476 Associations between hospital mergers and hospital level nursing factors, nurse well-being, and nurse-sensitive patient safety and quality of care outcomes: A scoping review

Background: Hospital mergers have proliferated across the U.S., yet a comprehensive understanding of how mergers affect nurses' well-being and their ability to provide safe, high-quality care is lacking. Objective: Determine the known associations between U.S. hospital mergers and hospital-level factors that influence nursing, nurse well-being, and nurse-sensitive patient safety and quality-of-care outcomes. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines, we conducted a scoping review by systematically searching 10 databases comprised of business and healthcare literature up to January 2025. Two reviewers independently screened articles and extracted data to focus on empirical research that examined hospital mergers and nursing. Results: Our search yielded 1,772 articles; 10 met our inclusion criteria and were included in the analysis: 5 quantitative, 3 qualitative, 2 multi-methods. Only 3 studies analyzed data from 2003 or later: the most recent 2017. Although the data were sparse and older, we found that hospital mergers introduced organizational changes among the nursing workforce-nurse staffing, leadership, and operations. Whether nurse-sensitive patient safety and quality of care outcomes improved post-merger was equivocal. Qualitatively, nurses described poor communication, a perceived lack of trust in leadership, a loss of identity and unity, decreased morale, increased fear or uncertainty, and issues with equal and/or respectful treatment. Employed study methods and designs lacked the ability to draw strong causal and/or detailed conclusions. The dearth of recent studies may limit relevance to newly emerging issues in today's healthcare system. Conclusion: Our findings suggest that hospital mergers may impact nurses and the nursing workforce in several ways. As hospital mergers continue to increase, future research with rigorous methods and recent data is imperative to develop timely and applicable policy to mitigate the potential harms associated with hospital mergers and leverage their potential benefits for nurses and patients.