Associations Between Hospital Mergers and Hospital-Level Nursing Factors, Nurse Well-Being, and Nurse-Sensitive Patient Safety and Quality-of-Care Outcomes

Background: Hospital mergers have proliferated across the United States, yet a comprehensive understanding of how mergers affect nurses’ and patients is lacking. Objective: Determine the known associations between US hospital mergers and hospital-level factors that influence nursing, nurse well-being, and nurse-sensitive patient safety and quality-of-care outcomes. Research Design: A scoping review of systematically searching 10 databases comprised of business and health care literature up to January 2025. Results: We found 1775 articles; 10 met our inclusion criteria and were included in the analysis: 5 quantitative, 3 qualitative, 2 multimethods. Only 3 studies analyzed data from 2003 or later. Although data were sparse and older, we found that hospital mergers introduced organizational changes in nursing—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, as well as a dearth of recent studies, influenced the ability to draw strong causal and/or detailed conclusions, especially about newly emerging issues in today’s health care system. Conclusions: Our findings suggest that hospital mergers may impact nurses and the nursing workforce. As hospital mergers continue to increase, future research with recent data and rigorous methods is needed to develop timely and applicable policy to mitigate any potential harms and leverage potential benefits of hospital mergers for nurses and patients.