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Experiencing Discrimination:
Nurses Perceptions of the Hospital
Sociology 201; Social Research
Aaron Guerdet
Introduction
The United States has long championed itself upon the ideal that through hard work and
perseverance one can attain their goals. However, in many industries we continually see
discrimination. Discrimination is practiced through derogatory comments, rejecting a group or

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an individual based on ethnic background, advancement in positions based upon ethnic
background, as well as regression in positions based upon ethnic background. Through
discrimination one is hindered in their pursuit of goals. The hospital setting is no exception.
Prior studies have identified three major barriers; lack of communication, exploitation and
isolation, that inhibit career trajectories (Wheeler, Foster, & Hepburn, 2013). These barriers
inhibit patient care and overall workplace environment of that hospital.
By creating these barriers communication becomes affected. Hospital workers, mainly
nurses, become afraid to ask questions or express opinions (Wheeler, Foster, & Hepburn, 2013).
The act of exploitation places these workers in undesirable settings that may be hostile. By
isolating these workers, patients, as well as co-workers, may draw negative conclusions and not
recognize the qualifications of these nurses, exasperating the problem even further.
These barriers have resulted in discrimination. Discrimination is defined as any act that
inhibits or denies human rights to categories of individuals based upon a prejudice (Moceri,
2012). For the purpose of this study we will focus on acts of discrimination that inhibit the
career trajectories of registered nurses who give direct care to patients. As stated above, the
three acts of discrimination, lack of communication, exploitation, and isolation, will be the focus
of this study.
The U.S.A. has been affected by discrimination since it’s foundation, especially to
minority populations. As early as post World War II African American nurses were prohibited
from training with White nurse. These nurses were seen as “inferior, incapable, and inadequate”
(Wheeler, Foster, & Hepburn, 2013). More recently these previously bigoted populations have
received patronage with their cohorts through the passing of civil rights acts. Despite
discriminatory actions taken against these populations, increased race/ethnicity diversity was

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shown to be associated with higher levels of job satisfaction (Gates and Mark, 2012). These
populations in the U.S.A. consist of Asian, African, Latino, and those of American Indian
descent (U.S. Census, 2015). While the majority of the population in the U.S.A. consists of
White individuals.
Direct care providers support patients during their times of illness, in an attempt to heal,
in order for patients to become an effective, functioning member of society again. This study
will focus on registered nurses. While physicians have been held in high regard throughout
modern medicine due to their qualifications; allowing them to “diagnose, treat, and prevent
illness, disease, injury, and other physical and mental impairment and maintain general health in
humans through application of the principles and procedures of modern medicine” (World
Health Organization, 2010) registered nurses who “provide treatment, support, and care services
for people who are in need of nursing care due to the effects of aging, injury, illness, or potential
risks to health, according to the practice and standards of modern nursing”(World Health
Organization, 2010) are of equal importance. By assuming the responsibility, incoordination
with the physician and other integral members of the recovery process, of the overall
management and care of patients, registered nurses provide an integral role in a medical setting.
As such, it is of considerable importance that this industry is not undermined by any acts of
discrimination.
Hospital settings reflect the cultural and social diversity of a city, as no ethnic or social
background is exempt from poor health (Wheeler, Foster, & Hepburn, 2013). These settings are
the major areas that prevent the spread as well as the effects of an ailment on the individual. A
hospital setting is an organized staff of medical professionals who provide inpatient facilities and

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other related services. Developing or developed societies have benefited greatly from one form
or another of these settings, increasing their function.
Employers often provide space for advancement. However, as research suggests,
discrimination hinders this opportunity to all populations (Wheeler, Foster, & Hepburn, 2013;
Gates & Mark, 2012; Morceri, 2012). These advancements provide employees with motivation,
essential for a healthy work environment. With advancements comes higher wages, increased
benefits, and increased respect among peers. This advancement also gives the employee more
responsibilities, increased authority, and an increased skill set.
Patients are individuals receiving or attempting to receive medical services within a
hospital setting. Services received enable individuals to recover and fulfill their social role. By
fulfilling these roles individuals are able to pursue their interpersonal relationship goals with
employers, families, and organizations.
Non- patients are those who are not receiving care, but may be affected by policy or
orders from direct care providers. These individuals may include a patients family, friends, as
well as a patients employers. By working and adhering with a direct care providers orders, non-
patients have the ability to execute a full and effective recovery for patients. However, non-
patients also have the ability to hinder this process.
Non-direct care providers are individuals who play an essential role in a hospital setting,
but do not recommend cares for patients. These non-direct care providers may be janitors, cooks,
cafeteria workers, or security. Although essential for hospitals, these workers will not be the
focus of this study.
By studying barriers affecting the career trajectories of registered nurses, researchers may
begin to uncover what affects this industry negatively. Through prior research, it becomes

