Giving while grieving: Racism-related stress and psychological resilience in Black/African American registered nurses

Resilience in Black Women: Lifeline or Double-Edged Sword?

Black women face many health disparities, many of which are tied to the stress of being a marginalized group member. Resilience, defined as the ability to bounce back from adversity and continue with life, has been introduced as a method to buffer the stress that Black women experience and improve their outcomes. However, there is not a universally agreed-upon definition of resilience in the literature. Thus, it is unclear how resilience works broadly, particularly for Black women. It is important to explore whether resilience is as positive as many scholars have perceived it to be. The current review analyzes 28 empirical articles that looked at stress, resilience, and health outcomes in Black women. The review revealed that there are many inconsistencies in how both stress and resilience are measured. Further, the positive effects of resilience seem to be largely context-dependent and vary depending on the demographic and health outcomes explored.

Our New Normal: Pediatric Nurse Residents' Experiences with Transition to Practice during the COVID-19 Pandemic

This phenomenological qualitative study examined the lived experience of pediatric nurse residents' transition to practice during the COVID-19 pandemic. The purposive sample included nine pediatric nurses, participating in a nurse residency program, who entered the nursing profession during the first year of the pandemic. The setting was a free-standing, Magnet-recognized, pediatric academic medical center in the Northeastern U.S. Individual interviews were audio recorded and transcribed. Narratives were analyzed using a hermeneutic phenomenological approach. Five themes emerged from the data: Our New Normal; The Rules Keep Changing; I'm Not Ready for This (transition to practice); The Toll of COVID; and Shattered Family-Centered Care. Sub-themes emerged in The Toll of COVID theme: COVID and the Nursing Care Environment, Emotional Toll of COVID, Burnout: A Universal Truth, and The Pandemic within the Pandemic. The nurse residents' narratives uncovered the essence of their uncertainty, sorrow, growth, and resilience. Through the eyes of pediatric nurse residents, this study illuminated the experiences of these novices as they entered the nursing profession amid a pandemic.

Anti-Black racism: Gaining insight into the experiences of Black nurses in Canada

The call to address anti-Black racism in workplaces resonates across several organizations and institutions in Canada. But specifically, the coronavirus disease 2019 pandemic shed further light on how health inequities negatively impact the Black community. After conducting a literature review of the experiences of Black nurses in Canada, a deeper understanding of their plight was gained. In healthcare, the findings from the Black Nurses' Task Force report conclude that anti-Black racist practices are pervasive in nursing, and there remains a paucity of research in this area. This study builds off the report by exploring how Black nurses experience anti-Black racism while working in Canada's healthcare system. Inspired by critical race theory and Black feminist thought, an exploratory qualitative research study was conducted, using semistructured interviews to gather data. The study concludes that Black nurses experience anti-Black racism within the workplace, and it manifests itself through some of the attitudes of colleagues, patients, and nurses in leadership roles. Despite policies and statements that were in place to protect them, anti-Black racism continues to occur systematically. The findings point to the need for change in the overall workplace culture, which includes a fair representation of Black nurses in leadership roles, further research to identify best practices for tackling anti-Black racism within Canada's healthcare system, and mandatory training on anti-Black racism for healthcare leaders, educators, and service providers.

Modeling the social determinants of resilience in health professions students: impact on psychological adjustment

Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.

Characterizing burnout and resilience among nurses: A latent profile analysis of emotional exhaustion, emotional thriving and emotional recovery

AIMS

To identify subgroups of nurses with distinct profiles of burnout (emotional exhaustion) and resilience (emotional thriving and emotional recovery) and describe nurse characteristics associated with each profile.

DESIGN

Cross-sectional, correlational design.

METHODS

Data were collected via electronic survey from 2018 to 2019. Latent profile analysis was used to identify subgroups of nurses with distinct profiles of emotional exhaustion, emotional thriving and emotional recovery, with each measured on a 0-100 scale. Bivariate statistics were used to determine profile differences in nurse sociodemographic, professional and psychological characteristics.

