Racial Concordance of Nurses and Patients Across Hospitals

Area of Science:

• Health Equity
• Nursing Workforce Diversity
• Structural Competency in Healthcare

Background:

• A structurally competent healthcare workforce recognizes how social, economic, and political factors impact health.
• Social determinants of health and external factors contribute to health inequities.
• Evidence indicates minority patients benefit from care provided by a diverse healthcare workforce.

Purpose of the Study:

• To evaluate patient-nurse racial concordance at the hospital level.
• To analyze racial composition in a large, geographically representative sample of hospitals.

Main Methods:

• Cross-sectional descriptive study using 2015 nursing survey and 2019 Medicare patient data.
• Racial concordance calculated by subtracting hospital nurse percentage from patient percentage.
• Hospitals categorized as Black-serving hospitals (BSH) based on Black patient representation (25/50/25).

Main Results:

• Black nurses were significantly less represented than Black patients across 574 hospitals.
• Higher Black patient populations were associated with more Black nurses, but also greater discordance.
• Black nurse representation varied considerably across low, medium, and high BSH categories, with highest discordance in high BSH.

Conclusions:

• Few Black nurses are present in hospitals where Black patients predominantly receive care.
• Urgent need for healthcare institutions and policymakers to enhance structural competency and diversify nursing staff.
• Further research needed on the impact of racial concordance and workforce representativeness on health disparities.