An Examination of Nursing Work Outcomes and the Experiences of Nurses of Color During COVID-19

Abstract

Background. The COVID-19 pandemic has underscored nursing workforce issues such as burnout and turnover, with disproportionate impacts for nurses who identify as Black, Indigenous, or other People of Color (BIPOC). Available workforce research is limited by a lack of theoretical structure for examining registered nurse (RN) job outcomes as well as inadequate representation of BIPOC RNs. The purpose of this multimethod study was to examine the impact of COVID-19 on job experiences for BIPOC RNs, to explore factors that affect their decisions to stay in or leave jobs, and to develop a useful framework to advance nursing workforce research.Methods. 1: The first part of the study was a secondary analysis of data on RNs (n=3782) from the Current Population Survey (CPS). Logistic regression analysis was used to examine the influence of individual demographics, family situation, and job characteristics on negative job impacts (inability to work or look for work) due to COVID-19. 2: The second part of the study was a phenomenological exploration of BIPOC RNs’ (n=13) experiences throughout the pandemic, with a focus on meaning in nursing and job decisions. 3: Findings from these studies illustrated the utility of a model that facilitates the examination of holistic outcomes for RNs. Results. 1: The secondary analysis of CPS data suggested that while race and gender alone were not associated with higher odds of a negative job impact due to COVID-19, other individual and family factors influenced the odds of having a negative impact. 2: Findings from the phenomenological study revealed an overall theme of answering the call along with four subthemes: being consumed by COVID, COVID shining a light, dimensions of trust, and questioning ‘is it worth it?’. 3: The proposed model, The Dynamic Model of RN Job Outcomes, provides structure to examine individual to systems level factors that impact RNs and is centered around the RN amidst the dynamic contexts of work and life. Discussion. Results from this dissertation provide important data on the experiences of BIPOC RNs during the pandemic. Findings suggest that racism is impacting this critical workforce in subtle but important ways, echoing general employment data showing the intersection of race and sex on job loss. For most BIPOC RNs in the qualitative study, pandemic experiences were not centered on their racial identity, but they report microaggressions and incidents of overt racism that are part of their everyday experience at work and may lead to disproportionate intent to leave and turnover rates as well as affecting their wellbeing. Conclusion. Together, these studies show the need for advancing the science of nursing workforce research, and for study aimed at improving the understanding of systems and contextual factors impacting RNs, and particularly BIPOC RNs, in the workplace. A critical component of future study is a focus on identifying and eliminating racist policies and systems that lead to negative outcomes in the RN workforce.