Original Research: Nurses' Experiences with Racial, Ethnic, Cultural, and Religious Discrimination in the Workplace: A Qualitative Study

Perspectives of Asian Foreign-Educated Nurses on Career Advancement in the United States: A Qualitative Descriptive Study

AIM

This study aimed to understand what influences career advancement among Asian foreign-educated nurses who have obtained an advanced degree in nursing in the United States.

BACKGROUND

Asian nurses represent one of the largest racial minority groups within the U.S. registered nurse workforce. The perspectives of Asian nurses regarding career advancement have been less explored.

METHODS

The participants were recruited using purposive and snowball sampling techniques. A semistructured interview was conducted with 11 Asian foreign-educated nurses. NVivo software was used for interview transcription and data management. Data analysis followed the steps of the conventional content analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used to ensure quality.

RESULTS

Five main themes were developed from the data: opportunities to advance in position and education, career advancement indicating personal and professional growth, a strong inner drive and motivation for career advancement, the influences of family and culture, and the need for time and other resources.

DISCUSSION

The main themes described perspectives, such as opportunities for advancement in position and education. The challenges with time, financial need, communication, and discrimination were discussed. Understanding the perspectives is crucial to ensure a supportive work environment and improve career advancement opportunities.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Financial support and flexible work schedules are crucial for Asian foreign-educated nurses seeking career advancement. Policies and procedures related to paperwork processing and mandatory prerequisites for enrollment to advance nursing education need to be revisited. Nursing leaders and administrators should consider improving policies to facilitate equal opportunities for career advancement.

The Mediating Role of Subjective Social Status and Psychological Distress in the Relationship Between Perceived Prejudice and Job Satisfaction Among Male Nurses: The Moderating Role of Self-Esteem

We aim to investigate the mediating effects of subjective social status and psychological distress on the relationship between perceived prejudice and job satisfaction, and explore the moderating effect of self-esteem on these relationships. A cross-sectional questionnaire survey was conducted among 626 Chinese male nurses. Results showed that perceived prejudice had both direct and indirect impacts on job satisfaction, with the latter partially mediated by psychological distress but not subjective social status. Self-esteem moderated these relationships. To improve job satisfaction among male nurses, measures should be taken to reduce their sensitivity to prejudice and change public stereotypes.

The Relationship Between Perceived Discrimination and Blood Pressure in Black Adults: A Narrative Review

BACKGROUND

Cardiovascular disease is the leading cause of death in the United States, with disproportionately higher morbidity and mortality rates among Black people. Experiences of discrimination and racism constitute a public health crisis. Given the significant race- and ethnicity-related disparities in cardiovascular health, it's essential to understand the mechanisms by which these disparities occur.

PURPOSE

The purpose of this review was to identify and synthesize the current literature on the relationship between perceived discrimination and its impact on blood pressure among Black adults.

METHODS

A literature search was conducted to locate relevant research. To be included, articles had to report on quantitative studies that were conducted in the United States among Black adults, used discrimination as an independent variable, and used blood pressure or hypertension as an outcome variable. These articles also had to have been peer-reviewed and published in English between 2010 and 2021. Discrimination was categorized as everyday, lifetime, or both.

RESULTS

Eleven studies met all criteria and were included for analysis. Eight of these studies reported an association between increased racial discrimination and higher blood pressure; moreover, of the eight studies that reported this finding, seven specified lifetime discrimination.

CONCLUSIONS

This narrative review found significant evidence supporting a positive association between perceived lifetime discrimination and blood pressure in Black adults. But the relationship isn't clearly understood, and future research should explore the underlying mechanisms and potential confounders. Priorities include more rigorous assessment of Black individuals' experiences with both lifetime and everyday discrimination and how these interact with confounders (such as stress), so that blood pressure control can be better achieved in this population. Specific areas for investigation include considering how we measure discrimination, the impact of provider bias and discrimination, and the impact of discrimination on medication adherence. This work is essential to developing the urgently needed, evidence-based interventions that will help to prevent racial and ethnic discrimination and mitigate its effects.

