Time scarcity is a common occurrence in the nurse work environment that stimulates a decision-making process, known as clinical prioritization or implicit rationing. In implicit rationing, nurses must decide what care they will complete and what they will leave unfinished. Five mechanisms that influence this process are supported in the literature. The effects of these influential mechanisms leave patients vulnerable to unmet educational, psychological, care coordination and discharge planning needs. Potential areas for intervention by nurse leaders include redesigning care delivery models to reduce time scarcity, adding balancing measures to performance monitoring systems to promote patient-centered care, and creating work cultures that support the values of nursing.