Hospital Ownership Type Correlated With Investments in Nursing Services: Evidence From Illinois

The association between hospital ownership type and patient care quality has garnered increased public attention.

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.

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.

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.

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).

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.