Sociotechnical Needs of Registered Nurses in the Heart Failure Hospitalizations of African American Patients: Cross-Sectional Study

The African American population is disproportionately impacted by congestive heart failure (CHF). The impact includes a hospitalization rate that is 2.5 times higher and a hospital stay that is, on average, a quarter of a day longer compared with Caucasians. Notably, nursing care has been associated with nearly a 30% decrease in hospitalizations and readmissions. Previous studies have demonstrated that registered nurses (RNs), working in conjunction with electronic health record systems to conduct care tasks, may optimize length of stay in African Americans with CHF.

This study aimed to identify the needs of RNs who performed sociotechnical tasks, the perceived importance of these sociotechnical tasks, and the perceived performance of these tasks by RNs, in relation to the length of stay of their African American patients with CHF.

The study used an observational, cross-sectional survey design in RNs who were randomly selected from a total population of 3498 RNs who provided care to 22,703 African American patients with CHF within 113,543 heart failure hospitalizations between January 1, 2015, and January 1, 2024. The RNs were retrospectively stratified into 2 groups based on EHR data: those whose African American patients had a mean length of stay of 10 days or less (Group A) and those whose mean length of stay was greater than 10 days (Group B). Descriptive statistics, Cohen d, and a 2-sided unpaired t test were used to analyze the data.

The total sample of 200 RNs responded to the survey (100% survey completion rate). Group A (100 RNs) reported the least important task as drawing conclusions about how to use the EHR to care for African American patients (mean 4.66, SD 1.82). The least important task in Group B (100 RNs) was reading published research on African American patients (mean 4.88, SD 1.70). Group A reported performing best in caring for African American patients (mean 5.61, SD 1.44). Group B reported performing best at caring for all patients (mean 5.86, SD 1.04). A total of 17 significant sociotechnical needs were identified among groups. In total, 2 sociotechnical needs were unique to group B: caring for patients (ie, the full scope of social and technological processes in nursing care; Cohen d=0.32, 95% CI 0.04-0.59; P=.04) and working with information related to a patient's CHF in the EHR (eg, laboratory results, discharge summaries, or radiographic images) to care for the patient (Cohen d=0.33, 95% CI 0.05-0.61; P=.03).

Lengths of patient stay may be reduced by identifying and addressing sociotechnical needs through targeted training, nursing care interventions, and RN-led risk stratification guidelines for working with EHRs to reduce lengths of stay in those who are disproportionately impacted by CHF.