Purpose: The purpose of this study is to test the mediation effect of rationing of nursing care (RONC) and the relationship this has between nurse staffing and patient outcomes. Methods: The analytic sample included 7802 nurse surveys and 5430 patient surveys. Three patient outcome indicators, nurse staffing, RONC, and confounding factors were considered in the model pathways. Results: The hypothesized model was shown to be statistically significant. In the model, nurses who were in the units with lower nurse-to-patient ratios reported higher scores on RONC, which meant that an increased level of withheld nursing care or a failure to carry out nursing duties was apparent. Nurses who reported a higher score on RONC, scored poorly on the quality assessment and were more frequently involved in patient adverse events. Nurse staffing influenced quality assessments and patient adverse events through RONC. In units with poorer nurse-reported quality assessments or more frequently patient adverse events, patient-reported dissatisfaction scores were higher. Conclusions: The results suggest that a lack of nurse staffing leads to RONC, which leads to poorer patient outcomes. These results are seen when considering the evaluations completed by both nurses and patients. The relationship between staffing numbers and patient outcomes explains the mediating role of RONC.

Background: Patients on maintenance hemodialysis (MHD) experience elevated rates of anxiety, depression, and poor sleep. Intradialytic hypotension (IDH) is a serious complication linked to increased mortality and hospitalization, yet its association with psychological and sleep disturbances remains unclear. This study aimed to examine the prevalence of IDH, anxiety, depression, and poor sleep in MHD patients, and to explore whether IDH is associated with these symptoms. Methods: In this cross-sectional study, 467 patients from four dialysis centers in Suzhou, China, were enrolled. IDH was assessed over 36 sessions using medical records. Anxiety (GAD-7), depression (PHQ-9), and sleep quality (PSQI) were measured. Results: Among 16,812 dialysis sessions, IDH incidence was 11.7%. A total of 123 patients (26.3%) experienced IDH frequently (≥4 episodes). Anxiety was present in 30.4% of the total sample (142/467), depression in 44.3% (207/467), and poor sleep in 39.9% (182/456). Multivariable analysis indicated that frequent IDH was significantly associated with higher anxiety, depression, and sleep quality scores (P< 0.05). Conclusion: Frequent IDH is correlated with greater symptom burden of anxiety, depression, and poor sleep quality in MHD patients. These findings highlight the need to integrate hemodynamic monitoring with psychological and sleep assessment in MHD care. Further longitudinal studies are needed to clarify causal mechanisms and evaluate interventions.