The Experience of Marginalization Among Psychiatric Advanced Practice Nurses: A Cross-Sectional Study

Abstract

Purpose: The purpose of this study was to describe and compare the differences in self-reported marginalization and resilience within the psychiatric advanced practice registered nurse (APRN) community while describing the potential role marginalization may have in the psychiatric APRN’s resilience, interactions with patients, their professional community, career trajectory, and well-being.Background: APRN provider marginalization negatively impacts patient care outcomes, provider health, and ultimately the fiscal stability of health care systems. Deeper insight into the dynamics that may mitigate marginalization and optimize resilience within professional acculturation, can empower the nursing community to innovate early intervention programs aimed at sustaining provider health and professional fulfillment. Research Design: A descriptive cross-sectional design. Methods: A purposive sample of clinically practicing psychiatric APRNs were invited to complete a survey with 7 demographic questions, the Englund Marginality Index (EMI), the Connor-Davidson Resilience Scale 10 (CD-RISC-10), and 4 open-ended questions. Data were analyzed using descriptive and inferential statistics. Qualitative content and constant comparative analysis were used to analyze the open-ended questions. Results: Age, race, and ethnicity predicted EMI, while terminal academic degrees predicted CD-RISC-10. Content analysis of qualitative data added trust, distrust, and provider relationships to the themes inherent in the Intersectionality theoretical framework. Implications: Global mental health provider and nursing shortages are increasing across clinical and academic domains. Both non-psychiatric and psychiatric nurses manifest the stigma common when interacting with those with mental illness. As both psychiatric and non-psychiatric RNs seek advanced practice training, they may harbor and/or grow these biases towards their peers and themselves, providing the fertile breeding ground for not only the culture of marginalization but the community of oppressed group dynamics, historically identified in nursing. Key findings point to addressing biases within the nursing profession, healing the splintered physician: APRN relationship and distrust in healthcare, and initiating an ontological renaissance within the ranks of the APRN profession. Preserving provider health, while mitigating both patient risk and overall health care cost through a deeper understanding of these dynamics and innovation of early academic interventions, may lead to less provider attrition and greater retention, thus addressing our national nursing and skilled psychiatric provider shortages.