses reduced lack of care. A large international study (Sakr et al., 2015) demonstrated that a nurse-to-patient ratio higher than 1:1.5 was independently associated with a lower risk of hospital death. Restricting the availability of nursing care may pose a serious risk to patient safety and adversely affect the quality of healthcare services.

Work environment and work safety climate have a significant impact the rationing of nursing care (Hessels et al., 2019). There are many tools that examine nurses’ work environments. Nurses’ work safety climate can be assessed using the Safe Attitudes and Behaviours Questionnaire (Polish abbreviation: BePoZa) in the Teamwork and Safety Climate version. Safe attitudes and climate are defined as a product of individual and group values, attitudes, observations, competence, and behavioural patterns, which determine their involvement in occupational safety, health management, and work style and proficiency (Sexton et al., 2006). Safety climate is an integral part of a more extensive concept of safety culture, which reflects healthcare personnels’ attitudes towards patient safety issues regarding their work environment.

According to the American Association of Critical Care Nurses (AACN), a healthy work environment is important for prioritising patient safety, improving staff morale, reducing turnover, and sustaining the financial viability of organisations (Vollers et al., 2009). The healthy work environment (HWE) concept is based on defining and developing the elements of each standard and teaching personnel about the importance and usability of these elements. According to the AACN, the key elements of a healthy ICU work environment include skilful communication, true cooperation, effective decision-making, proper staffing, and authentic leadership (Connor et al., 2018). Communication, cooperation, and personnel can affect the quality of care provided to patients. These standards represent evidence-based relationship-focused professional rules. Each standard is considered essential for achieving effective and consistent results. The work environment for ICU nurses is particularly demanding. They are increasingly exposed to hazardous physical and mental conditions (Ramírez-Elvira et al., 2021). Many studies have examined the rationing of nursing care in Poland (Jarosz and Mlynarska, 2023, Uchmanowicz et al., 2020, Witczak et al., 2021). However, only one study was conducted in the context of ICUs (Mlynarska et al., 2020).

Therefore, the rationing of care in ICUs in Poland and assessment of the impact of a sense of a HWE and safety climate on the rationing of nursing care in ICUs require further examination.