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apparent that discriminatory actions are culpable. In order to explain these phenomena a solid
framework of theories will be employed.
Conceptual Framework
Structuration theory, proposed by Giddens (1984), states that individuals are agents (the
capacity to act independently) whose interactions form structures (patterned social
arrangements). In the case of this study the agents are nurses, who interact according to rules
and their access to resources, affecting the structure of the health care facility.
Structural functionalism provides the major framework for Gidden’s (1984) structuration
theory. This framework states that society is a complex system that works together to promote
solidarity and stability. In the case of structuration theory, individual agents make-up the
society, while their specific structure promotes the agents solidarity and stability. Through acts
of discrimination a specific group promotes solidarity and stability to their own group. This
results in that specific groups ability to further their own ideals while disassociating with other
groups.
Social identity theory, also provides explanations into how nurses relate to others in their
organization based upon different attributes. These attributes can be race/ethnicity, age, gender,
and education. Nurses then use the attributes to classify as part of the in-group, when they share
each others own attributes, or as part of the out-group, when these attributes differ (Tajfel &
Turner, 1986). Due to these different groups, in-group members are seen as more familiar and
tend to be regarded positively, while out-group members are viewed unfavorably, compared to
their in-group counterparts (Tajfel & Turner, 1986). By being part of the in-group, registered
nurses experience a higher self-esteem and favoritism than those of the out-group. When this

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favoritism is threatened discrimination is promoted by those of the in-group in order to
consolidate their position (Tajfel & Turner, 1986).
While both theories provide valuable insight into this phenomenon; for the purpose of
this study, an application of social identity theory will be used for three reasons. The first being
that social identity theory suggests that nurses have a degree of power to affect their
environment. Throughout history social change has come from groups of individuals within a
structure, therefore implying that these groups do indeed have power, no matter how large or
small. By being part of the in-group this power is consolidated and, when threatened, may
encourage discrimination. Second, this theory explains how discriminatory interactions, within
an environment, may be influenced by their own social identity. That is to say that nurses may
be influenced to act in a discriminatory manner based upon existing procedures practiced by
veteran nurses or from broader social structures outside of the hospital setting. Lastly, this
theory implies that through acting within these groups, nurses can change the organization. By
viewing a nurses coping strategies, a change to discriminatory structures may result.
Through a long history of institutional racism, the nursing field has been able to provide
this solidarity and stability to those who have had access to resources as well as an understanding
of the rules, mainly White nurses. Because of this we are still seeing the lasting effects of
institutional racism. However, interactions from nurses (individual agents) and changes in laws,
as well as policy changes that promoted discrimination have formed new structures that are
designed to promote solidarity and stability for all. Although discrimination is still practiced by
agents who continue to affect these structures, much progress has been made.
Limitations

