Penn Nursing study finds link between nurse work environment quality and COVID-19 mortality disparities

PHILADELPHIA (October 7, 2024) – A new Penn Nursing Center for Health Outcomes and Policy Research (CHOPR) study – published in INQUIRY – has found a strong association between the quality of the nurse work environment and COVID-19 mortality rates among socially vulnerable Medicare beneficiaries. The study examined data from 238 acute care hospitals across New York and Illinois.

The researchers found that patients from socially vulnerable communities, including those facing higher levels of poverty, housing insecurity, and limited transportation, were more likely to die from COVID-19 if they were hospitalized in hospitals with poor nurse work environments. Conversely, patients from these communities were less likely to die from COVID-19 if they were hospitalized in hospitals with high-quality nurse work environments.

"Our findings suggest that the quality of the nurse work environment is a critical factor in determining outcomes for socially vulnerable patients with COVID-19," said lead-author J. Margo Brooks Carthon, PhD, RN, FAAN, the Tyson Family Endowed Term Chair for Gerontological Research; Professor of Nursing in the Department of Family and Community Health; and Associate Director of CHOPR. "By investing in nursing resources and improving the nurse work environment, hospitals can help to reduce health disparities and save lives."

The study analyzed data from Medicare claims, American Hospital Association Annual Survey data, and the Social Vulnerability Index (SVI). The researchers found that patients in the highest quartile of social vulnerability were more likely to die from COVID-19 than those in the lowest quartile. However, this disparity was narrowed when patients from the most socially vulnerable communities were cared for in hospitals with high-quality nurse work environments.

"Our findings suggest that hundreds of COVID-19 related deaths among the most socially vulnerable patients may have been avoided if all hospitals had a high-quality nurse work environment," said Brooks Carthon. "Strengthening the quality of nurse work environments may help to reduce health disparities and should be considered in public health emergency planning, specifically in hospitals serving socially vulnerable communities."  

The study highlights the importance of investing in nursing resources and improving the nurse work environment to ensure equitable access to high-quality care for all patients, especially those from socially vulnerable communities.

This research was funded by grants from the National Institutes of Nursing Research (R01NR020471; R01NR014855; T32NR007104), the Agency for Healthcare Research and Quality (R01HS028978), and the National Council of State Boards of Nursing. Co-authors include: K. Jane Muir, PhD, FNP-BC; Christin Iroegbu, PhD, RN; Christine Langston, RN, BSN; Kelvin Amenyedor, MD, MS; Jacqueline Nikpour, PhD, RN; Karen B. Lasater, PhD, RN, FAAN; Matthew D. McHugh, PhD, JD, MPH, RN, FAAN (all from Penn Nursing) and Ann Kutney-Lee, PhD, RN, FAAN (Penn Nursing and Corporal Michael J. Crescenz VA Medical Center).

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