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Investigating occupational stress, racial identity, and mentoring for African American women in health care.

This study examined the influence of racial identity and mentoring experiences on occupational stress among African American women in health care (N = 76). The women were surveyed about their occupational stress (role stress, psychological strain, and personal resources), racial identity, demographic information, and mentoring experiences. Results indicated that racial identity was negatively related to role stress and psychological strain, and level of education was closely related to personal resources. Mentoring was not found to have a significant impact on occupational stress as hypothesized. The implications for enhancing occupational satisfaction were discussed in relation to advocacy for career development professionals.

Keywords: African American women, occupational stress, racial identity, mentoring, health care


Work and race-related stress are inherent in primary and secondary job markets and have affected African American women's work and personal lives (Barnett & Baruch, 1987; Gianakos, 2000). Cook, Heppner, and O'Brien (2005) recognized the complexities of understanding race and gender within an organizational structure and stated, "At the individual level, one of the most important but poorly understood variables influencing interactions with the environment is that of race or gender identity" (p. 171). Racial discrimination at work has had deleterious consequences for African American women and has been associated with high levels of psychological strain and low levels of satisfaction (Brown et al., 2000; Niles & Harris-Bowlsbey, 2013; Robinson & Howard-Hamilton, 2000).

Work-related stress is recognized as one of the most serious occupational hazards, resulting in employee dissatisfaction, lowered productivity, absenteeism, and turnover (Barnett & Baruch, 1987; Karasek, 1979). Lazarus and Folkman (1984) wrote that stress can affect individuals through disturbed affect, impaired motor behavior, changes in cognitive functioning, and physiological change. Many African American women face even more elevated levels of stress because of more restricted economic opportunities (U.S. Department of Labor, Women's Bureau, 2014; Ward & Bingham, 2001). African American women continue to experience intense stress related to work concerns, especially role conflict and personal strain (Cook et al., 2005; Lach, 1999).

Burlew and Johnson (1992) examined African American women in traditional and nontraditional occupations and found that both occupational groups experienced strain related to role conflict. The role conflict resulted when the women tried to balance their work lives with their family roles and responsibilities. Compared with their European American counterparts, African American women experienced strain related to racial discrimination, which might exacerbate the strain related to role conflict (Hackett & Byars, 1996; Woods-Giscombe, 2010).

Catalyst, a leading research and advisory organization, surveyed 963 African American women in 2004 about their experiences in the workforce with the hope of providing tools for recruitment and retention for managers. There were two significant findings: (a) African American women felt their greatest employment barrier was not having an influential mentor/sponsor (43%), and (b) more than half of the women (56%) agreed strongly that racial stereotypes about women of their race/ethnicity exist in their company.

African American women are stressed economically. According to the U.S. Department of Commerce, Executive Office of the President, and White House Council on Women and Girls (2011), African American women continue to experience a pay gap when compared with non-Hispanic White women and African American men, and they are significantly more likely be classified as poor. The precedent for lower wages and lack of opportunity for economic advancement originated within the institution of slavery; after emancipation, African American women historically worked in three different arenas: agriculture, outside domestic employment, or home (Collins, 2000; Ward & Bingham, 2001). African American women later began to expand their work opportunities by moving into still lower paying service occupations such as clerical, food, and building services positions, where they are currently overrepresented (U.S. Department of Labor, 2012).

In this article, we use African American and Black interchangeably as we examined the experiences of the women in this study. We are cognizant that there is a dearth of literature on racial identity and mentoring after 1999, with less attention being paid to Black racial identity and mentoring of Black women; hence, the citations are primarily found in the 1990s. Black racial identity refers to perceptions of oneself and others as a member of a racial group (Black/African American), with the respective original culture being from Africa (Helms & Cook, 1999; Helms & Piper, 1994). Each status of racial identity is considered a distinct worldview that becomes cognitive templates helping individuals to organize racial information about themselves, other people, and institutions (Helms, 1990). The cognitive templates begin with Preencounter attitudes (individuals think of themselves as being non-Black, dominated by a White frame of reference). Helms and Piper (1994) reported greater satisfaction by Black workers when racial identity was underdeveloped. The other cognitive templates include Encounter attitudes (individuals question the old identity because of a startling person or social event), followed by Immersion/Emersion (individuals tend to idealize everything that is Black and denigrate everything that is White and may present with anger), and finally Internalization (individuals begin to achieve inner peace and tend to feel satisfied with their Blackness). The Internalization status is characterized by reason rather than emotion, ideological flexibility, and a general decline in strong anti-White feelings (Helms & Parham, 1990). According to Helms (1990), the Internalization status allows greater freedom for connecting with others, which highlights the potential to develop mentoring or developmental relationships at work.

