About

Dr. Deena Kelly Costa is the Helen Porter Jayne & Martha Prosser Jayne Associate Professor of Nursing at Yale School of Nursing, with a secondary appointment in the Section of Pulmonary, Critical Care & Sleep Medicine at Yale School of Medicine. She is a trained health services researcher with nearly a decade of clinical expertise in adult critical care nursing. Her research uniquely focuses on healthcare workforce research that includes all members of the interprofessional team, such as nurses, physicians, and others, aiming to optimize the organization and management of healthcare to support clinicians and improve patient care. Dr. Costa's work emphasizes the nursing workforce and critical care teams, with a dedication to creating environments that enable clinicians to deliver high-quality care. Her research incorporates both quantitative and qualitative methods to examine ICU interprofessional teams, patient outcomes, and strategies to support patients, families, and clinician well-being. She has been recognized with several awards and honors, including induction as a Fellow in the American Academy of Nursing and awards from the American Thoracic Society and the Midwest Nursing Research Society. Dr. Costa has contributed to policy advising, notably serving as an advisor for Michigan's governor during the COVID-19 pandemic to inform scope of practice laws for nurses. Her academic background includes a Master’s and PhD in nursing outcomes research from the University of Pennsylvania and a post-doctoral fellowship in critical care medicine at the University of Pittsburgh. She has also earned a Bachelor's degree in Italian Studies from Boston University and a BSN from Binghamton University.

Research topics

• Chromatography
• Chemistry
• Acoustics
• Anesthesia
• Surgery
• Medicine
• Mechanics
• Physics

Selected publications

• “I feel abandoned by nursing and not accepted by medicine”: Factors undermining a healthy work environment for hospital-based nurse practitioners in the United States

  Journal of the American Association of Nurse Practitioners · 2026-01-07 · 1 citations

  article

  BACKGROUND: Nurse practitioners (NPs) are a rapidly growing segment of the US health care workforce and are increasingly integral to patient care in hospital settings. Despite their expanding roles, little is known about the work environment factors that affect their well-being in hospital settings. PURPOSE: To examine the factors that influence hospital-based NPs' work environments and identify strategies to enhance their well-being and support retention. METHODOLOGY: This qualitative descriptive study used directed content analysis to examine responses from 493 NPs across 264 hospitals in 10 US states with varying scope-of-practice laws to three open-text survey questions regarding their workplace experiences and work environment, drawn from the 2024 Penn Nurses4All Study. To identify factors influencing healthy work environments, themes were developed using both inductive and deductive analytic approaches, guided by the American Association of Critical-Care Nurses' Healthy Work Environment (HWE) framework. RESULTS: Six emergent themes related to factors that influence NPs' work environments included the following: (1) structural barriers to effective communication; (2) workplace incivility and lack of inclusion; (3) limited clinical autonomy and organizational influence; (4) misalignment between NP roles and staffing demands; (5) invisibility and devaluation of NP contributions; and (6) leadership gaps in supporting NP practice and well-being. CONCLUSIONS: Hospital-based NPs face unique barriers to a HWE that affect their well-being and hinder optimal practice. IMPLICATIONS: Implementing NP-informed strategies can foster supportive work environments that enhance NP well-being, retention, and the quality of patient care.

  PublisherDOI

• Organizational Resilience in Critical Care Nursing: Perspectives from a Large National Health System

  SSRN Electronic Journal · 2026-01-01

  preprintOpen accessSenior author
  PublisherDOI

• Associations Between Specialty Registered Nurse Certification and Patient Outcomes: A Nurse–Patient Level Analysis

  SSRN Electronic Journal · 2026-01-01

  preprintOpen access
  PublisherDOI

• Nursing Workforce Characteristics and Their Impact on Intensive Care Unit Interprofessional Team Collaboration

