What nurses need to address SDOH, treat vulnerable patients

Support safe nurse staffing ratios, staff teamwork

Perhaps most notable were the nurses' calls for safer nurse staffing ratios.

These calls are backed by the evidence, with numerous studies citing the adverse consequences of poor nurse staffing ratios. When there are not enough nurses to meet patient demand, care quality and patient safety suffer.

Some states are starting to mandate safe nurse staffing ratios, the researchers noted. But in addition to safer nurse staffing ratios, survey respondents urged an overall better working environment for nurses.

"Nurses across hospitals described how limited resources in their work environment contribute to suboptimal outcomes for patients with substantial social needs, which is supported by over 15 years of evidence," the researchers said.

Having enough resources certainly entails adequate staffing, but it also includes nurse-physician collegiality, nurse autonomy, nurse integration in hospital decisions and having an overall organizational foundation for quality care.

Promote more cultural competence training

In addition to having enough staff to meet patient demand, nurses flagged more robust cultural competence training as a key enabler for treating socially disadvantaged patients.

More specifically, nurses stated that trainings emphasizing the effect implicit bias has on healthcare providers and the experiences of patients from traditionally minoritized groups will be essential to understanding how best to deliver high-quality care to all patients.

"Although most hospitals require sensitivity training, such modalities are often one-time, virtual offerings," the researchers pointed out. "The responses of nurses in our study demonstrate that on-going continuing education about a wider range of patient populations is desired."

Provide staff resources to address SDOH

Nurses from healthcare organizations with strong community health partnerships, which are a key aspect of a comprehensive SDOH strategy, reported that partnerships were beneficial. As nurses struggle to provide high-quality care to individuals who need post-hospital attention, SDOH interventions will be key, they said.

"Nurses also outlined the need for hospitals to develop, expand, and promote programs that address the social determinants of health, such as legal services, housing support, food packages, and resources for those experiencing interpersonal violence," the researchers reported.

Invest in language services, communication accessibility

One of the biggest barriers reported by nurse respondents was in relation to language services and access to interpreters.

Indeed, separate studies have documented the barriers LEP patients face in accessing high-quality care. When patients can't have meaningful conversations with their healthcare providers, engagement in care suffers.

Ensuring adequate language and interpreter services is important, nurses told the researchers, but access must go beyond LEP patients.

"Nurses recommended reliable and high-quality language access services and equipment to provide equitable communication to individuals with language needs, such as those with limited English proficiency, elderly individuals, and individuals with auditory and visual impairment," they said.

Making changes that support nurses in direct patient care is essential, as most experts agree that nurses are among those with the most facetime with patients. By providing key resources, ensuring safe nurse staffing ratios and supporting more cultural responsiveness among clinical staff are key first steps to improving care for socially disadvantaged patients.

Sara Heath has reported news related to patient engagement and health equity since 2015.