The scale of the investigation lends considerable weight to its conclusions. The research team examined the outcomes of more than 1.17 million patients treated at 143 for-profit and 798 nonprofit adult acute care hospitals across 10 states. By drawing on such a large patient population and a substantial share of hospitals in each ownership category, the researchers were able to compare mortality, readmission, and patient experience measures across ownership types while accounting for differences in nurse staffing, the factor that emerged as a central explanation for the quality divide. The findings suggest that the ownership structure of a hospital is not merely an administrative detail but a variable with tangible consequences for the people it treats.

The mortality differences were stark. Compared with nonprofit hospitals, for-profit hospitals recorded roughly 11 additional deaths per 1,000 medical admissions and 5 additional deaths per 1,000 surgical admissions. For medical patients, differences in nurse staffing were identified as a main explanation for the higher mortality observed in for-profit settings. In other words, a meaningful portion of the excess deaths was associated not with the complexity of the patients themselves but with the conditions under which nurses were working, particularly the number of patients each nurse was assigned to care for at one time. This distinction matters because staffing levels are, unlike many drivers of surgical outcomes, directly amenable to policy and management decisions.

Readmission rates told a parallel story. Thirty-day readmissions were 2.04 percentage points higher for medical patients and 1.76 percentage points higher for surgical patients at for-profit hospitals, which translates to roughly 20 additional readmissions per 1,000 medical discharges and 18 per 1,000 surgical discharges. Differences in nurse staffing accounted for 16 percent of the readmission gap among medical patients and 30 percent of the gap among surgical patients. Readmissions are widely used as a quality indicator because they often signal that a patient left the hospital without adequate recovery support, discharge planning, or in-hospital care that fully addressed their condition. The finding that staffing explains a substantial share of these differences points to a modifiable pathway through which hospital ownership may influence patient trajectories after discharge.

Patients themselves appeared to sense the difference. Individuals treated at for-profit hospitals rated their institutions lower overall than patients at nonprofit hospitals did, and worse nurse staffing accounted for the lower overall hospital ratings. Patient ratings are not simply measures of satisfaction with amenities or food; decades of research have linked patients’ assessments of their hospital care, particularly their confidence in nursing care, to objective outcomes including mortality and readmission. That patient perceptions aligned with the hard clinical endpoints in this study strengthens the argument that the staffing shortfalls documented by nurses were visible in the everyday experience of care.

The consequences for the nursing workforce were equally concerning. Nurses in for-profit hospitals reported markedly worse staffing conditions, with 71 percent saying their assigned patient workloads were not safe. Nurse burnout was significantly higher in for-profit hospitals, and nurses working in them were far less likely to recommend their hospital to family and friends, either as a place to receive care or as a place to work, because of concerns about poorer staffing. These findings matter beyond workforce statistics. Burnout and unsafe workloads are known drivers of turnover, and turnover compounds understaffing in a self-reinforcing cycle that can degrade care quality over time. A hospital that cannot retain experienced nurses faces rising costs and mounting risks to patients simultaneously.

Lead author Matthew D. McHugh, PhD, JD, MPH, RN, FAAN, the Independence Chair for Nursing Education, Professor of Nursing, and Director of the Center for Health Outcomes and Policy Research at Penn Nursing, as well as a Senior Fellow at the Leonard Davis Institute of Health Economics, framed the implications in pointed terms. Treating safe nurse staffing as a core component of quality rather than a discretionary operating expense is especially important where incentives to cut labor costs are strongest, he said. Minimum safe staffing requirements and ownership transparency are practical safeguards for patients and nurses, he added. The statement underscores the study’s central policy argument: because labor is one of the largest controllable expenses in a hospital budget, ownership models that prioritize profit margins have both the incentive and the opportunity to trim nursing resources, and the evidence suggests that some do.

The research was conducted with co-authors Karen B. Lasater, PhD, K. Jane Muir, PhD, Trissa Lyman, MPH, Angelo Petto, BSN, and Linda H. Aiken, PhD, several of whom are fellows of both the Center for Health Outcomes and Policy Research and the Leonard Davis Institute of Health Economics. The work was supported by the National Institute of Nursing Research of the National Institutes of Health under grant award numbers R01NR014855, T32NR007104, and R01NR021707. The study, titled Patient Outcomes and Nurse Understaffing in For-Profit Hospitals, carries the DOI 10.1097/MLR.0000000000002376 and is available open access, allowing clinicians, policymakers, and the public to examine the evidence directly.

