Hospital Working Experience of Chinese Nurses and Racial Discrimination associated with the COVID-19 Pandemic: A Thematic Analysis

This research proposal focuses on the hospital working experience of Chinese nurses and the racial discrimination they face during the COVID-19 pandemic. The study aims to analyze the impact of perceived racial discrimination on international nurses and suggest strategies to address the issue. The research follows a qualitative study design and uses both primary and secondary data sources.

Research Proposal

Abstract
There is an escalation of racial discrimination against Chinese population in the Novel
Coronavirus (COVID-19) pandemic. Some healthcare providers with Chinese ancestry were
racially harassed by the local Australians. Thus, during the study, qualitative study design is
followed that helps to collect in- depth research and both primary and secondary data sources has
used in order to conduct the entire research in more precise manner. Under secondary study,
relevant books and articles are chosen and also link with theories on racial discrimination that
explain the hostility may be linked with White supremacy, Social Identity Theory and Realistic
Conflict Theory. However, these theories do not address one limitation as seen in COVID-19.
While on the other side, for primary study, Chinese nurses working in a local hospital will be
recruited for an individual face-to-face semi-structured interview. Thus, results are generated
with the help of Thematic analysis to analyse the data followed by comparing and contrasting the
individual accounts of the participants.

Table of Contents
Abstract............................................................................................................................................2
INTRODUCTION...........................................................................................................................4
Literature Review............................................................................................................................5
Theme 1: Perceived racial discrimination in nursing before COVID-19 pandemic...................5
Theme 2: Impacts of perceived racial discrimination on international nurses............................5
Theme 3: Reaction towards perceived racial discrimination.......................................................6
Rationale for Study......................................................................................................................7
Methodology....................................................................................................................................8
REFERENCES..............................................................................................................................12

Topic: Hospital Working Experience of Chinese Nurses and Racial Discrimination associated
with the COVID-19 Pandemic: A Thematic Analysis
INTRODUCTION
In Australia, the Nursing population is the largest among all healthcare workers.
According to the 2015 census, there were 306487 nurses and midwifes, which was 57.6% total
number of registered and employed healthcare providers (Health Workforce Summaries, 2020).
Within this population, there were 20.4% employed overseas nurses. The recruitment does not
limit to English-speaking countries, but also nurses from Asia (Negin and et al., 2013). It is also
analysed that nonlocal nurses may experience racial discrimination, the mistreatment of a
different race, colour, or nationality. There are instances of Australian patients racially harassing
healthcare professionals with a Chinese origin during the COVID-19 pandemic. This was
revealed by a Chinese doctor who was scolded by a stranger to go back to China. Similar
instance was reported in a hospital setting where doctors and nurses with ‘Asian faces’ were
physically abused by the patients who accused them as the COVID-19 virus carriers.
These occurrences suggest that frontline healthcare providers need to prepare for any racist abuse
from the residents. However, Australian healthcare providers may also have racial discrimination
against nonlocals. This is supported by an instance that an Australian doctor refused to perform
COVID-19 testing on Aboriginal and Torres Islander patients without justification. The codes of
conducts of nurses encourages the nurses to report to a supervisor when they perceive racial
discrimination at workplace (Kawi and Xu, 2009). In the same way, current proposal will
highlight the current situation of Australia in terms of discrimination and also suggest the ways
through which the problem is minimized up to some extent. With the help of primary and
secondary data sources, investigator highlight the issues and tries to meet the define aim.
The experience of Chinese nurses working in a hospital can reveal the extent racial
discrimination may affect their working. Their experiences help in developing a more effective
strategy or training program for acting against racial discrimination in workplace. These
measures will be important to protect Chinese nurses who may be forced to work with local
healthcare team members and patients due to current nursing shortage in Australia.