RESULTS

Four distinct profile subgroups were identified: (1) "exhausted" (14% with very high emotional exhaustion, low emotional thriving and moderate emotional recovery), (2) "exhausted with thriving" (6% with high emotional exhaustion, moderate-high emotional thriving and low emotional recovery), (3) "exhausted with thriving and recovery" (52% with moderate-high emotional exhaustion, emotional thriving and emotional recovery), and (4) "thriving and recovery" (27% with low emotional exhaustion and very high emotional thriving and emotional recovery). Nurses in the "exhausted" and "exhausted with thriving" profiles reported greater depression and poorer work-life integration. Nurses in "exhausted" profile were more likely to work in an inpatient setting. Nurses in the "exhausted with thriving and recovery" and "thriving and recovery" profiles reported more positive emotions, more well-being behaviours, and better work-life integration, with the "thriving and recovery" subgroup having the highest levels of these characteristics, lower depression scores and greater racial minority representation.

CONCLUSION

Approaches designed to improve nurse well-being should be tailored to the nurses' profile of emotional exhaustion, thriving and recovery to maximize effectiveness.

IMPACT

Given the growing shortage of nurses in healthcare systems, it is critical that multilevel strategies be investigated to retain nursing staff that consider the intersectionality and complexity of the different aspects of burnout and resilience experienced by the nurse.

NO PATIENT OR PUBLIC CONTRIBUTION

The aim was to assess burnout and resilience among nurses.

The associations among nurse work engagement, job satisfaction, quality of care, and intent to leave: A national survey in the United States

Objectives

Employee work engagement, job satisfaction, quality of care, and intent to leave are critical indicators for healthcare organizational performance. This study aimed to analyze the current state of nurses' work engagement and its factors to examine the associations among nurses' work engagement, job satisfaction, quality of care, and intent to leave in the United States (US).

Methods

This is a quantitative descriptive cross-section design. Data were collected online from the US registered nurses from March to September 2022. Measures comprised the Utrecht Work Engagement Scale, the demographics, and questions regarding job satisfaction, perceived quality of care, and intent to leave.

Results

Nine hundred nurses participated in the online survey. Among the participants, 79.2% reported holding a specialty certification, 59.4% scored high/very high on job satisfaction, 82.2% expressed high/very high on the perceived quality of nursing care, and 28.4% conveyed likely/very likely to leave in the following year. Nurses' work engagement was positively associated with nurses' job satisfaction and their perceived quality of care but negatively associated with intent to leave. More certified nurses reported high or very high job satisfaction than non-certified nurses. As for demographics, the linear regression analysis showed that nurses who were older, identified as White, and held doctorate degrees reported higher levels of work engagement in comparison to their counterparts.

Conclusions

This study shows that nurses' work engagement is associated with their job satisfaction, perceived quality of care, and intent to leave. Nurses' work engagement in this study is lower than in other studies, especially before the COVID-19 pandemic, which may indicate a possible association with the COVID-19 impact. Because nurses' work engagement is significantly associated with job satisfaction, nurse leaders need to find ways to promote nurses' job satisfaction and retention.

A Cross-Sectional Study of the Social Work Environment and Black Registered Nurses' Sleep

INTRODUCTION

Workplace experiences may place Black nurses at higher risk for poor sleep and adverse health outcomes. This study aimed to identify poor sleep prevalence and associations of workplace discrimination and workplace social capital with sleep.

METHODOLOGY

Descriptive statistics and multiple linear regression with exploratory analyses were conducted of cross sectional survey data from US Black nurses.

RESULTS

On average, 63 respondents reported sleeping 6.15 h, 45 min less daily than 6.9 h reported nationally for nurses. Ninety-percent of respondents reported poor sleep quality. While no direct significance was found, respondents reporting sleep quality changes had lower workplace social capital and higher workplace discrimination.

CONCLUSION

Black nurses may have higher prevalence of poor sleep than the larger nursing workforce. A potential relationship between decreased sleep quality and negative perceptions of the work environment may exist. Organizations should examine sleep and potential occupational health inequities among Black nurses when considering worker health.

The role of self-efficacy and psychological resilience on the relationship between perfectionism and learning motivation among undergraduate nursing students: A cross-sectional descriptive study

BACKGROUND

People's high requirements for medical care and the difficult academic tasks associated with the nursing profession require nursing students to have stronger learning motivation.

