UC Irvine

Background: A diverse nursing workforce improves care quality and reduces health disparities. The predominantly White U.S. nursing workforce does not reflect the diverse population it serves. To attract and retain nurses of color, we must understand work-related factors affecting their well-being. Racism has long impacted minority nurses, adding to the inherent stress of the profession. The COVID-19 pandemic exacerbated these stressors affecting minority nurses' well-being including that of Filipino American nurses - a group vital to the U.S. healthcare system. Purpose: This body of work aimed to explore associations between COVID-19 related workplace experiences, racism, and the psychological well-being of minority nurses, with a final study focused specifically on Filipino American nurses. Methods: We performed three studies: A scoping review to identify associations between racism and the well-being of nurses of color in general; a scoping review to examine the associations between COVID-19 nursing experiences and the psychological well-being of nurses of color; and a descriptive, cross-sectional study of Filipino American registered nurses to examine associations among pandemic-related nursing experiences, racism, work characteristics, and psychological well-being. Results: Findings from all studies in the first review suggested that racism is associated with worse outcomes among nurses of color regardless of the setting, professional role, or source of racial animus. The second study found few significant differences in the psychological well-being of different racial and ethnic groups of nurses during the pandemic. However, when differences emerged, White nurses appeared to experience more distress. This prompts us to question whether the measures used were effective at capturing the nuanced experiences of minority nurses, particularly given the well-documented impact of racism on their psychological well-being. Finally, in the Filipino American nurse study, pandemic-related nursing experiences and racial microaggressions were associated with worse psychological outcomes. Moral injury strengthened the associations between work experiences and symptoms of traumatic stress and functional impairment, but not depression or anxiety. Conclusion: This body of research highlights the need to address racism as a serious risk factor undermining the psychological well-being of minority nurses. Among Filipino American nurses, who were disproportionately affected by the COVID-19 pandemic, both working conditions and racism need to be addressed. The findings emphasize the importance of interventions to support minority nurses to improve patient care, mitigate the nursing shortage, and sustain a diverse healthcare workforce.