Literature Review
Theme 1: Perceived racial discrimination in nursing before COVID-19 pandemic
Hawthorne (2001) stated that there are many ways through which nurses are
discriminated such that overseas nurses may perceive racial discrimination from their colleagues
and patients. This was reported by an employed Malaysian nurse who recalled the local nurses
did not believe in her qualification and described her as inferior and incompetent when she
started working. Similar encounter was reported by Mapedzahama and et.al., (2012) in which
black nurses whom some local nurses described as being ‘innocent’ at work because the black
nurses could not integrate well with the nursing team. International nurses may perceive racial
discrimination based on some behaviours of their colleagues. They may think their colleagues
isolate them because of their nationality.
Zhou and et.al., (2011) also stated that a Chinese nurse thought a local doctor
discriminated her because of her nationality when he ignored her and went to a local nurse for
information about a patient she was in-charge of. This clearly reflected that she was
discriminated by other. Another incident of an immigrant nurse from a non-English background
also recalled an instance of racial discrimination where the local nurses did not talk to her during
break. Local patients may racially discriminate overseas nurses by refusing them as healthcare
providers (Doctor and nurses at Melbourne hospital racially abused over coronavirus, 2020).
Omeri and Atkins (2002) also evaluated that similar to some local nurses, patients also
mistreat with nonlocal nurses. This was evident in an account from a black nurse that one patient
refused her care because the nurse was a ‘black filthy thing’. A thorough search in the literature
did not yield any result on the racial discrimination reported by the White overseas nurses in
Australia. The result suggests the locals may discriminate overseas nurses primarily based on the
differences in physical attributes, which was consistent with the personal accounts from the
nurses during the COVID-19.
Theme 2: Impacts of perceived racial discrimination on international nurses
According to O'Donoghue (2005) Perceived racial discrimination may affect nurses in
two areas: mental wellbeing and working performance. Overseas nurses may experience stress
and have low self-esteem when they face the aggressive attitude from the local staff members.
Local nurses may hold a hostile attitude for a long time as bullying new employees, regardless of

their race or specialty, is considered a common norm within the nursing community. Along with
this, patients are also holding a racist attitude against international nurses can act as another
stressor.
Randle, J. (2003) also presented own views that Asian nurses became stressed and
frustrated when they did not know how to handle patients refusing care and making racist
comments. Prolonged stress is related to the development of anxiety, depressive symptoms, and
suicidal ideation. Overseas nurses are more vulnerable to these clinical symptoms because of the
limited support that they may have in a hospital setting. The stress associated with perceived
racial discrimination can lower the working performance of the international nurses. An
Australian study found 63.5% of 2407 nurses who became stressed because of workplace bully
made more mistakes when delivering care to patients (Indigenous Doctor warn that racism will
cost lives, 2020).
Theme 3: Reaction towards perceived racial discrimination
Yildirim and Yildirim (2007) evaluated that international nurses may react to the
instances of perceived racism differently at work. Nurses may remain silent and continue to work
without launching a complaint on any instances of racist bully from their colleagues. Some
overseas nurses may attempt to reduce or avoid further racial encounter by quitting the job.
However, some nurses may choose to confront and develop an effective coping strategy. A
Maori nurse working in New Zealand experienced stress initially when her patients made racist
comments. She decided to express her feelings to the patients who later apologised for their
behaviours. Hence, this is clearly reflected that due to discrimination nurses affect their entire
working and lead their performance in negative manner as well.
Theories on racial discriminatory acts
The racial discrimination against non-White overseas nurses demonstrates local Australians
believe in White supremacy. It is a notion that people with White skin are more superior to other
races and should granted with more power and rights. This concept explains the instances of
racial discrimination associated with the sense of superiority among local nurses and patients.
Local nurses who hold this belief perceive themselves more superior than nonlocal nurses of
other skin colours (Farrell, Bobrowski and Bobrowski, 2006). This belief is reinforced when
local nurses are more familiar with the Australian culture, the logistics and protocols in the