PURPOSE

This study aimed to investigate the effect of perfectionism on the learning motivation of undergraduate nursing students and to explore the mediating factors influencing these two variables.

METHOD

A total of 1366 nursing students from four undergraduate universities in Henan Province, China, were surveyed from May to July 2022. We conducted Pearson's correlation analysis and a regression analysis using PROCESS Macro Model 6 to explore the relationships among perfectionism, efficacy, psychological resilience, and learning motivation.

RESULTS

The results indicated that perfectionism affected undergraduate nursing students' learning motivation not only directly but also indirectly through self-efficacy and psychological resilience.

CONCLUSION

The results of this study offer certain theoretical support and guidance for research and interventions pertaining to undergraduate nursing students' learning motivation.

Examining Race-Based Discrimination, Depression, and Occupational Stress in Black Registered Nurses

Nursing is a highly stressful and demanding profession that can negatively affect mental health, as shown by nurses' high rate of depression. Furthermore, Black nurses may experience additional stress due to race-based discrimination in the work environment. This research aimed to examine depression, experiences of race-based discrimination at work, and occupational stress among Black nurses. To better understand associations between these factors, we conducted multiple linear regression analyses to assess whether (1) past-year or lifetime experiences of race-based discrimination at work and occupational stress predicted depressive symptoms; and (2) controlling for depressive symptoms, past-year and lifetime experiences of race-based discrimination at work predicted occupational stress in a cohort of Black registered nurses. All analyses controlled for years of nursing experience, primary nursing practice position, work setting, and work shift. The results indicated that both past-year and lifetime experiences of race-based discrimination on the job were significant predictors of occupational stress. However, experiences of race-based discrimination at work and occupational stress were not significant predictors of depression. The results of the research highlighted the predictive effect of race-based discrimination on occupational stress in Black registered nurses. This evidence can inform the development of organizational and leadership strategies to improve the well-being of Black nurses in the workplace.

Critical Clinical Events and Resilience Among Emergency Nurses in 3 Trauma Hospital-Based Emergency Departments: A Cross-Sectional Study

INTRODUCTION

Emergency nurses experience occupational stressors resulting from exposures to critical clinical events. The purpose of this study was to identify the critical clinical events for emergency nurses serving 3 patient populations (general, adult, pediatric) and whether the resilience of these nurses differed by the patient population served.

METHODS

This study used a cross-sectional survey design. A total of 48 emergency nurses were recruited from 3 trauma hospital-based emergency departments (general, adult, pediatric). Clinical Events Questionnaire, Connor-Davidson Resilience scale, and an investigator-developed demographic questionnaire were used to collect data from respondents.

RESULTS

All respondents were female (n = 48, 100%), and most were White (n = 46, 96%). The average age of participants was 39.6 years, the average number of years as a registered nurse was 12.7 years, and the average number of years as an emergency nurse was 8.8 years. Clinical events considered most critical were providing care to a sexually abused child, experiencing the death of a coworker, and lack of responsiveness by a colleague during a serious situation. The least stress-provoking event was incidents with excessive media coverage. Nurses were less affected by the critical events they experienced more frequently at work. Nurses in the 3 trauma settings had high level of resilience, with no statistically significant differences between groups.

DISCUSSION

The occupational stress from exposure to significant clinical events varied with the patient population served by emergency nurses. It is important that interventions be adopted to alleviate the effect of work-related stressors and promote the psychological health of emergency nurses.

Race-induced trauma, antiracism, and radical self-care

Being racialized as Black in the United States has contributed to this population having to operate with a level of race-induced trauma, especially those who are darkly melanated. Historically, Black persons have been terrorized into colonization, and the cultural psychology of anti-Blackness has been entrenched in our society. Through the practice of racialization, the historical, social, and political processes of constructing racial identities and meanings have impacted the formation of understanding of the body and the rationalization of hierarchy. In addition, the internalization of these ideas of hierarchy and difference within power/knowledge relations that they (re)produce is pervasive among people in the United States. This article aims to explicitly highlight racism as trauma, address the relevance of radical self-care when disrupting anti-Black racism, and consider steps to promote trauma responsiveness when incorporating these practices.