Discrimination, racism, violence are common and weighing heavily on healthcare workers, surveys show

A pair of new healthcare workforce surveys outline widespread reports of discrimination, racism and workplace violence perpetuated by patients and coworkers alike.

Among the findings were acknowledgments from respondents that incidents of discrimination are rarely reported to management or law enforcement.

Additionally, more than half of the respondents to one survey said that they believed that incidents of workplace violence have increased over the course of their tenure, while nearly half of the nurses who responded to the other survey said they believe “a culture of racism/discrimination” was present as early as in nursing school.

“If we are to truly provide just and equitable care to our patients, we as nurses must hold ourselves accountable for our own behavior and work to change the systems that perpetuate racism and other forms of discrimination.” Beth Toner, RN, director of program communications at the Robert Wood Johnson Foundation (RWJF), which backed one of the two surveys, told Fierce Healthcare in a statement.

RWJF’s poll (PDF) exploring nurses’ perceptions and experiences with discrimination was designed and conducted collaboratively by the National Opinion Research Center at the University of Chicago and public relations firm McCabe Message Partners.

Between March and April 2022, it collected a sample of 980 nationwide nurses oversampled by race and ethnicity “to ensure representation and allow for greater between group comparisons across racial and ethnic groups.” Respondents predominantly (82%) identified as female.

Seventy-nine percent of the nurses said they had seen or experienced racism/discrimination from patients while 59% said the same regarding their colleagues, according to the survey. Nurses who were Asian, Black/African American and Latino/Hispanic were significantly more likely than white/Caucasian nurses to say they’d seen or experienced microaggressions, which were also more commonly reported among those working at nursing homes or hospitals.

About two in five nurses said they have discussed race or ethnicity-based discrimination with their supervisors, but less than a quarter said they had ever formally reported or documented any incidents, per the survey report.

Forty-four percent said that racism and/or discrimination was a part of their nursing school’s culture. At the same time, 58% said their school at least moderately taught racially or ethnically sensitive bedside manner, while about a third said the same about racial bias/stereotypes or systemic racism in healthcare.

As for their current employment, between 80% and 90% of nurses said diversity, equity and inclusion were an organizational priority and was supplemented by educational programs or training. The majority also said they believed hiring practices focused on diversity could help better recruit and retain diverse nurses, as would establishing zero-tolerance policies, clear consequences and reporting anonymity for racism or discrimination.

Meanwhile, a second survey released this week by Premier Inc. and the Agency for Healthcare Research and Quality suggests that nurses are also on the frontlines of workplace violence.

Across a 672-person sample of clinical, administrative and security personnel in healthcare polled from February to April 2023, 40% said they were directly involved in workplace violence over the previous two years, with 60% of the impacted respondents working in a nursing role.

“Among those who responded that experienced workplace violence, they indicated the incidents occurred most often while explaining or enforcing an organizational policy, or while providing an update on a patient’s condition to the patient or to the patient’s family members,” Premier wrote in its report. “… More than half of all respondents felt that workplace violence incidents had increased during their tenure.”

Women who experienced workplace violence said their incidents were evenly split between emotional/verbal assaults and physical/sexual abuse, per the survey. Men more often said they experienced physical abuse (62%) as opposed to verbal or emotional assaults (38%).

More than three in five respondents said the perpetrator of their workplace violence was a man. Sixty-one percent said their perpetrators were between 36 and 65 years of age, and just over half of those who provided details about their workplace violence experience said it was at the hands of a combative patient.

Forty-five percent of respondents who experienced workplace violence said that law enforcement was “responsive” to their reported physical or sexual violence, while 22% said the same regarding their reported verbal or emotional violence. Premier contrasted the low levels of escalation reported by healthcare respondents to those seen across other occupations such as police officers, paramedics or emergency medical technicians, against whom such acts are routinely viewed as a criminal matter.

"Premier continues to actively support legislation, like the SAVE Act, and believes that the hardworking staff at our hospitals and health systems deserve enhanced legal protections that criminalize intimidation and violence against healthcare workers,” the organization wrote in the report. “If passed, this legislation could create a federal standard that would help ensure consistent application of these protections across the country.”

These survey reports and others from healthcare workforce groups have highlighted the mental impact on-the-job experiences like discrimination and violence can have on mental resiliency—a key concern as burnout runs rampant throughout clinical staff.

Late last year, the Centers for Medicare & Medicaid Services released a memorandum reinforcing hospitals’ “regulatory obligation to care for patients in a safe setting,” which can range from patient environmental safety standards to protections for their physical and emotional health.