hospital, and have a higher English fluency than most overseas nurses from a non-English
speaking background. Local patients with this belief may hold similar stance and do not trust in
the non-White overseas nurses. They use the power and rights granted by White supremacy to
demand changing the nurse who is in-charge of them. White supremacy matches with the
consumerist culture within a medical setting requires nurses, regardless of races, are always
reminded to put patient in the first priority, suggesting they are obligated to satisfy patient’s
demands Rutherford and Rissel, 2004). Overseas nurses often find it difficult to deny their
demands because patients are in a higher power position than nurses.
Theorists explain racial discriminatory acts in terms of ethnic nepotism. The social identity
theory (SIT) suggests people innately search for social identity by seeking a relationship with a
group. People distinguish themselves from outsiders based on the unique positive aspect of their
belonging group. In-group favouritism is observed as in-group members treat others more
favourably, which strengthens the sense of social identity (Shields and Price, 2002). SIT and
White supremacy may explain the observed avoidance of interacting with overseas nurses from
non-English origins among local nurses and patients. Local patients and nurses think they belong
to the same group because of the same race. Local nurses believe it is easier to socialise with
other local nurses because both have similar knowledge and background. They may hold a
prejudice that nonlocals do not understand them, leading to marginalisation of nonlocal nurses in
workplace. According to SIT, local patients may believe local nurses will deliver more
favourable treatments than nonlocal nurses. The patients may believe the nursing care delivered
by the local nurses is better than that by the nonlocal nurses, which explains their refusal for
letting nonlocal nurses be in-charge of them.
Theorists elaborate from SIT and suggest that intergroup conflicts lead to tension and hostility.
The realistic conflict theory (RCT) posits that intergroup conflict arises over limited resources. It
builds on a zero-sum premise that only the ‘winner’, or the dominant group, can access the
resources (Tajfel and Turner, 2001). Each group resorts to aggressive or violate methods to
secure or claim the available resources. The theory may explain the hostility between local and
overseas nurses. Local nurses may engage in overt discriminatory acts against nonlocal nurses
based on a belief that they steal the job opportunity from the locals.

Rationale for Study
The rationale for conducting the research is researcher analyse that there is a
discrimination between the Chinese nurses after COVID-19. So, with the help of this study,
investigator wants to draw attention of readers towards an issues. Moreover, Local nurses may be
forced to work with Chinese nurses and even patients are not even ready to get treated with
Chinese nurses and this reflected the discrimination. As pandemic has been lasting for over six
months and that is why, all the nurses and patients also change their perception towards Chinese
nurses. Hence with the help of the current study, scholar wants to provide the ways through
which the issues is minimized up to some level. Also, another reason is scholar have their own
interest to study on this which in turn helps to enhance the knowledge and meet the define aim.
Research Question
The study tries to answer what is the experience of Chinese nurses working in a hospital when
there is a racial discrimination associated with COVID-19 pandemic. The following sub-
questions will also be answered:
 What is, if any, the experience did Chinese nurses faces related to racial discrimination in
a hospital?
 What is the relationship between the working experience of Chinese nurses in hospital
and perceived racial discrimination at work?
Methodology
Research Strategy
There are two types of study, Qualitative and quantitative. So, between both qualitative
study design will be used because of the nature of the subjective experience of Chinese nurses,
which may not be reflected using objective measurements employed in a quantitative study. It
also help in-depth research through which scholar conduct the research in proper manner and
generate the valid outcomes as well (Parker, 1999).
Sampling and Participants
This study will recruit 12 participants to reach data saturation. Purposive sampling will be
used to recruit participants of a specific demographic. Participants who have the following

inclusion criteria will be recruited: (1) They have a Chinese ancestry. (2) They are working as a
licensed nurse. (3) They are working in a public or private hospital in Australia. Both overseas
Chinese nurses and Australia-born Chinese will be suitable participants because recent accounts
and past study indicate that local Australians harass people of other races based on primarily skin
colour. Internet advertisement will be used for recruitment because it can help to reach the
targeted population. Study invitations will also be sent to hospitals for assistance in recruitment.
Participants will be recruited using a snowball sampling method (Jackson, 1993). Each
participant will be asked to send the study invitation to other Chinese nurses working in a
hospital. The target population is small compared to that of Australian local nurses. The referral
from the participant will help the study by speeding up the recruitment process.
Data Collection
Under the study, both primary and secondary data sources will be used that assist to
conduct the study in more precise manner. Such that for secondary study, different books and
journals are selected which in turn help to meet the define aim. While in the case of primary
study, Semi- structure interview will be chosen. The interview will be conducted in a common
public area. The background and aims of the research will be explained to the interviewees upon
arrival.
Process of Conducting Interview
The language for the interview will be chosen based on the preference of the interviewees. The
interview will be expected to last for forty-five minutes to one hour. The interview will be audio-
recorded. The interviewer will jot notes during the interview to assist in developing follow-up
questions that are worth raising (Guest, Bunce and Johnson, 2006). Each participant will be
reminded they can pause or quit the interview if necessary. Interviewees will also be asked to
provide a pseudonym to protect their privacy. Participants will be given an English and a
Chinese consent form. Informed consent will be sought before the interview.
A semi-structured interview will be used to allow greater flexibility for data collection. The
interview protocol will be divided into two parts. The first part will enquire the descriptive
experiences of the participants. This section includes questions enquiring the general working
background and the specific working experience with people in hospitals (e.g. How is your