  Military Medicine · 2025-08-23

  articleSenior author

  INTRODUCTION: Nursing workforce characteristics, such as staffing and specialized training, are integral to the delivery of high-quality patient care in the intensive care unit (ICU). Nurse staffing is defined as the number of nurses per patient but also skill-mix (combination of registered nurses and other nursing support staff) and expertise of available nurses for the specific patient population each shift. When nurse staffing is suboptimal the risk of adverse patient outcomes and patient mortality increases. In addition, existing research has established the importance of staffing ICUs with interprofessional teams-registered nurses (RNs), physicians, and respiratory therapists (RTs). Yet, shifting characteristics of the nursing workforce- such high turnover and a more novice workforce- are still under studied and may impact the interprofessional team and its ability to collaborate effectively. MATERIALS AND METHODS: This study is an analysis of previously collected qualitative data from 9 ICUs within a single academic medical system in the US. Participants (RNs, physicians, RTs, and other ICU providers) working in study ICUs across 4 hospitals were purposively sampled and interviewed individually. Thematic analysis was used to analyze interview transcripts; 2 researchers coded each transcript independently. Consensus on any coding disagreement was reached through discussions at research team meetings. Once all data was coded, the team iteratively reviewed the data and codes and generated themes that focused on the primary research question of this analysis: how nursing workforce characteristics influence the interprofessional team. RESULTS: Our final sample included RNs (n = 11), RTs (n = 4), physicians (n = 4), and a dietician (n = 1). Three interconnected themes were identified in the analysis: (1) The effects of a transition to a more novice nursing workforce in ICUs extends beyond nurse staffing to the interprofessional team and their ability to provide care; (2) Staffing decisions do not incorporate interprofessional team needs, leading to decreased collaboration and disruptions in patient care; and (3) Adequate nurse staffing and additional support can balance increased burden on the interprofessional team. These themes highlight how nurse workforce characteristics can influence the interprofessional team in adult ICUs in a post-COVID era. CONCLUSIONS: Characteristics of the nursing workforce, such as nurse experience and expertise, have downstream effects on interprofessional team members and their ability to deliver care in the ICU. A multi-pronged approach, which includes adequate support staff for nursing, increased retention of experienced ICU nurses, and improving communication across professions, is vital to improve interprofessional team collaboration and allow ICU teams to provide the best care possible to their patients.

  PublisherDOI

• Organizational Resilience in Healthcare: A Scoping Review

  Journal of Healthcare Management · 2025-05-01 · 6 citations

  reviewOpen accessSenior author

  GOAL: Healthcare organizations have always faced challenges, yet the past decade has been particularly difficult due to workforce shortages, the COVID-19 pandemic, and economic demands, all of which can impact quality of care. While some healthcare organizations have demonstrated the ability to adapt to such stressors-which has been termed "organizational resilience"-others have not. Most of the research on resilience in healthcare has been on individual clinicians; less is known about how extra-individual groups such as teams, units, and systems develop resilience. Understanding what organizational resilience is, how to measure it, and how healthcare organizations can develop it is essential to responding effectively to future acute and chronic stressors in the healthcare industry. The purpose of this scoping review is to synthesize how organizational resilience is defined and measured in the current healthcare literature and to inform future interventions to improve organizational resilience. METHODS: We searched PubMed and Scopus databases for articles mentioning organizational resilience in healthcare. Eligible sources were those published in English through December 2023 in any format, and that described or measured organizational resilience in healthcare. Titles and abstracts were screened, and information was extracted from eligible articles. PRINCIPAL FINDINGS: We screened 243 articles and included 97 in our review. Across these studies, organizational resilience was described as a healthcare system's ability to continue functioning and meet its objectives when exposed to stressful stimuli. Reactive and proactive strategies, as well as reflection, were identified as key components of organizational resilience. Four measures of organizational resilience were developed for use in healthcare, but only two have been validated. PRACTICAL APPLICATIONS: Future studies should focus on validating and comparing existing measures of organizational resilience and using them to investigate how organizational resilience may impact quality of care and clinician well-being, allowing the field to move beyond the focus on individual clinician resilience.

  PublisherDOI

• Retention and Morale in the Icu: Clinician Perspectives on Interprofessional Staffing in Adult Icus

  SSRN Electronic Journal · 2025-01-01

  preprintOpen accessSenior author
  PublisherDOI

• Trends In Registered Nurse Wages Relative To Other Health Care Occupations, 2012–23

  Health Affairs · 2025-10-01

  article

  Registered nurses (RNs) represent the largest clinical workforce in the US. We examined RN wages relative to wages for other health care occupations for the period 2012-23. Although annual inflation-adjusted wages increased across all health care occupations, RNs experienced the smallest growth (0.51 percent), and nursing assistants experienced the greatest (1.48 percent). Comparing 2012 to 2023, wage gaps between RNs narrowed compared with some professions and widened compared with others.

