Nurses cite staffing shortages, language barriers, and profit focus as key care challenges

A new Penn Nursing Center for Health Outcomes & Policy Research (CHOPR) study sheds light on the critical factors that help or hinder hospital nurses in providing quality care to socially disadvantaged populations. The findings, published in JAMA Network Open, offer vital insights to inform hospital strategies for advancing high-quality, equitable care.

The study, which analyzed open-text responses from 1,084 direct care hospital nurses across 58 New York and Illinois hospitals, identified six key themes impacting care delivery:

Profits over patients: A systemic challenge where financial incentives are misaligned with equitable patient care.
Care continuity and hospital-community partnerships: The crucial role of social workers and community resources in connecting patients with needed support.
Insufficient staffing and time constraints: High workloads and inadequate staffing levels as major impediments to quality care.
Technology to address language barriers: The importance of language access technology and in-person interpreters for patients with limited English proficiency.
Patients’ determinants of health: Factors like health literacy, family support, and patient trust impacting care.
Individual nurses’ beliefs and backgrounds: How personal experiences and biases, as well as the need for increased cultural competency training and workforce diversity, influence care.

“Our research highlights that nurses, as frontline care providers, possess invaluable perspectives on the systemic, institutional, community, and individual factors that shape high quality care,” says lead-author J. Margo Brooks Carthon, Ph.D., RN, FAAN, the Tyson Family Endowed Term Chair for Gerontological Research; Professor of Nursing in the Department of Family and Community Health; Director of the Bates Center for the Study of the History of Nursing; and Associate Director of CHOPR; “Their experiences underscore the urgent need for hospitals to prioritize patient-centered approaches, invest in adequate staffing, strengthen community partnerships, and foster a diverse and culturally competent nursing workforce. By listening to and acting on these insights, we can significantly improve health outcomes for all patients, including those from socially and economically disadvantaged backgrounds.”

Nurses proposed several solutions to improve care, including improving language technology support, strengthening community resources for patients, and advancing tailored cultural competency education. This study complements a recent study conducted by the same team that emphasized the need for improving nursing resources—including nurse staffing levels and work environments—particularly in hospitals that serve socially vulnerable communities.

Co-authors from Penn Nursing include K. Jane Muir, Ph.D., MSHP, RN; Daniela Golinelli, Ph.D.; and Ann Kutney-Lee, Ph.D., RN; Lee Ang from the University of Pennsylvania Mixed Methods Lab; and Kelvin Amenyedor, MD, MPH and Shelli Feder, Ph.D., APRN, both from Yale University.