The Lived Experiences of Racial and Ethnic Minority Nurses Exposed to Racial Microaggressions in the Hospital Setting: Qualitative Study.

Abstract

Background: Type II (client-on-worker) workplace violence (WPV) between patients and nurses is an ongoing safety and health challenge in health care. However, little is known about the experiences of racial and ethnic minority nurses specifically in a profession in which most individuals identify as White. During and after the COVID-19 pandemic, type II WPV against certain minority groups increased, which suggests that underrepresented racial and ethnic minority nurses may have unique experiences with type II WPV inflicted by patients, their family members, or visitors.

Objective: The aim of this study was to (1) explore the lived experiences of racial and ethnic minority nurses who have faced type II WPV from patients in the hospital setting, and (2) assess the emotional and physical effects of type II violence among racial and ethnic minority nurses.

Methods: Semistructured individual interviews were conducted with racial and ethnic minority nurses. The research team recruited participants through snowball sampling. Nurses were eligible to participate if they (1) were ages 18 years and older, (2) were currently working as a registered nurse in a hospital in the United States or had previous experience in this role, with the experience dating no earlier than March 2020, when the COVID-19 pandemic began, (3) had experienced WPV from patients, their family members, or visitors at some point during their career, and (4) identified as a racial and ethnic minority. Interviews were conducted between February 2023 and March 2023. A qualitative descriptive approach was used to analyze the findings.

Results: A total of 10 nurses from racial and ethnic minority groups were interviewed: 5 Asian, 2 Latina, 2 African American, and 1 Middle Eastern nurse. Violence experienced by the nurses fell under 2 categories: macroaggressions and microaggressions. Macroaggressions included physical violence, verbal abuse, and sexual violence. Microaggressions were subtle and often unconscious and unintentional comments, interactions, or behaviors relating to the participants' race. All nurses (10/10) reported experiencing racial microaggressions and considered them very harmful. Microaggressions left a negative impact on these nurses in terms of their self-esteem, the nurse-patient relationship, and their job performance. However, many participants did not speak up about microaggressions to either the perpetrator or management because they feared that their experiences would be dismissed. Minimization and normalization of microaggressions were common themes among participants. In total, 90% of participants (9/10) expressed that they do not feel supported in the hospital as nurses of underrepresented minority groups.

Conclusions: Microaggressions are a form of WPV. "Micro" implies small, but the consequences of microaggressions are additive and detrimental. Racial microaggressions negatively impact nurses in terms of their personal well-being, job performance, and ability to deliver quality patient care. Given this, more policies, procedures, and resources must be in place to support racial and ethnic minority nurses in the hospital setting.