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A limitation of this study is the potential for those experiencing discrimination in the
workplace to feel that divulging certain information may result in further discrimination or
termination from their career. Workers may feel they can only share their positive experiences,
while leaving out experiences that may have been negative. As such, the reviewer may expect
different responses from what actually may have happened. As such a variety of diverse,
qualified researchers may remedy this situation.
Further limitations may include unfamiliarity with direct care providers in a hospital
setting, policies, and procedures. Researchers must be familiar with these concepts in order to
identify misinformation. As such, one may be inclined to study a direct care provides policy and
procedures for that particular setting.
Review of the Literature
Social inequality has been present in almost every labor market (Browne & Misra, 2005).
Whether these inequalities are based upon gender, race/ethnicity, and/or age, these inequalities
affect employee retention, workplace consistency, overall quality of services provided, continued
discrimination, decreased job satisfaction, as well as increased or decreased workload (Browne
& Misra, 2005; Elliot & Smith, 2004; Gates & Mark, 2012; Wheeler et al., 2013; Moceri, 2012).
The healthcare industry is no exception to these inequalities. This includes all hospital care
providers; registered nurses, the focus of this study, are not a deviation from the norm.
As of 2007 just under two and half million nurses were employed in the U.S. (World
Health Organization, 2010) Nurses provide support for patients during their times of illness, in
an attempt to heal, in order for patients to become an effective, functioning member of society
(World Health Organization, 2010). However, according to the U.S. Census, by 2050 1 in 5
Americans will reach the age of sixty five or older. This implies that more nurses will begin to

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retire resulting in a shortage. This shortage is exacerbated by the fact that with this aging
population comes more health problems, therefore increasing nurses workload. As such, policies
to not only retain, but to also promote and encourage this population are needed.
Currently, literature suggests that nurses experience workplace discrimination (Gates &
Mark, 2012; Wheeler, Foster, & Hepburn, 2013; Moceri, 2012). Discrimination affects overall
job performance as well as job satisfaction and retention (Gates & Mark, 2012; Wheeler, Foster,
& Hepburn, 2013; Moceri, 2012). With an ailing population these problems need to be
addressed. According to Gates and Mark (2012) increased diversity was associated with higher
levels of job satisfaction among registered nurses. This is but one example of how
discrimination affects everyone negatively. By recognizing these problems we can begin to
assess and monitor the current situation. Through further research answers to this complex
phenomena may be attained. As such the healthcare industry must recognize these problems and
consolidate its efforts in order to create an attractive, discrimination free workplace comprised of
motivated workers.
However, a study by Wheeler, Foster, & Hepburn (2013) found that nurses experienced
discrimination regardless of education or position. This was found to be experienced in any case
of unit or shift being worked. Nurses reported supervisors who favored certain ethnic groups;
most often the supervisors own race was the ethnic groups of favor. Further findings show that
White nurses were more commonly assigned to advanced positions and that doctors favored
communication to White nurses rather than nurses who were African American or were
internationally educated. Nurses were also found to practice discrimination among each other,
most commonly through derogatory comments regarding ethnicity. The biggest contributor to

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discrimination was from that of the patients and/or their families. Derogatory comments as well
as refusal of care was demonstrated.
These findings outline a hostile work environment. According to Moceri (2012) nurses
who experienced a more hostile work environment were found to have a negative effect on their
retention rates. That is, with increased hostility comes less retention of these nurses. Patient
discrimination may be accounted to a generational difference. As more patients from
increasingly recent generations become hospitalized this phenomenon may decrease. It is
imperative that the healthcare industry recognizes that hostility must be minimized. This may be
done by addressing the issue immediately on a case by case scenario. By working out ways to
minimize hostility nurse retention rates will increase resulting in a healthy work environment.
Nurses from ethnically diverse backgrounds may have the potential to enhance cultural
sensitivity to the patients. With this increased sensitivity comes better patient care, which may
result in shorter patient stays and ultimately a healthier community. As such Moceri (2012)
suggests policies may need to be put in place to support nurses as well as educate and promote
non-bias interactions.
With an increasingly aged population and a large demand for healthcare workers it is
imperative that we address the issues plaguing the health care industry. Employee retention must
be increased through less bias’ and less discrimination abused by other hospital staff. Those of
diverse backgrounds may already face these acts from patients and require additional support
from their cohorts. With an increased retention rate, workplace consistency increases resulting
in better patient care and clearly defined work loads. With an increase in both retention as well
as consistency, job satisfaction is greatly increased.

