The impact of organizational inclusion for a diverse workforce on organizational climate assessments and hospital recommendations among nurse practitioners

BACKGROUND: While the nursing profession has advocated for workforce diversity, limited research has examined how institutional inclusion efforts are associated with the experiences of nurse practitioners (NPs), particularly in hospital settings. PURPOSE: To examine whether institutional inclusion efforts were associated with NPs' strong recommendation of their hospital and whether this relationship was explained by NPs' assessments of organizational climate. METHODS: This cross-sectional study analyzed 2023 data from 742 NPs across 412 U.S. hospitals, drawing on the Penn Nurses4All Survey, the Healthcare Equality Index (HEI), and the American Hospital Association Annual Survey. The independent variable was employment in an HEI-participating hospital, and the dependent variable was NPs' strong recommendation of their hospital to family and friends. Mediating variables included NPs' assessments of organizational climate. Mediation analysis using weighting estimators was conducted to adjust for confounding and evaluate the extent to which organizational climate explained the relationship between HEI participation status and hospital recommendation. RESULTS: NPs in HEI-participating hospitals were 15% more likely to strongly recommend their hospital (95% CI: .07-.22). Significant indirect associations were observed and accounted for the total association through overall organizational climate (26.6%), professional visibility (26.6%), and NP-administration relations (20%), respectively. PRACTICE IMPLICATIONS: Hospital participation in the HEI is associated with stronger hospital recommendations among NPs, partly through more favorable assessments of organizational climate. As health care systems work to improve work environments and job outcomes for a diverse workforce, cultivating a climate of inclusion through meaningful, everyday practices will be essential.