working experience with local colleagues and patients during the COVID-19?). Participants will
also be asked to recall any experience related to their Chinese ancestry before and during the
pandemic (e.g. What is your experience of working with local colleagues and patients that is
relevant to your Chinese ancestry before and during COVID-19?). The second part of the
protocol will enquire about the thoughts on the working experience. Interviewees will be asked
to compare and comment on whether there is a change in the working experience with local
people before and during the COVID-19 (e.g. How do you comment on any difference in
working with your colleagues and patients before and during COVID-19?). They will be also
asked about the impacts that COVID-19 may have brought to their work (e.g. How do you think
your working experience with your colleagues and patients has been affected during the CVOID-
19 pandemic?). Participants will also be asked about the perceived impact of their Chinese
ancestry during work in the pandemic (e.g. How relevant is your Chinese ancestry to your
working experience with your colleagues and patients before and during COVID-19?).
Interviewees will be asked about anything they want to add at the end.
After the interviews, verbatim transcription will be done. Each transcription will be saved as a
Microsoft Word document file with a password. All files will be saved in the personal computer
of the researcher to limit the access to the data.
Data Analysis
For the current study, Codes of each transcription will be analysed through thematic
analysis. The emerged themes of all transcripts will be compared and contrasted. The researcher
will follow the guidelines by Braun and Clarke (2006) in thematic analysis. The steps include
familiarising with data, generating initial codes, searching for themes, reviewing themes,
defining and naming themes and writing up the report. Themes that are common in all transcripts
will be kept. Themes that are different from the common themes will also be kept to demonstrate
the diverse range of perspectives on the study topic.
Validating Strategies
The report will develop credibility through respondent validation, reflexivity of the researcher
and using thick rich description. Respondent validation involves the respondents to check the
accuracy of the transcripts by making any appropriate changes (Torrance, 2012). This process

will repeat until respondents agree there is no more need for modification within the transcript.
Reflexivity will help the researcher to become aware of any cultural sensitivity issue during the
study. Thick rich description will be provided by using the words from participants to support the
emerging themes.
Ethical consideration
It is the duty of the researcher to take prior consent and make sure that proper respect and
dignity is maintained so that results will not affected in negative manner. Also, scholar should
make sure that there must be a proper flow of communication so that it will not cause delay in
the result. Moreover, Data Protection Act must be followed by the researcher in which proper
confidentiality should be maintained to get proper results.
Reflexivity
I was born in Hong Kong and I have been living in Hong Kong for more than twenty years. I
moved to Australia to pursue my psychology degree one year ago. I had a part-time job as a shop
assistant at a local clothing shop. I did not experience any racial harassment from a foreigner in
Hong Kong and Australia. Contrarily, they were friendly and treated me as if I was another
Westerner. Therefore, I realise the problem of racial discrimination might not be as serious as
portrayed in the media. This perception may lead me to underestimate the extent of racial
discrimination in the thematic analysis. I may dismiss the participants’ perceived racial
discrimination as over-exaggeration, which can lower the credibility of the emerging theme. I
need to put more emphasis on validation strategies to maintain the credibility of the overall
analysis. The Chinese ancestry that I have may assist in data collection. The interviewees may be
more open to share their experiences. To reduce the bias that I have, I need to ask questions to
confirm what I understand is the same as what the participants convey. This can be achieved by
referring to the jotted notes to raise follow-up questions during the interview.

REFERENCES
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Online
Doctor and nurses at Melbourne hospital racially abused over coronavirus. 2020. [Online].
Available through: <https://www.theguardian.com/world/2020/feb/27/doctors-and-nurses-
at-melbourne-hospital-racially-abused-over-coronavirus-panic>.
Indigenous Doctor warn that racism will cost lives. 2020. [Online]. Available through:
<https://www.aida.org.au/wp-content/uploads/2020/03/Indigenous-Doctors-warn-that-
racism-will-cost-lives-MEDIA-RELEASE.pdf>
Health Workforce Summaries. 2020. [Online]. Available through:
<https://hwd.health.gov.au/summary.html#part-1>