Mentoring relationships can happen on two levels: career related and psychosocial (Kram, 1988; Schwiebert, 2000). Career-related mentoring has a career development orientation, providing career guidance, protection, exposure/visibility within an organization, and sponsorship. Psychosocial mentoring has an interpersonal orientation, providing role modeling, counseling, acceptance, confirmation, and friendship. The most significant mentoring dyad reported in the literature is same-race/same-gender mentoring, with beneficial consequences for individuals and organizations through increased career self-efficacy, job involvement, and self-esteem at work, along with a decrease in propensity to leave the organization (Catalyst, 2004; Hackett & Byars, 1996; Lazarus & Folkman, 1984; Schwiebert, 2000; Thomas, 2001).

Given the impact of racial identity and mentoring on African Americans, we designed this study to investigate whether racial identity personal and work environmental factors would influence African American women's occupational stress. More specifically, the study addresses whether racial identity, occupational positions, educational level, and mentoring influence the level of occupational stress for African American women.



The participants were 76 African American women who were employed in a nonprofit health care organization in the Midwest. They were from three different occupational groups: professional/managerial (22.4%), technical/sales/admin/clerical (26.3%), and service (50%); 1.3% did not report their occupation. Of the sample, 39.5% reported having some college, followed by 22.4% with high school/GED, 10.5% with a bachelor's degree, 9.2% with less than high school education, 3.9% with a master's degree, and 1.3% with a doctoral degree; 13.2% did not report their education. The 36-45 age group represented in the sample was the largest at 39.5%, followed by 21.1% for the 46-55 age group, 9.2% for the 18-25 age group, and 18.4% for the 26-35 age group; 11. 8% did not report their age. More than 80% of the participants were employed full time, with approximately 11% working part time and the remainder not reporting their employment status. Ten women (13.2%) reported having a mentor, with all being same race and same gender except one, who reported having a mentor of the same race and a different gender.


Demographic questionnaire. The questionnaire included questions about age, race (to identify only African American women as the focus for this study), marital status, occupation, education, and mentoring. We identified position titles for participants and then placed them in the three occupational groups: professional/managerial, technical/sales/admin/clerical, and service. Six questions inquired about the nature of any mentoring relationships and the race and gender of the mentor. Participants also rated their mentors on a favorability scale from 1 (low) to 5 (high).

Black Racial Identity Attitudes Scale (RIAS-B). We used the RIAS-B (Helms & Parham, 1990) to assess levels of Black identity. This scale assesses one's affective connection to African Americans and the sophistication of one's awareness of the social implications of race (Helms, 1990; Neville, Heppner, & Wang, 1997). The RAIS-B long form consists of 50 items, in which participants respond using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

The RIAS-B subscales were scored by averaging the appropriately keyed items so that respondents received a scale score for each of the four types of racial identity attitudes (Helms, 1990; Pope-Davis, Liu, Ledesma-Jones, Nevitt, & McEwin, 2000). Higher mean subscales indicate a greater degree of that racial identity attitude. The participants who embraced the racial attitude of Internalization endorsed the following items: "I believe that being Black is a positive experience" and "People, regardless of their race, have strengths and limitations."

The RIAS-B short form and long form have been tested on reliability using Cronbach's alphas. The Cronbach's alphas for the long form are as follows: Preencounter = .76; Encounter = .51; Immersion/Emersion = .69; and Internalization = .80, with relatively little difference in scores from the long form to the short form (Helms, 1990; Pope-Davis et al., 2000). The reliability scores for Preencounter and Internalization prove to be more consistent than the scores for Encounter and Immersion/Emersion.

