Uncovering the extent and drivers of burnout among Hispanic nurses

Surveys from the COVID pandemic have found that as many as 50% of nurses experienced burnout and that stressors were linked to younger age, fear of caring for patients with COVID and of infecting family members, and limited organizational resources.

Researchers from the University of Pennsylvania School of Nursingand Leonard Davis Institute of Health Economics, however, saw that little attention was paid to the crisis specifically among Hispanic nurses, who make up 6% of the nursing workforce in the United States but face disproportionate challenges.

While past research has documented pay disparities and higher reports of intent to leave among Hispanic nurses, along with a higher likelihood of contracting COVID and experiencing familial losses from the virus, the new study from Penn Nursing researchers, published in the journal Nursing Outlook, focused on burnout among Hispanic nurses.

The researchers found that 55% of Hispanic nurses reported burnout and 18% experienced COVID-related post-traumatic stress disorder, compared to 51% and 13% of non-Hispanic white nurses, respectively. They show that this disparity was tied to both work environment and differences in nurse characteristics, such as age.

"It was surprising and alarming to see the rates of burnout for Hispanic nurses and even more so because so many of them are younger," says Penn Nursing's J. Margo Brooks Carthon, the study's first author. "It's concerning when we see nurses from underrepresented backgrounds and have so much to contribute experiencing the greatest toll."

Brooks Carthon asked Dean Antonia M. Villarruel,who has extensive experience working with Hispanic communities and advocating for the mobility of Hispanic nurses, to get involved with this research.

"There needs to be attention paid to nurses' well-being given the continued stress of dealing with complex life and death situations on a daily basis," says Villarruel, the paper's senior author. "There are important system issues (e.g., nurse environment) that need to be addressed while at the same time understanding personal stressors that may vary by race, ethnicity, gender, and years of practice experience."

She says that understanding how to improve the well-being of the nursing workforce, which impacts patient outcomes, fits into the School of Nursing's broader approach of viewing research, practice, and education through a health-equity lens. This work builds on Penn Nursing research related to workforce and efforts to understand "the unique contributions of and challenges experienced by Hispanic and other nurses of color," Villarruel says.

The study sample included 798 Hispanic and 6,642 non-Hispanic nurses in 249 hospitals in Illinois and New York who were surveyed in the spring of 2021. Hispanic nurses were younger on average than non-Hispanic white nurses-38-years-old compared to 43-and the surveys found that younger nurses were more likely to experience burnout.

The researchers found that Hispanic nurses were more likely to work in poor work environments than non-Hispanic white nurses and that 63% of nurses in such settings experienced burnout compared to 36% of nurses in good work environments. They measured the work environment using a scale that assessed perceptions of nurse participation in hospital affairs, foundations for quality care, management ability, staffing and resources, and interpersonal collaboration.

"I don't want our findings to simply raise awareness. We would like to see these results used in framing dialogue for co-creating solutions," Brooks Carthon says. One key step is making sure hospital administrators are aware of who is most at risk.

She notes that minority nurses are more likely to experience microaggressions and bias, but they may not know how to report incidents or fear reprisal if they do. Brooks Carthon says the orientation period for nurses is therefore an opportunity to set the tone and explain a zero-tolerance policy.

Another strategy to support newer-to-practice nurses is working with academic partners to ensure graduates have the skills to adapt to the practice setting, such as knowing how to de-escalate violent situations, Villarruel says. She adds that another is providing support for the transition, such as new nurse internships and mentoring.

Their research into burnout among Hispanic nurses isn't stopping here. To get a view of the landscape in 2024, Brooks Carthon says, Penn Nursing's Center for Health Outcomes and Policy Researchhas fielded a survey not only in Illinois and New York but also in eight other states.

J. Margo Brooks Carthon is the Tyson Family Endowed Term Chair for Gerontological Research and a professor in the School of Nursing's Center for Health Outcomes and Policy Research and Department of Family and Community Health at the University of Pennsylvania.

Antonia M. Villarruel is the Margaret Bond Simon Dean of Nursing, a senior fellow at the Leonard Davis Institute for Health Economics, and director of the WHO Collaborating Center for Nursing and Midwifery Leadership at Penn.

The other co-authors are the School of Nursing's Kelvin Amenyedor, Heather Brom, Jennifer Gil, Christin Iroegbu, Alexandra Maye, and John Rizzo and the National Association of Community Health Centers' Wanda Montalvo.

This research was supported by the National Institute of Nursing Research under the National Institutes of Health (T32NR007104).