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Quite simply, with a satisfied and cohesive industry, the more attractive it becomes,
resulting in an upturn in nurses. It is now more important than ever that we promote this
standard to provide support to future populations. The implications if this standard is not meant
are monumental. However, if this standard is meant, we as a society gain benefits, resulting in a
healthier, satisfied, and motivated population both inside and outside of the hospital setting.
Methodology
A qualitative method will be used to understand how discrimination, within a hospital
setting, affects the career trajectory of minority populations in comparison to their white
counterparts. This research proposal will employ a qualitative method, using interviews for two
reasons. The first, is due to the nature of discrimination. Discrimination has been addressed and
laws have been put in place barring it from the workplace. However, it is still prevalent, just not
at the surface. As such, a qualitative method provides researchers with descriptions and
observations directly from the nurses. Second, qualitative data describes viewpoints from both a
minority nurse perspective and a majority nurse perspective.
Due to the complex nature of this phenomena, having an interviewer present will lower
the chances of confusion, resulting in clear, articulate responses. The sensitivity of
discrimination is also considered. Having an interviewer propose these questions may result in
reactivity, negatively affecting this study. To combat this, interviewers will inform all
participants that their replies will be kept confidential and completely anonymous. Further more,
by conducting interviews, researchers will be able to probe deeper into responses from
participants.
The population being studied will be registered nurses in the United States. A total
sample of 100 registered nurses will be recruited for this study from two urban hospitals in

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Minnesota. An equal number of Black, Asian, and Latino nurses and an equal number of White
nurses will be sampled from both of the two urban hospitals, respectively. That is 25 registered
nurses who are either Black, Asian, or Latino will be chosen for interviews and 25 White nurses
from each urban hospital. By interviewing both groups, this study will identify barriers, if any,
perceived within their setting. The sample will also give researchers the ability to identify if
incidence of discrimination is isolated or prevalent throughout the industry.
This study employs the use of purposive sampling. The researcher will select nurses
based upon perceived race across a variety of all shifts and units in order obtain the most
comprehensive sample. By using purposive sampling researchers can seek out nurses from both
populations without having to compromise the nursing staffs privacy. Furthermore, sampling
across all units and shifts, may yield further insight into perceived discrimination, resulting in an
exhaustive examination.
The anticipated sample size will be a total of 100 registered nurses within two urban
hospital settings in Minnesota. Purposively sampling 50 nurses from one urban hospital and the
remaining 50 from another urban hospital, researchers will be able to obtain an all-inclusive
sample. Of the 100 registered nurses sampled, 50 will be of a minority population, while the
remainder will be White, from each hospital respectively.
By requesting access into these hospital settings we can begin to understand the role of
registered nurses. This study will outline how registered nurses feel discrimination affects their
performance, quality of care to patients, and nurse retention. With a large population of nurses
nearing retirement, this field is slated to have a large deficit of workers. As researchers, we can
begin to identify key aspects affecting this field negatively. By identifying and addressing these

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issues one can begin to positively impact and draw a larger population into this increasingly
important field.
50 registered nurses from minority populations and 50 White registered nurses will be
sampled across all shifts from each hospital. By sampling an ethnically population the
researcher will attain a clearer picture of obstacles experienced. As prior research suggests
White nurses experience fewer (if any) perceived obstacles than minority populations. The
interviewer will address what the nurses like and dislike about nursing. Throughout the interview
process the participant will be voice recorded. Doing this ensures proper transcription
throughout the interview, resulting in a conclusive study.
Expected Findings
Through this study, researchers will be able to begin to answer how discrimination affects
nurses. The setting, in which this study will take place, will be two urban hospitals located in
Minnesota. By looking across all units, as well as all shifts, a clear picture will be present.
Conducting interviews in this manner will allow researchers to have representative data from the
hospitals nursing staff. By ensuring that all units and all shifts are interviewed a concise sample
will be drawn.
By focusing on acts of discrimination that nurses have received or have perceived from
other nurses, other staff, and patients researchers can begin to investigate which acts have the
greatest impact on nurses. The individuals studied must have a registered nurse degree, work in
one of the two urban hospitals in Minnesota being studied, and willing to complete the survey.
Acts of discrimination will be the specific actions that will be focused on. During the
interview processes nurses will report any perceived acts of discrimination. These acts can range
from derogatory comments, assigning work based upon the nurses ethnic background, as well as

