Discrimination against persons based on characteristics linked to their ethnicity or migration status is prevalent worldwide [1]. In Germany, too, representative longitudinal studies of the population documented a general polarization of society and the emergence of extreme right-wing and nationalist tendencies [2]. We understand discrimination to entail people being disadvantaged and belittled in relation to ascribed features, such as, e.g., gender, social background, age, disability and sexual orientation, as well as religion, language and ethnic origin [3, 4]. Discrimination mechanisms are anchored on the individual and institutional levels and in society as a whole [4]. Numerous systematic reviews documented the negative effects on the mental and physical health of those affected, such as increased prevalence of depression, anxiety disorders and excess weight [5, 6].
The health system mirrors the state of society and, therefore, also reflects existing discrimination dynamics that may impact both patients and staff. Relevant studies in the hospital environment previously examined different professions and clinical specialties [7, 8] and certain forms of discrimination, e.g., regarding the gender of affected persons [9–11]. Studies focusing on systematic discrimination against healthcare staff based on features associated with their ethnicity, such as, e.g., nationality, language or religion, showed that in countries of the Global North, e.g., the USA, the UK and Canada, racial discrimination in their profession is an everyday experience for nurses [12, 13] and physicians [14,15,16] and that such discrimination has a continuous history. Forms of discrimination included disadvantageous treatment on both interpersonal and institutional levels, e.g., more difficult career progression [17,18,19], more frequent disciplinary procedures [20], more unpaid overtime and less participation in work planning [21] and most recently in relation to the COVID-19 (coronavirus disease 2019) pandemic, indications of higher rates of mortality and exposure to infection [22]. Studies pointed to a wide spectrum of persons, e.g., patients, colleagues and superiors, as the source of reported discrimination [23,24,25]. A clustering of discrimination experiences linked to precarious forms of employment such as part-time work [10, 21] and the educational level of those affected [7, 26] was further observed. In addition to well-known effects of discrimination on individual health and well-being, additional professional and institution-related impacts of such experiences in the workplace were widespread. Discrimination and threats at the workplace were associated with lower job satisfaction [13], poorer mental and physical health [7, 27], higher stress levels [8], more days lost through sickness and more frequent mental and physical withdrawal [23, 28, 29]. Persons affected by discrimination reported diminished self-esteem and reduced productivity [30, 31]. Studies also showed that in terms of institutional outcomes, discrimination was related to staff fluctuation of both nurses and physicians [13, 32]. Direct and indirect effects of discrimination in clinical workplaces were further associated with negative impacts on the quality of patient care and higher costs in the healthcare system [8, 28, 31].
Studies on discrimination of healthcare staff demonstrated the importance of taking into account the interplay and mutual reinforcement of discrimination mechanisms based on characteristics of the affected persons, such as social background, gender, professional status, age and ethnicity or experience of migration [16, 30, 33, 34]. This so-called intersectional approach is highly relevant in analysing discrimination both on the micro level and in institutional structures, e.g., in a hospital, where hierarchical structures and a high proportion of women (particularly in nursing) prevail [8, 17, 33]. Racism and discrimination against persons due to their nationality, ethnicity or migration status followed specific historical lines of development on the national level [35]. It is, therefore, important to take into account the particular national situation and its distinctive features from other contexts. In Germany, the early loss of its colonies after the first World War, the extermination of ethnic minorities during the Nazi regime, and a high influx of migrant workers and their families from Turkey, the former Yugoslavia and Southern European countries such as Greece and Portugal in the 1950´s to 1970´s have led to a different formation of minorities in comparison with, e.g., the USA [36]. Despite some qualitative studies in German-speaking countries, in comparison with the state of international research there are large gaps in quantitative research in Germany on discrimination experienced by hospital healthcare staff. Large-scale studies in Germany are thus required relating to the two numerically largest groups of staff in the healthcare field.
Accordingly, an online survey of discrimination experiences addressing hospital nurses and physicians was carried out as part of a larger multicenter mixed-methods research project. Our study was the first to focus on (a) the description of healthcare staff’s observed or personally experienced discrimination in the workplace and of identified perpetrators and ascribed reasons, and (b) the examination of interpersonal and institutional factors associated with these discrimination experiences of healthcare staff.
