6 ways to drive more equitable care, per nurses

When surveyed, nurses consistently identified six areas where hospitals could improve equitable patient care quality for disadvantaged patients.

The study, conducted between April and June 2021 by Philadelphia-based University of Pennsylvania and published in JAMA Network Open, used the RN4CAST-NY/IL survey, which included responses from 1,084 registered nurses who worked in 58 New York and Illinois hospitals. The mean experience of nurses was 18.9 years. Of the hospitals, 25 were identified as high-performing and 33 were low-performing for COVID-19 mortality outcomes in 2021. 

Nurses were asked open-ended questions about how to improve equitable care delivery for socially disadvantaged populations. Here were the six most commonly discussed solutions:

1. Profits over patients: Nurses said financial incentives often diverged from patient-centered care. 

2. Care continuity and hospital-community partnerships: Nurses said social workers play a critical role in connecting patients to community resources. 

3. Technology to address language barriers: Access to technology, including interpreter services and language assistance equipment, facilitated high-quality care and reduced barriers. 

4. Addressing staffing and time constraints: Inadequate staffing was the most common barrier to good care and resulted in high workloads that burdened nurses. 

5. Minding patientsl determinants of health: Patient characteristics, including health knowledge, family support and individual demographics, affected quality of care. There can also be a lack of trust among disadvantaged patients based on past experiences in the healthcare system, nurses said. 

6. Accounting for individual nurses’ personal beliefs and backgrounds: Biases among nurses can hinder care, but a more diverse workforce that reflects patient populations can improve quality. 

Overall, nurses proposed improving healthcare workforce diversity, strengthening community resources and advancing tailored cultural competency education to improve care.