A new study from the University of Pennsylvania’s School of Nursing has revealed the real-life challenges nurses face when trying to care for patients from disadvantaged backgrounds.
The research, published in JAMA Network Open, offers firsthand insights from more than 1,000 hospital nurses in New York and Illinois—and highlights how deep-rooted problems in hospitals may be standing in the way of fair, high-quality care.
The nurses surveyed work directly with patients and shared their thoughts in open-ended responses.
Their experiences pointed to six main issues that make it hard to deliver the best care to patients who are socially or economically disadvantaged.
One of the biggest concerns was that hospitals often seem to put profits ahead of patients.
Nurses felt that decisions were frequently based on money rather than what’s best for patients, especially for those who already face barriers in the healthcare system.
Another major issue was staffing. Many nurses said they were stretched too thin, with not enough time or colleagues to provide the kind of care they know patients need.
Language barriers also stood out. Patients with limited English skills often struggle to understand their care, and nurses stressed the need for better technology and more in-person interpreters to help bridge the communication gap.
Other challenges involved the broader lives of patients. Factors like low health literacy, a lack of family support, and mistrust in the healthcare system can all make it harder for patients to get and follow through with care.
Nurses also recognized that their own personal experiences, cultural backgrounds, and unconscious biases can influence how they deliver care—highlighting the importance of cultural competency and a more diverse nursing workforce.
Dr. J. Margo Brooks Carthon, the study’s lead author, emphasized how important it is to listen to nurses. “They are on the frontlines every day and have a clear view of what patients need—and what’s missing,” she said. “To truly improve outcomes, hospitals must focus on patients, invest in more staff, connect better with local communities, and make sure nurses are trained to understand and respect cultural differences.”
The nurses didn’t just point out problems—they also offered solutions. These included better language support, stronger community partnerships to help patients access resources after discharge, and more training on how to provide culturally sensitive care.
This study adds to previous research by the same team showing that hospitals serving vulnerable communities need better nurse staffing and work environments.
By listening to nurses and acting on their recommendations, hospitals can take real steps toward making healthcare fairer and more effective for everyone.
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