Mixed signals: an analysis of diversity value signaling in leading U.S. hospitals

Abstract

Background: As the United States (U.S.) population continues to diversify, the recruitment and retention of a diverse and culturally competent nursing workforce is paramount to delivering high quality care. To meet this challenge, organizations may use diversity value signaling (DVS) in recruitment materials. DVS, defined as the use of inclusive language and terms in organizational communication, is an extension of Signaling Theory which suggests that the content in a job description provides both instrumental and symbolic signaling of the organization's values, goals, and expectations. The purpose of this study is to examine the prevalence of DVS in leading U.S. hospitals and to explore whether there is a relationship between DVS and performance. Methods: A purposive sample of hospitals from the 2021-2022 U.S. News Best Hospitals rankings was examined for the use of DVS content in nursing job advertisements from leading U.S. hospitals (n=100) to investigate the prevalence of DVS in leading hospitals and to explore the relationship between DVS and hospital performance. Results: Hospitals with DVS are ranked higher than hospitals that rely on compliance-based statements or no signaling at all. In addition, hospitals with no DVS have the lowest average patient experience. Among the hospitals without DVS, hospitals with compliance-based statements have a lower rank than those with nothing at all. Conclusions: This paper serves as a call for further research to examine diversity as a value in job recruitment and how DVS is related to nurse staffing and patient outcomes.