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any other act solely based upon the nurses ethnic background. These acts may come from any
individual while the nurse is actively working at the hospital, whether it be hospital staff,
patients, or other nurses.
Based upon findings from literature it will be expected that minority nurses will receive
the most discriminatory actions from patients. Other findings based upon the literature includes
superior nurses, as well as doctors, paying more attention to White nurses. Further expected
findings include minority nurses receiving discrimination from other nurses, with acts such as
derogatory comments or scheduling these populations to less favorable shifts.
The nursing relationship with patients, other nurses, and hospital staff will be expected to
be complex as well as dynamic. These relationships may require further research to fully
understand the working conditions of registered nurses. Data provided will outline a sound
scientific outcome. This is due to the decision to sample two urban hospitals, survey across all
units, survey across all shifts, as well as the sample size of 100 registered nurses. The large
sample size ensures against skewed results from a-typical individuals sampled. This along with
all units and all shifts engages the nursing staff as a whole. By examining two hospitals the
chances of having an atypical staff due to organizational issues is greatly reduced.
Signals from individuals interviewed are expected. Some nurses may deny an interview
altogether while others are expected to gladly participate. Be explaining the intent of this study,
as well as ensuring complete anonymity and confidentiality, it is in the hopes of the researcher
that any negativity or skewed responses will be avoided. Involvement in the interview process is
essential for this type of research and although it may affect individuals responses slightly
through reactivity, it will not jeopardize this research.

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Through this research the healthcare field will benefit greatly. Barriers will be identified
and addressed. These barriers can then begin to be broken down. The results of this study are
but one step in this problem plaguing a soon to be ailing industry. Through the addressing of
these issues we can begin to work on ways to progressively attain a work environment free of
discrimination, resulting in a motivated and satisfied population.
Citations
Allen, Helen & John Larsen. 2003. “‘We need Respect’: Experiences of Internationally
Recruited Nurses in The U.K.” European Institute of Health and Medical Sciences.
14:178-187.
Browne, Irene and Joya Misra. 2005. “Labor Market Inequality: Intersections of Gender,
Race, and Class. Pp. 165-189 in The Blackwell Companion to Social Inequalities, edited
by Mary Romero and Eric Margolis. Malden, MA: Blackwell.
Elliot, James R. and Ryan A. Smith. 2004. “Race, Gender and Workplace Power.” American
Sociological Review. 69:365-386.
Gates, Michael G., and Barbara A. Mark. 2012. “Demographic Diversity, Value Congruence,
and Workplace Outcomes in Acute Care.” Research in Nursing & Health 35:265-276.
Giddens, Anthony. 1984. The Constitution of Society: Outline of the Theory of Structuration.
University of California Press, Berkeley.
Moceri, Joane T. 2012. “Bias in the Nursing Workplace: Implications for Latino(a) Nurses.”
Journal of Cultural Diversity. 19:94-101.

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Tajfel, Henri & John Turner. 1986. “The Social Identity of Intergroup Behavior.” Psychology
and Intergroup Relations. 1:7– 24.
U.S. Census. 2015. “State & County Quickfacts.” U.S. Department of Commerce. February 2,
2015. Retrieved February 22, 2015 (quickfacts.census.gov/qfd/states/00000.html)
Wheeler, Rebecca M., Jennifer W. Foster, and Kenneth W. Hepburn. 2013. “The Experience
of Discrimination by U.S. and Internationally Educated Nurses in Hospital Practice in the
U.S.A.: A Qualitative Study.” Journal of Advanced Nursing 70: 350-359.
W.H.O. 2010. “Classifying Health Workers: Mapping Occupations to the International Standard
Classification.” World Health Organization, Geneva. Retrieved February 19, 2015
(www.who.int/hrh/statistics/workforce_statistics)

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Appendix A (Script)
I am Aaron Guerdet, conducting research for social research 201. I am doing research on
the prevalence of discrimination perceived by registered nurses in a hospital setting in
Minnesota. I am going to give you information and invite you to be part of this research. Before
you decide, feel free to talk to anyone you feel comfortable with about this research.
This study will outline how registered nurses feel discrimination affects their
performance, quality of care to patients, and nurse retention. With a large population of nurses
nearing retirement, this field is slated to have a large deficit of workers. As researchers, we can
begin to identify key aspects affecting this field negatively. By identifying and addressing these
issues one can begin to positively impact and draw a larger population into this increasingly
important field. We believe that you can help us by telling us what you have experienced in your
time working in this hospital.