  PublisherDOI

• Using Implementation Science to Understand Barriers to Telemedicine Use for Burn Care During a Crisis

  Journal of Burn Care & Research · 2025-04-01

  articleOpen access

  During a crisis, hospitals need help to meet the needs of patients with burns. Very few clinicians (1%) of medical doctors and registered nurses and few hospitals (2%) have burn care expertise. Due to these capacity limitations, patients with burns as extensive as 40% TBSA remain outside of burn centers for days to weeks before reaching definitive care. Telemedicine technology (TT) effectively connects a caregiver in any location to an expert burn clinician. However, it remains underused for unknown reasons. Implementation science seeks to uncover the factors affecting the use of innovations like telemedicine to increase uptake. We administered a questionnaire to assess burn center and emergency department clinician perceptions of the feasibility, acceptability, and intention to use TT across a network of 24 hospitals representing 4 of the 6 current American Burn Association disaster response regions. We also collected monthly current TT referral usage rates (# acute burn referrals using TT / # total acute burn referrals). Clinician ratings were generally in the neutral to agreeable (3.04 to 4.01) range for acceptability, feasibility, and intention to use; however, there was no significant relationship between these constructs and the actual use of teleconsultation across the sample. Strong correlations between feasibility and intention to use were observed. However, weaker correlations between ease of use and perceived usefulness suggest that interventions targeting these perceptions are needed to fully realize the potential of teleconsultation in improving the quality of initial and ongoing burn care during a crisis and usual care.

  PublisherOA PDFDOI

• Health-Related and Social Drivers of Chronic Absenteeism in an Urban School District

  Academic Pediatrics · 2025-07-17 · 3 citations

  articleOpen access
  PublisherOA PDFDOI

• Healthcare Utilization and Costs Among Commercially Insured Infants With and Without Medically Complex Conditions

  Advances in Neonatal Care · 2025-03-14 · 1 citations

  article

  BACKGROUND: Little is known about healthcare use and costs for commercially insured infants in the first year of life following a Neonatal Intensive Care Unit (NICU) hospitalization. PURPOSE: To evaluate healthcare utilization and costs in the 12-months after a neonatal hospitalization among commercially insured infants, comparing infants with and without medically complex conditions. METHODS: This retrospective, cross-sectional, cohort study uses data from the IBM MarketScan Commercial database (2015-2019). The cohort included infants with and without medically complex conditions, hospitalized at birth in the NICU, discharged alive, and had 12-months continuous coverage. The primary outcomes are healthcare utilization (i.e., hospital readmissions, emergency department (ED) visits, and primary care and specialty outpatient visits) and out-of-pocket (OOP) costs. RESULTS: The analysis included 23,940 infants, of which 84% resided in urban areas, 48% were born term (>37 weeks) and 43% had a medically complex diagnosis. Medically complex infants exhibited higher rates of readmissions, ED visits, specialist utilization, and specialty services. Average OOP costs for medically complex infants was $1893, compared to $873 for noncomplex infants. Almost half (48%) of the cohort had costs that exceeded $500 in the first year of life. IMPLICATIONS FOR PRACTICE AND RESEARCH: This study provides insights into the financial implications of post-NICU care for infants. Findings underscore the importance of considering medical complexity over gestational age when understanding healthcare use and spending patterns. Policymakers, healthcare providers, and families can use these insights to address the financial challenges associated with caring for infants with complex medical conditions beyond the NICU.

  PublisherDOI

Recent grants

• The role of interprofessional teamwork in complex care delivery

  NIH · $784k · 2016–2021

Frequent coauthors

• Milisa Manojlovich

  University of Michigan–Ann Arbor

  30 shared

• Yun Jiang

  University of Michigan–Ann Arbor

  25 shared

• Dante Anthony Tolentino

  University of California, Los Angeles

  25 shared

• Nathan Wright

  Yale University

  23 shared

• Theodore J. Iwashyna

  VA Center for Clinical Management Research

  23 shared

• Christopher R. Friese

  19 shared

• Amanda C. Blok

  17 shared

• Olga Yakusheva

  Johns Hopkins University

  14 shared

Education

• Post-doctoral fellowship, Critical Care Medicine

  University of Pittsburgh School of Medicine

  2014

• PhD, Center for Health Outcomes and Policy Research

  University of Pennsylvania School of Nursing

  2012

• MS, Center for Health Outcomes and Policy Research

  University of Pennsylvania School of Nursing

  2011

• BSN, Decker School of Nursing

  Binghamton University Decker School of Nursing

  2005

• BA, Italian Studies

  Boston University

  2004

Awards & honors

• Fellow in the American Academy of Nursing (2019)
• ATS Nursing Assembly Early Career Achievement Award (2019)
• Harriet H. Werley New Investigator Award from Midwest Nursin…