Health equity efforts must pay particular attention to the socially disadvantaged. Their needs come into sharper focus during hospital stays. How do we ensure that these often complex patients are well treated? As providers who spend the most time with patients, nurses can offer key insight into treating this vulnerable population.

In a new qualitative study, LDI Senior Fellows J. Margo Brooks Carthon, K. Jane Muir, Daniela Golinelli, and colleagues analyzed responses from more than 1,000 hospital nurses outlining barriers and facilitators to caring for disadvantaged patients. Surveyed nurses came from hospitals categorized as either high-performing or low-performing based on average mortality rate. Some of their comments are included below.

Here are six factors that nurses say help or hinder quality care to disadvantaged populations:

1. Profits over Patients

Nurses described how financial incentives often diverge from patient-centered care. Some criticized hospital administrators, managers, and the overall health system for encouraging this behavior: “The organization philosophy seems to promote earning and saving money over staff and patient safety and well-being.”

2. Care Continuity and Hospital-Community Partnerships

Nurses emphasized the critical role social workers play in connecting patients with community resources. “A lot of our patients are homeless and/or unfunded. They get great care, and our social workers are excellent at finding them placement.”

3. Technology to Address Language Barriers

Nurses identified language access technology, such as interpreter services and language assistance equipment, as a facilitator of high-quality care. Such technology helps address limited English proficiency and similar barriers: “The video language system has helped with language barriers in this time of limited visitor assistance.”

4. Insufficient Staffing and Time Constraints

Nurses cited inadequate staffing as the most common barrier to good care. Staff shortages result in high workloads that burden nurses: “[We are] stretched so thin due to inadequate staffing that we do not have enough time to determine what patient’s needs are and care for them based on their needs other than medical.”

5. Patients’ Determinants of Health

Nurses described how patient characteristics—such as health knowledge, family support, or individual demographics—affect the quality of care: “Patients are often under- or misinformed when it comes to their care. This further hinders the care they need in the hospital setting.” Some also identified a lack of trust among disadvantaged patients because of past experiences with the healthcare system.

6. Individual Nurses’ Beliefs and Backgrounds

Nurses acknowledged the influence of their personal beliefs and experiences in caring for disadvantaged patients. Biases among nurses and other staff can hinder care, while a more diverse workforce that reflects patient populations can improve quality: “You can’t take great care of vulnerable populations when you don’t recognize the homogeneity of your own team.”

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The study, “Hospital Nurse Perspectives on Barriers and Facilitators to Caring for Socially Disadvantaged Patients,” was published on June 6, 2025 in JAMA Network Open. Authors include J. Margo Brooks Carthon, K. Jane Muir, Lee Ang, Kelvin Amenyedor, Daniela Golinelli, Shelli Feder, and Ann Kutney-Lee.

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