The authors conclude that policies establishing minimum safe nurse staffing requirements and enhancing hospital ownership transparency could meaningfully improve patient, nurse, and hospital outcomes. Such conclusions carry particular relevance as state legislatures across the country debate mandated nurse-to-patient ratios and as regulators scrutinize private equity investment and corporate consolidation in health care. The study suggests that investments in nursing and state policies establishing safe staffing requirements are important and actionable mechanisms to ensure patient safety, nurse retention, and quality of care for patients regardless of the ownership type of their hospital. In practical terms, this means that the quality gap documented between for-profit and nonprofit hospitals is not an inevitability of ownership structure but a consequence of resource allocation decisions that regulation could influence.

The findings also connect to a growing body of research on hospital ownership and nursing investment, including a 2025 study by Muir and colleagues published in Medical Care showing that hospital ownership type correlated with investments in nursing services using evidence from Illinois. Taken together, this line of inquiry points toward a consistent conclusion: where the profit motive is strongest, nursing resources tend to be thinnest, and patient outcomes suffer as a result. For a health system grappling with nurse shortages, rising burnout, and intensifying corporate ownership of care delivery, the study offers a clear and testable proposition. Protecting staffing levels, whether through legislation, accreditation standards, or transparency requirements that let patients see how hospitals are resourced, may be one of the most direct levers available for improving the safety of American hospital care.

Subject of Research: The relationship between hospital ownership type, nurse staffing levels, and patient outcomes in US acute care hospitals

Article Title: For-profit hospitals linked to worse patient outcomes and nurse staffing shortfalls, new Penn Nursing study finds

Article References: For-profit hospitals linked to worse patient outcomes and nurse staffing shortfalls, new Penn Nursing study finds. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: for-profit hospitals, nurse staffing, patient outcomes, mortality, readmissions, hospital ownership, nurse burnout, Penn Nursing, Medical Care, health policy, patient safety, staffing requirements

The research team, led by Katia Iglesias of the Geneva home care institution imad, interviewed twelve nurses who had originally enrolled in a randomised controlled trial designed to promote advance care planning among patients receiving early palliative care at home. That trial, launched in January 2020, was suspended almost immediately because face-to-face meetings with frail patients became impossible under public health restrictions. Rather than abandon the project entirely, the researchers pivoted, expanding their interview guide to capture the nurses’ lived experiences of practising home care during the crisis. Between November 2021 and February 2022, eleven interviews were conducted by videoconference and one in person, each lasting an average of fifty-two minutes, and all were transcribed verbatim and analysed using the five-stage descriptive phenomenological method of Giorgi and colleagues.

The participants, eleven women and one man aged between 33 and 54, brought between four and twenty-four years of professional experience to their accounts. Their neighbourhoods spanned low, medium and high socio-economic districts of Geneva, and most worked at eighty percent of full-time hours. Because all had prior exposure to training on advance directives and a communication tool called the Go Wish card game, the researchers could also examine how the pandemic shaped their engagement with end-of-life conversations, a dimension of nursing work that the crisis made simultaneously more urgent and more difficult.

The analysis identified six interrelated themes, and the first is perhaps the most visceral: confronting a changing and uncertain reality. The nurses described the first wave as an entirely novel situation devoid of clear guidelines, built on fragmentary scientific knowledge, in which directives changed so rapidly that instability became the only constant. They adopted pragmatic, adaptive postures guided by immediate needs and practical judgment while waiting for clearer instructions, yet patients looked to them for answers they could not provide. Fear emerged as the dominant emotion, taking multiple forms: fear of infection, of transmitting the virus to patients or to loved ones at home, and of making professional mistakes. As the months accumulated, sadness at the loss of spontaneity in professional relationships and anger at the crisis’s duration and mounting demands surfaced alongside it.

Institutional responses played an ambivalent role in this emotional landscape. Formalised communication through newsletters, written protocols and email instructions became a reassuring point of reference, counterbalancing the contradictory messages circulating in the media. Health measures such as mask wearing, physical distancing and the suspension of face-to-face meetings were sometimes experienced as burdensome, but they also restored a degree of predictability. The institution facilitated childcare, temporary hotel accommodation, additional days off and simplified border crossings for cross-border workers, and created specialised teams to care for COVID-positive patients. Yet access to essential protective equipment remained insufficient during the first waves, generating frustration and anxiety, and promised reinforcements often proved poorly adapted to the realities of home care, where chronic staff shortages and pandemic-related absences pushed workloads to breaking point.

To survive this prolonged strain, the nurses developed a repertoire of coping strategies. Individually, they put situations into context, relativised difficulties, filtered their media exposure and established restorative routines, from leisure activities to time in nature, sometimes achieving a form of emotional habituation that allowed them to live with the virus. Collectively, mutual support among colleagues proved to be the single most important source of resilience, particularly in the early stages. But the study documents how this fragile equilibrium eroded: health restrictions curtailed informal interaction, team meetings were suspended, and the loss of collective connection became a factor of psychological fragility, deepening the isolation inherent in working alone in patients’ homes.