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Appendix B (Questionnaire)
1. Have you ever experienced any act directed at you based upon your race?
2. Did you find these acts to be positive or negative?
3. Based upon your experience could you describe the situation in your own words?
4. Has a co-worker ever been critical toward you based upon your race?
5. Has a patient or other non-staff questioned your qualifications?
6. Do you believe your employer does their best to offer a positive work environment?
7. Do you feel your employer could do more to offer a positive work environment?
8. In your own words, could you describe an act of discrimination you witnessed or
experienced within your work environment? How was this situation resolved?
9. Do you feel your co-workers are fair to each other?
10. Have you ever thought about leaving your position due to negative emotions?
Appendix C (Access Request Letter)

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Dear Hospital Administrator:
As you may know, a group of researchers are investigating registered nurses and their
perceived indications of discrimination within Minnesota hospitals. Previous studies suggest
discrimination is found in hospital settings, with the main source received from patients and
patients families. This discrimination affects nurses job performance as well as retention rates.
We would like to evaluate your hospital for perceived discrimination affecting registered
nurses. As part of this process, individuals from my research team will collect interviews from
registered nurses, across all shifts and units. This sampling will be conducted at no cost to you
and a summary of the analytical results will be provided to you. All sampling will be performed
in accordance with the MSU’s internal review board.
Please note that following this study’s publication your facility and all participants
remain anonymous. Thank you for your assistance in this matter. If you have any questions
about this study, please contact Aaron Guerdet at aaron.guerdet@mnsu.edu.
Sincerly,
Aaron Guerdet, Senior research director
Appendix D (Informed Consent Form)
Minnesota State University, Mankato
Social Research 201

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Research Proposal
This Informed Consent form has two parts:
-Information Sheet (to share information about the study with you)
-Certificate of Consent (for signatures if you choose to participate)
You will be given a copy of the full Informed Consent Form
Information Sheet
I am Aaron Guerdet, conducting research for social research 201. I am doing research on
the prevalence of discrimination perceived by registered nurses in a hospital setting in
Minnesota. I am going to give you information and invite you to be part of this research. Before
you decide, feel free to talk to anyone you feel comfortable with about this research.
This consent form may contain words you do not understand. As such, please ask me to
stop and I will take time to explain. If you have any questions later you may contact me or
another researcher.
This study will outline how registered nurses feel discrimination affects their
performance, quality of care to patients, and nurse retention. With a large population of nurses
nearing retirement, this field is slated to have a large deficit of workers. As researchers, we can
begin to identify key aspects affecting this field negatively. By identifying and addressing these
issues one can begin to positively impact and draw a larger population into this increasingly
important field. We believe that you can help us by telling us what you have experienced in your
time working in this hospital.
This research will involve 100 other nurses from two urban hospitals in all units and all
shifts. Each interview may take up to a half hour and has been approved by the hospital
administrator. All answers and content will be kept anonymous and your identity protected.

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Your participation is entirely voluntary. It is your choice to participate or not and will have
absolutely no bearing on your job or other work-related evaluations.
I have read the foregoing information, or it has been read to me. I have had the opportunity to
ask questions about it and any questions I have been asked have been answered to my
satisfaction. I consent voluntarily to be a participant in this study.
Certificate of Consent
Print Name of Participant__________________
Signature of Participant ___________________
Date ___________________________
Day/month/year
Print name of witness____________ Thumb print of participant
Signature of witness _____________
Date ________________________
Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the potential participant, and to the best of
my ability made sure that the participant understands that the following will be done:
1. A formal interview asking questions related to discrimination.

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2. All answers will be kept confidential.
3. All names and answers will be kept anonymous
I confirm that the participant was given an opportunity to ask questions about the study, and
all the questions asked by the participant have been answered correctly and to the best of my
ability. I confirm that the individual has not been coerced into giving consent, and the consent
has been given freely and voluntarily.
A copy of this ICF has been provided to the participant.
Print Name of Researcher/person taking the consent________________________
Signature of Researcher /person taking the consent__________________________
Date ___________________________
Day/month/year