Subtypes of Job Satisfaction and Health-Related Quality of Life in Chinese Male Nurses: A Latent Profile Analysis

In this cross-sectional study, we aimed to identify subgroups of job satisfaction and health-related quality of life (HRQoL) in Chinese male nurses and examine the factors associated with subgroup profiles. A convenience sample of 626 Chinese male nurses were enrolled from January to October 2021. Latent profile analysis was performed to identify profiles based on self-esteem, psychological resilience, social support, neuroticism, perceived prejudice, occupational stress, job satisfaction, and HRQoL. Chi-squared tests were used to examine predictors of profiles. Results indicated that a three-profile model provided the best fit: low job satisfaction and health (9.90%), moderate job satisfaction and health (64.06%), and high job satisfaction and health (26.04%). The average number of monthly night shifts was negatively correlated with the male nurses' subgroups. Psychological resilience, social support, and neuroticism were the key factors associated with the HRQoL of male nurses, while perceived prejudice, occupational stress, and self-esteem were the key factors associated with job satisfaction. Nurse administrators could improve their job satisfaction and health by reducing perceived prejudice, and job stress, increasing organizational support and resilience.

The Influence of Burnout, Resilience, and Resources to Support Clinical Practice Among Newly Licensed Nurses Intended Job Plans

OBJECTIVE

Survey newly licensed nurses (NLNs) with respect to burnout, resilience, perception of the work environment, and intended short- and long-term job plans.

BACKGROUND

NLN retention is a significant contributing factor to the nursing shortage.

METHODS

A 126-item survey measuring demographics, burnout, resilience, work environment, and job plans distributed via email, using Listservs to recruit nurses licensed for 5 years or less.

RESULTS

Participants (N = 547) reported moderate burnout, specifically emotional exhaustion, and resilience. Overall scores on perception of the work environment were positive. Multiple logistic regression suggests odds of 1-year intended job flight are positively associated with emotional exhaustion (odds ratio [OR], 1.77; P < 0.001), resilience (OR, 1.07; P = 0.003) and non-White racial identity (OR, 2.99; P < 0.001) and negatively associated with staffing and resource adequacy (OR, 0.63; P = 0.038).

CONCLUSIONS

Retaining NLNs requires mitigating burnout, addressing the experience of non-White NLNs in clinical practice, and improving support and resources for NLNs.

Original Research: Exploring Black Nurses' Perceptions of Workplace Safety and Personal Health

PURPOSE

This study aimed to assess the perceptions of nurses who self-identify as Black or African American regarding their workplace health and safety and to explore how these perceptions are associated with their perceived personal health.

BACKGROUND

Nurses practicing in unhealthy work environments can experience poorer physical and mental health. Recent civil unrest and ongoing dialogue about structural and systemic racism have prompted calls for greater efforts to understand the workplace perceptions and experiences of ethnic minority nurses, and how these influence nurses' personal well-being. But there is a dearth of relevant evidence concerning these nurses, including Black nurses.

METHODS

This cross-sectional, descriptive study involved analysis of secondary data collected from May 1, 2017, through December 31, 2019, by the American Nurses Association's HealthyNurse Survey (N = 19,131). We employed descriptive, bivariate, and multivariate analyses to examine the data for the 1,143 respondents who both self-identified as Black or African American and responded to all items concerning the major variable of personal health.

RESULTS

Overall, respondents reported a slight tendency to agree or strongly agree that their practice environments were safe. When looking at various factors explaining personal health, the perception of workplace health and safety was found to be a significant contributing factor.

CONCLUSIONS

The study findings suggest that, among Black nurses, perceptions about workplace health and safety are associated with perceived personal health. These findings underscore the importance of fostering healthy work environments.

'There is no justice in nursing school': A qualitative analysis of nursing students' experiences of discrimination shared on Reddit

AIM

To explore nursing students' experiences of stigma and discrimination within nursing programmes as shared on Reddit, and how other Reddit users offer support and guidance.

DESIGN

Qualitative interpretive description.