The pandemic also transformed care itself. Directives from the first wave onwards reduced the number and duration of home visits, and non-urgent interventions such as hygiene care were spaced out, shortened or temporarily suspended. Nurses compensated with telephone follow-ups and by remaining physically present despite personal risk. Some found that even brief interactions acquired a more human, egalitarian quality, reflecting the shared experience of the crisis, and for socially isolated patients the nurse became the only remaining link to the outside world. Dedicated Covid home teams relieved pressure on regular staff, but raised questions about continuity of the therapeutic relationship and the boundaries of professional roles.

Perhaps the most striking finding concerns professional identity, which the crisis simultaneously strengthened and eroded. On one side, navigating successive waves fostered expertise, empowerment and unprecedented social recognition: patients turned to nurses for guidance beyond their traditional scope, and society briefly rediscovered the centrality of care. Several participants expressed pride at seeing their profession valued in its most human, relational dimension. On the other side, accounts of physical and emotional exhaustion exceeding ordinary workload, moral depletion and gradual disengagement reveal a crisis of identity, an oscillation between vocation and discouragement that the repetition of waves and chronic uncertainty only deepened.

The sixth theme, engagement with end-of-life discussions and advance care planning, proved especially revealing. For some nurses, emotional overload and shifting priorities relegated these conversations to the background, or the memory of their training simply faded amid the turbulence. For others, the pandemic acted as a catalyst: confronting fragility of life daily made discussions about wishes, values and fears more tangible and legitimate. The Go Wish card game was described as a powerful relational aid, easing the emotional weight of these exchanges, and some nurses developed confidence even without formal tools. Yet implementation was frequently interrupted by ineligible patients, language barriers, lack of time and, crucially, a gap between acquired competence and institutional authorisation: no formal recognition, no possibility of billing such interventions, and systematic delegation of these discussions to palliative care teams. Some participants even carried the reflection into their private lives, initiating conversations about end-of-life wishes with their own families, where taboos and fear of intrusiveness proved harder to overcome than in professional settings.

The authors are careful to note the study’s limitations: the retrospective design means the accounts are reconstructed narratives rather than longitudinal observations, the sample excluded nurses who had left the service, and one interviewer’s prior involvement in the training may have shaped some responses despite safeguards against social desirability bias. Still, the findings carry a clear message that extends well beyond the pandemic. Training alone is insufficient; without clear role definitions, time allocation, documentation and formal recognition, relational competencies remain underused and vulnerable to being displaced by urgent clinical demands. As ageing populations increase the complexity of community-based care, the Geneva nurses’ experience suggests that health systems must build organisational structures that recognise both the technical and the deeply human dimensions of home care nursing, before the next crisis tests them again.

Subject of Research: Lived experiences of home care nurses during the COVID-19 pandemic in Switzerland

Article Title: Lived experiences of home care nurses during the COVID-19 pandemic in Switzerland: A descriptive phenomenological study

Article References: Iglesias, K., Verga, M.-E., Baptista Peixoto Befecadu, F., Kipfer, S., Pautex, S., Busnel, C., Séchaud, L., & Jaquier, V. (2026). Lived experiences of home care nurses during the COVID-19 pandemic in Switzerland: A descriptive phenomenological study. Heliyon, 12(15), Article e45503. https://doi.org/10.1016/j.heliyon.2026.e45503

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45503

Keywords: home care nursing, COVID-19 pandemic, Switzerland, Geneva, phenomenology, qualitative research, professional identity, advance care planning, end-of-life care, nurse burnout, coping strategies, healthcare workforce

Psychiatric nursing presents a distinctive set of challenges. Patients frequently experience impaired communication, emotional dysregulation, social isolation, and stigma, and establishing a trusting therapeutic relationship can be slow and difficult. Nurses in these settings rely heavily on empathy, therapeutic communication, and emotional presence, yet the demanding nature of the work exposes them to burnout, emotional exhaustion, and reduced job satisfaction when those emotional resources run dry. Previous research has hinted that aesthetics-based care, which draws on sensory experience, creativity, and reflective practice, correlates with higher levels of compassion, but rigorous educational trials in psychiatric settings have been scarce.

To address that gap, the research team recruited 90 registered nurses from a hospital workforce of roughly 170, all of whom held a bachelor’s degree or higher, had at least six months of psychiatric experience, and consented to participate. Participants were assigned to intervention or control groups of 45 each using a lottery-based allocation. Because blinding was impossible in an educational trial, the study was designed and reported as a quasi-experiment under the TREND reporting guidelines. Data were collected between June 2024 and March 2025, and remarkably, every participant completed the full study, giving a 100 percent response rate with no missing outcome data.

