Hospital Ownership Type Correlated With Investments in Nursing Services

BACKGROUND: The association between hospital ownership type and patient care quality has garnered increased public attention. OBJECTIVES: To describe differences in investments in nursing services, care quality and safety, and nurse job outcomes among for-profit and not-for-profit hospitals in Illinois. RESEARCH DESIGN: Cross-sectional, descriptive case study of hospital nursing services, patient care quality and safety outcomes, and nurse job outcomes in 113 hospitals in Illinois in 2021. Three datasets were linked through a common identifier: RN4CAST-IL nurse survey, National Academy for State Health Policy (NASHP) cost data, American Hospital Association (AHA) Annual Hospital Survey. MEASURES: Nursing services included patient-to-nurse staffing ratios and the quality of the nurse work environment. Nurse job outcomes included burnout, job dissatisfaction, and intent to leave. RESULTS: For-profits had statistically significantly lower investments in nursing services, worse nurse job outcomes, and poorer patient care quality and safety outcomes relative to not-for-profit hospitals, despite having no statistically significant differences in operating margins. For-profit hospitals had poorer nurse work environments (mean score 2.5 vs. 2.9, P<.001) and worse staffing ratios (6.8 vs. 4.7 patients per nurse, P<0.01), higher percentages of nurses intending to leave their employer (36.2% vs. 22.8%, P<.01), higher job dissatisfaction (37.9% vs. 23.4%, P<.01), higher burnout (63.8% vs. 46.2%, P<.05), and worse quality and safety (e.g., poor patient safety grades 53.6% vs. 33.8%, P<.01). CONCLUSIONS: Investments in nursing services as well as quality and safety of patient care in for-profit hospitals are worse than in not-for-profit hospitals, despite having no significant differences in operating margins.