title: The experience of discrimination by US and Internationally educated nurses in hospital practice in the USA: a qualitative study.
abstract: OBJECTIVE
  To document experiences of nurses educated abroad and in the USA in 2 urban hospitals in the southeastern USA.
  
  
  BACKGROUND
  Nurses are responsible for providing quality patient care. Discrimination against nurses in the workplace may create hostile environments, potentially affecting patient care and leading to higher nurse attrition rates. Structuration theory posits that agents' interactions create structures. Agents' use of resources and rules shapes interactions, potentially changing the structures. In this study, nurses described interactions with patients and their families and other healthcare personnel, their strategies for managing interactions and rationales behind their selected strategy.
  
  
  METHODS
  This study employed a qualitative, explorative approach using structuration theory.
  
  
  METHODS
  In 2011, 42 internationally educated and 40 USA-educated nurses practising in two urban hospitals in the southeastern USA were interviewed about their experiences in the workplace. Forty-one nurses were re-interviewed to explore the issues raised in the preliminary round: 21 internationally educated and 20 USA. Transcripts were analysed using the constant comparative method.
  
  
  RESULTS
  Although internationally educated nurses experienced more explicit discrimination, all nurses experienced discrimination from their patients, their nurse colleagues and/or other hospital personnel. Internationally educated nurses and USA nurses shared similar coping strategies.
  
  
  CONCLUSIONS
  The prevalence of nurses' experiences of discrimination suggests that healthcare institutions need to strengthen policies to effectively address this harmful practice. More research is needed about discrimination against nurses in the workplace because discrimination may have serious psychological effects that impact nurse retention and the quality of patient care.
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Wheeler
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Foster
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Hepburn
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D064700:Nurses, International / Q000523:psychology; D009745:Nursing, Supervisory; D011287:Prejudice / Q000523:psychology*; D015144:Southeastern United States; D017132:Workplace / Q000523:psychology; D055815:Young Adult
keywords: coping strategies; discrimination; ethnicity; internationally educated nurses; nursing