The intervention itself was deliberately experiential. Two nursing faculty members specializing in psychiatric nursing and aesthetics delivered four structured weekly sessions. The first introduced the concepts and theoretical foundations of aesthetics-based nursing care, tracing its history as the art of nursing. The second explored the psychological and spiritual dimensions of care, asking nurses to consider how touch, tone of voice, gestures, and deliberate word choice shape the patient experience. The third focused on empathy, therapeutic companionship, and creativity in solving clinical problems. The fourth summarized the links between aesthetics, job satisfaction, communication, and professional motivation. Between sessions, nurses in small groups of five completed reflective assignments and shared their own lived experiences of aesthetic care.

The researchers measured outcomes using two validated instruments. The Aesthetics of Nursing Care Scale, recently validated in Iran, spans 20 items across five dimensions: compassionate commitment and competence, stress-free care, humanistic attention to the patient, patient satisfaction and comfort, and admirable commitment and competence. The Compassion Competence Scale, developed by Lee and Seomun, assesses 17 items across communication, sensitivity, and insight. Both tools showed strong internal consistency in this sample. Questionnaires were completed before the intervention and again one month after the program ended, an interval chosen specifically to test short-term retention and real-world application rather than immediate post-training enthusiasm.

The results were dramatic. The overall aesthetic care score in the intervention group rose from a baseline of 43.26 to 81.02, while the control group remained essentially flat, moving only from 43.80 to 46.24 over the same period. Every one of the five aesthetic care dimensions improved significantly in the trained group, with between-group effect sizes ranging from roughly 2.0 to 4.1 on Cohen’s d, far beyond the conventional threshold of 0.8 for a large effect. The control group showed no statistically significant change on any measure. To ensure ethical fairness, the control nurses were offered an abbreviated version of the workshop after data collection concluded.

Compassion competence followed the same pattern. Total scores climbed from 40.80 to 60.73 in the intervention group while the control group rose only from 39.35 to 40.71. Communication subscale scores increased to 25.91 versus 18.17 in controls, sensitivity scores to 19.46 versus 12.28, and insight scores to 15.35 versus 10.24. The between-group effect sizes for compassion outcomes ranged from 1.26 to 1.68, again indicating substantial educational impact. No adverse events related to the training were reported during the study period.

The authors attribute these gains to the reflective and participatory character of the program. Group discussion, scenario-based learning, and the sharing of lived clinical experiences appear to encourage nurses to examine the emotional and interpersonal texture of their work, heightening self-awareness and sensitivity to patients’ needs. This aligns with prior qualitative work showing that aesthetic experience fosters more humane, empathetic connections with patients and helps convert intuitive understanding into artistic, attentive behavior. Importantly, the study suggests that compassion competence, often treated as a fixed personal quality, can be cultivated through structured education, potentially protecting nurses against the emotional labor and burnout that accumulate in psychiatric environments.

The implications extend to nursing curricula, orientation programs, and continuing professional development. Healthcare managers and educators may find that embedding aesthetics-based education into routine staff development strengthens therapeutic relationships, improves patient experiences, and nurtures a more humanistic care culture, particularly in mental health settings where trust and communication are central to recovery.

The researchers caution that the evidence has limits. The study took place at a single hospital, follow-up lasted only one month, and all outcomes were self-reported, leaving room for social desirability bias and expectancy effects, while the absence of blinding and the possibility of a Hawthorne effect cannot be excluded. Patient-centered outcomes such as satisfaction, therapeutic alliance, and clinical recovery were not measured. Larger multicenter trials with longer follow-up, objective measures, and patient-reported endpoints are needed. Even so, the scale of improvement in this trial makes a compelling case that the art of nursing, long celebrated in theory, can be systematically taught and meaningfully improved in the clinic.

Subject of Research: Aesthetics-based educational intervention to improve compassion competence and aesthetic care quality among psychiatric nurses.

Article Title: Effects of an Aesthetics‐Based Educational Intervention on Compassion Competence and Aesthetic Care Quality Among Psychiatric Nurses: A Quasi‐Experimental Study

Article References: Balideh, D., Farokhzadian, J., Miri, S., Shahraki, S. K., & Motamed‐Jahromi, M. (2026). Effects of an Aesthetics‐Based Educational Intervention on Compassion Competence and Aesthetic Care Quality Among Psychiatric Nurses: A Quasi‐Experimental Study. Nursing Open, 13(9), Article e70854. https://doi.org/10.1002/nop2.70854

Image Credits: AI Generated

DOI: 10.1002/nop2.70854

Keywords: psychiatric nursing, compassion competence, aesthetic care, nursing education, quasi-experimental study, therapeutic communication, nurse burnout, reflective learning, mental health care, Iran, humanistic care, continuing education