Objectives/Goals: Hospital mergers have proliferated in the USA, yet a comprehensive understanding of how mergers affect nurses’ well-being and their ability to provide safe, high-quality care is lacking. We examined the associations among hospital mergers, nursing, nurse well-being, and patient safety and quality of care to guide policy or hospital interventions. Methods/Study Population: 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 both business and healthcare literature up to January 2025. Eligible studies met the following inclusion criteria: (1) US-based sample, (2) specify a hospital merger and one nursing-related criteria, (3) use empirical data, (4) peer-reviewed, and (5) in English. Conference abstracts, protocols, interventions, non-empirical studies, theses or dissertations, quality improvement, and systematic review articles were excluded. Two reviewers independently screened articles and extracted data to focus on empirical research that examined hospital mergers and nursing. Results/Anticipated Results: Our search yielded 1,772 articles; 10 met our inclusion criteria and were included in the analysis: 5 quantitative, 3 qualitative, and 2 multi-methods. Only three studies analyzed data from 2003 or later. Although the data were sparse and older, we found that hospital mergers introduced organizational changes among the nursing workforce – nurse staffing, leadership, and operations. Nurse-sensitive patient safety and quality of care outcomes may not improve post-merger. 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. The identified study methods were unable to draw strong causal and/or detailed conclusions, and few variables were examined. Discussion/Significance of Impact: This review highlights potential links between US hospital mergers and nursing, nurse well-being, and patient safety and quality of care and emphasizes the lack of robust, up-to-date studies to guide policymakers and hospital administrators in making informed decisions – potentially leading to negative consequences.

This article examines the trust hypothesis: the claim that asymmetric information can explain the existence of non-profit enterprise in certain markets. We argue that this hypothesis, in order to be viable, has to meet three challenges: ‘reputational ubiquity’, ‘incentive compatibility’ and ‘adulteration’. Drawing on modern agency theory, we conclude that the trust hypothesis stands on shaky ground. It can be sustained only under particular conditions that have been neither carefully described in theory nor subject to empirical assessment. The available evidence, patchy and inadequate as it is, seems to suggests that there are some ownership-related differences in aspects of organisational performance connected with asymmetric information. However, there is little evidence that this relates to trust per se or provides a rationale for the existence of non-profit ownership in these industries. We conclude with a plea for substantial research on consumer expectations and provider motivations.

Even before the sharp downturn that began in 2007, many Americans were concerned about economic risks. Yet this widespread public concern has not been matched by attention from political scientists regarding how citizens experience and understand the economic risks they face or how those experiences and understandings shape their views of public policy. We develop here an argument about the role of personal economic experiences in the formation of policy attitudes that we validate using a distinctive opinion survey of our own design, fielded not long after the onset of the Great Recession. The survey tracks citizens' economic experiences, expectations, and policy attitudes within multiple domains of risk (employment, medical care, family, and wealth arrangements). These investigations show that economic insecurity systematically and substantially affects citizens' attitudes toward government's role. Citizens' economic worries largely track exposure to substantial economic shocks. Citizens' policy attitudes in turn appear highly responsive to economic worries, as well as to the experience of economic shocks—with worries and shocks creating greater support for government policies that buffer the relevant economic risk. Attitudes seem most affected by temporally proximate shocks, shocks befalling households that have weak private safety nets, and shocks occurring within the domain most relevant to the policy in question, though attitudes are also (more weakly) correlated with shocks in other domains. The magnitude of these associations rivals partisanship and ideology and almost always exceeds that for conventional measures of socio-economic status. Given the long-term increase in economic insecurity and current sluggish recovery, understanding how insecurity shapes citizens' policy attitudes and political behavior should be a major concern of political science.

Popular support for the welfare state varies greatly across nations and policy domains. We argue that these variations—vital to understanding the politics of the welfare state—reflect in part the degree to which economic disadvantage (low income) and economic insecurity (high risk) are correlated. When the disadvantaged and insecure are mostly one and the same, the base of popular support for the welfare state is narrow. When the disadvantaged and insecure represent two distinct groups, popular support is broader and opinion less polarized. We test these predictions both across nations within a single policy area (unemployment insurance) and across policy domains within a single polity (the United States, using a new survey). Results are consistent with our predictions and are robust to myriad controls and specifications. When disadvantage and insecurity are more correlated, the welfare state is more contested.

In this commentary I explore several ways in which the psychology of individual decision-making shapes consumers’ choices in medical settings and the potential for choice-based policies to improve the performance of the health care system. This analysis draws some crucial distinctions among the various pathways though which policymakers expect choice to improve outcomes and the various forms of support that might enhance patients’ engagement with choice. I also consider how choice-promoting policies interact with other strategies for patient empowerment and depend crucially on the ways in which individual patients develop the capacity to make sense of their experiences with medical care. Drawing largely on data and studies from medical consumerism in the US, I identify a number of choice ‘pathologies’ that might compromise the influence or beneficial effects of choice-promoting initiatives. Though these limitations are unlikely to turn public officials away from their consumerist policy aspirations, identifying the realistic limitations of such initiatives makes clear the need to complement them with other strategies for enhancing patients’ well being and encouraging a more responsive health care system.

This paper clarifies the theoretical bases for expecting women to be more supportive of government programs than are men. We identify several factors not developed in past literature: (1) differences in emotional responses to social problems, (2) gendered differences in the awareness of those problems among one's own kin, (3) differences in the perceived fairness of existing social institutions, (4) differences in the perceived efficacy of government programs, and (5) variations in the preferred form that those programs should take. Testing hypotheses using data from a 1995 survey of public opinion covering five policy domains, we find that the gender gap in these domains is substantial, comparable to that associated with race and partisanship. These differences are attributable in part to factors identified previously in the literature—such as gendered differences in perceived opportunity—but are also affected by differences between men and women in the perceived efficacy of government programs (e.g., the extent of fraud and abuse) and differences in the preferred form those programs should take.

The apparent ability of the American public to form coherent assessments of policy options—while being largely ignorant of political institutions, actors, and ideology—remains a persistent puzzle for political science. We develop a theory of political decision making that helps resolve this puzzle. We postulate that both the public and political elites comprehend complex policies in part through “reasoning by policy metaphor,” which involves comparisons between proposed alternative policies and more readily understood social institutions. Using data from 169 intensive interviews, we test claims about metaphorical reasoning for a particularly complex policy domain: health care reform. We demonstrate that our hypothesized policy metaphors are coherent to both elites and the general public, including the least sophisticated members of the public. We further show that elites and the public share a common understanding of the relevant policy metaphors, that metaphorical reasoning differs from other forms of analogic reasoning, and that metaphorical cognition is distinct from ideological orientation.