LGBTQ+ Inclusive Policies, Nurse Job Outcomes, and Quality of Care in Hospitals.

Importance: Despite emphasis on the establishment of inclusive hospital policies, the impact of these policies on employees and organizations remains unknown. Objective: To evaluate the association between inclusive policies for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender minority (LGBTQ+) and nurse job outcomes as well as nurse-reported quality of care. Design, Setting, and Participants: This cross-sectional study analyzed 4 survey datasets from 2021: the RN4CAST-NY/IL, including registered nurses from New York and Illinois, and the Healthcare Equality Index (HEI) data. The HEI evaluates and scores US health care facilities that voluntarily participate based on their LGBTQ+ inclusivity in policies, such as nondiscrimination policies and LGBTQ+ inclusive clinical services. The study used American Hospital Association Annual Survey data for hospital characteristics and Magnet organization data to classify hospitals by Magnet status. Data analyses were performed in December 2024. Main Outcomes and Measures: Nurse job outcomes included burnout and job dissatisfaction. Quality of care outcomes included nurses' perceptions of care quality and their likelihood of recommending their hospital. The independent variable was LGBTQ+ Healthcare Equality Leader (HEI Leader) status, which signified hospitals with the highest levels of LGBTQ+ inclusion. Multilevel logistic regression models included nurse-level (age, race and ethnicity, gender, and years of experience at the current hospital) and hospital-level (Magnet status, size, teaching status, specialized service capability, and ownership) covariates. Results: A total of 7343 nurses (mean [SD] age, 44.9 [13.4] years; 6584 [89.6%] women) from 111 hospitals were included in the study. Nurses in hospitals with HEI Leader status had lower odds of high burnout (adjusted odds ratio [AOR], 0.69; 95% CI, 0.52-0.92) and lower odds of job dissatisfaction (AOR, 0.62; 95% CI, 0.45-0.86) compared with those in hospitals without the status. They also had higher odds of reporting excellent or good quality of care (AOR, 1.83; 95% CI, 1.23-2.73) and higher odds of recommending their hospital (AOR, 1.72; 95% CI, 1.19-2.50). Conclusions and Relevance: In this cross-sectional study, nurses in hospitals with high LGBTQ+ inclusion reported more favorable job outcomes and care quality. Hospitals should understand that implementing LGBTQ+ inclusive policies goes beyond compliance or diversity; it is essential for improving the work climate, enhancing staff well-being, and optimizing care delivery.