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Including Nursing System Factors to Address Health Disparities: A Conceptual Framework.

Eileen T Lake¹, Celsea C Tibbitt¹, Christin Iroegbu¹

¹University of Pennsylvania School of Nursing, Philadelphia, USA.

Inquiry : a Journal of Medical Care Organization, Provision and Financing

|September 16, 2025

Summary

Nursing system factors, like staffing and work environment, significantly impact patient health equity. Addressing these nursing elements is crucial for reducing healthcare disparities and improving outcomes, especially for vulnerable groups.

Keywords:

health equity health inequities health outcomes nurses policy workforce working conditions

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Area of Science:

Nursing Science
Health Services Research
Health Equity

Background:

Evidence links nursing care to patient outcome disparities in acute care settings.
Existing health inequity frameworks often overlook critical nursing system factors.
Nursing factors such as staffing and work environment are not adequately addressed in current health disparity models.

Purpose of the Study:

To propose a novel framework identifying nursing system factors as contributors to health inequities.
To distinguish this framework from those focusing solely on individual or social determinants of health.
To emphasize the role of nursing in shaping equitable patient outcomes.

Main Methods:

Literature review of authoritative reports on healthcare disparities.
Adaptation of Kilbourne et al.'s framework to incorporate nursing system factors.
Analysis of existing evidence linking nurse staffing and work environment to patient outcomes.

Main Results:

Hospitals with better nurse staffing and work environments show lower mortality and complication rates, particularly for vulnerable populations.
Nursing factors demonstrate variation across hospitals and correlate with patient demographics and outcomes.
Nursing system factors, including staffing and work environment, are integral to patient-nurse clinical encounters.

Conclusions:

Nursing system factors significantly contribute to disparities in patient outcomes.
Health disparity frameworks must centralize nursing's role in promoting equitable care.
Policymakers and administrators should integrate nursing elements into equity performance measures and incentivize them.