METHODS

Through a critical social theory lens, this study draws on students' posts from three nursing subreddits: r/studentnurse, r/nursingstudent and r/nursing. Data were collected from March 2013 to March 2023. Reflexive thematic analysis was conducted to generate broad themes of nursing students' experiences of stigma and discrimination, and how other Reddit users offered support and guidance.

RESULTS

A total of 43 posts with 1412 associated comments were included in this analysis, which generated three predominant themes of nursing students' experiences. Nursing students faced stigma and discrimination across contexts, including from peers, nurses and other healthcare providers working in clinical practicum sites, and patients. Nursing students' posts described navigating the impacts and consequences of such experiences, including on well-being, and programme and career success. In contexts where students were often alone in their experiences of stigma and discrimination within their programmes and with few identified supports, Reddit users sought support and community through Reddit. While many comments offered validation and support, challenges of this social media platform included conflicting advice and unhelpful, judgmental messages.

CONCLUSIONS

Despite widely articulated social justice commitments in the profession, nursing students continue to experience stigma and discrimination across contexts within their nursing programmes.

IMPLICATIONS FOR PROFESSION

Nurses and nurse educators have a responsibility to acknowledge and make visible such experiences, and take direct action to prevent and remediate stigma and discrimination within nursing education.

IMPACT

This research contributes to the growing empirical evidence that nursing students' experience stigma and discrimination within nursing programmes and the healthcare system.

REPORTING METHOD

Adherence to COREQ guidelines was maintained.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Examining and mitigating racism in nursing using the socio-ecological model

Racism in nursing is multifaceted, ranging from internalized racism and interpersonal racism to institutional and systemic (or structural) elements that perpetuate inequities in the nursing profession. Employing the socio-ecological model, this study dissects the underlying challenges across various levels and proposes targeted mitigation strategies to foster an inclusive and equitable environment for nursing education. It advances clear, context-specific mitigation strategies to cultivate inclusivity and equity within nursing education. Effectively addressing racism within this context necessitates a tailored, multistakeholder approach, impacting nursing students, faculty, administration, professional organizations, and licensing and accrediting bodies. This all-encompassing strategy recognizes that the interplay of interpersonal dynamics, community culture, institutional policies, and broader societal structures intricately shapes individual experiences. Nurses, nurse leaders, educators, organizations, and policymakers can work together to create a more equitable and inclusive nursing profession by targeting each of these levels. This transformational process can yield positive outcomes across various environments where nurses learn, work, and serve people and enable the demographic composition of nurses to better match the populations served.

Original Research: 'Do I See Myself?' Exploring the Potential for Online Images to Attract a Diverse Nursing Workforce

BACKGROUND

The current nursing shortage is expected to worsen in the coming years. While this shortage has in part been attributed to challenging working conditions, which were exacerbated during the COVID-19 pandemic, there are other factors. Although recruiting a more diverse health care workforce might help to reduce this shortage, little is known about how to do so effectively. This study explored how online images of health care workers vary by gender and skin tone and considered how those representations might impact recruitment.

METHODS

This was a prospective pragmatic study. Using a popular image search engine, we obtained and evaluated images (photographs, drawings, and cartoons) of people representing different genders and a range of skin tones. The search terms used were student, nurse, and physician. The search took place during a single day and stopped once 50 images for each term had been retrieved. Images were included if they depicted at least one human. Each image was evaluated independently by two raters regarding gender (male or female) and skin tone (using a version of the 10-point Monk Skin Tone Scale).

RESULTS

The final sample comprised 150 images that depicted 259 faces. Compared with the general population, nurses were overrepresented as being female (84.1%) and having lighter skin tones (85.2%). Physicians were overrepresented as being male (58.7%) and having lighter skin tones (63.5%). Compared with physicians or students, nurses were more likely to be represented as female and as having lighter skin tones.

CONCLUSIONS

The findings show a significant lack of diversity in gender and skin tone regarding how nurses are depicted in online images found via a popular image search engine. This lack of diversity may discourage people in some population groups from entering the health care field and could further contribute to the nursing shortage.