Occupational Stress Inventory-Revised (OSI-R). The OSI-R (Osipow, 1998) is designed to measure three dimensions: role stress, psychological strain, and personal resources. The Occupational Role Questionnaire (ORQ) measures role stress and includes six scales: Role Overload, Role Insufficiency, Role Ambiguity, Role Boundary, Responsibility, and Physical Environment. The Psychological Strain Questionnaire (PSQ) includes four scales: Vocational Strain, Psychological Strain, Interpersonal Strain, and Physical Strain. The Personal Resources Questionnaire (PRQ) includes four scales: Recreation, Self-Care, Social Support, and Rational/ Cognitive Coping. High scores on the ORQ and PSQ suggest significant levels of occupational stress and psychological strain, respectively; high scores on the PRQ denote highly developed coping resources (Osipow, 1998). The ORQ consisted of 60 items, whereas the PSQ and PRQ both contained 40 items. The participants responded to the items on a 5-point Likert-type scale (1 = rarely/never, 5 = true most of the time). The endorsed items that reflect the ORQ are "At work I am expected to do too many different tasks in too little time" and "I feel caught between factions at work." The endorsed items that reflect the PSQ are "Lately, I dread going to work" and "Recently I have been absent from work." The endorsed items that reflect the PRQ are "I spend a lot of my free time in participant activities (sporting events, theater, movies, concerts, etc.)" and "There is at least one sympathetic person with whom I can discuss my concerns and work problems."

Internal reliability coefficients are high for each domain of the OSI-R and also for individual scales, ranging from .70 to .89. Studies have found test-retest reliability scores ranging from a low of .39 for the Self-Care scale to .74 for the total PSQ score. In addition, internal consistency measures were .88 for ORQ, .93 for PSQ, and .89 for PRQ, with the coefficients for the scales ranging from .70 to .89. The reliability coefficients for OSI-R have proved to be adequate.


The nonprofit health care organization provided us with the names of African American female managers as the first line of contact to identify potential participants. Approval was given to conduct the research in six of the hospitals within the organization. During our meetings with the employees, we distributed the RIAS-B, OSI-R, and demographic survey. The meetings lasted 30 to 60 minutes depending on whether the employees were given permission to complete the packet of information during the meeting time or whether they needed to complete it on their own time to mail back confidentially in the internal mail system to our office.

During the meetings, we gave the participants the aforementioned instruments and explained the disclosure statement highlighting the purpose of the study, along with instructions for completion and confidentiality information. Every effort was made to have the participants complete the information in person. The participants were also given time to ask questions and the option of receiving a summary of the study's results.

There were approximately 18 meetings held, with a total of 196 participants given the survey packets. Seventy-six women returned their surveys for a return rate of 40%. This return rate is consistent with other studies involving African American women where the participation range has been between 50 and 79 participants (Hughes & Dodge, 1997; Kennedy, 1999).


Data Analysis

We performed descriptive statistics to provide information about African American women's racial identity among the different occupational groups. We conducted correlations and multiple regression analyses to test the research questions about the relationship between racial identity, educational level, mentoring, and occupational stress. Following the conventional principle of sample size, based on Cohen's (1992) power analysis, we determined that a total of 76 participants was adequate at the power of .80 and an alpha of .05.

The descriptive statistics of the four subscales of RIAS-B are as follows: Preencounter, M = 1.97, SD = 0.56; Encounter, M = 2.57, SD = 0.57; Immersion/Emersion, M = 2.54, SD = 0.61; and Internalization, M = 3.68, SD = 0.66. According to Helms (1990), Preencounter is the initial stage of racial identity and Internalization is the highest stage. To have one continuous variable representing racial identity in multiple regression models, we computed a new variable. If the highest score among the four is Internalization, the ordinal score 4 is assigned; accordingly, Immersion/Emersion is 3, Encounter is 2, and Preencounter is 1. These scores are then used for all analyses. Subsequently, 75% (n = 57) of the participants were in the Internalization status of racial identity.

The means, standard deviations, and correlations of the examined variables are presented in Table 1. Racial identity was negatively correlated to role stress (r = -.28, p < .05) and psychological strain (r = -.30, p < .05). Level of education was significantly correlated to the women's ability to access personal resources (r = .29, p < .05); the higher the level of education, the greater the women's ability to utilize personal resources. The relationship among the three aspects of occupational stress revealed that psychological strain was correlated with role stress in a positive way (r = .62, p < .001) but was negatively correlated with personal resources (r = -.63, p < .001).

We performed a standard multiple regression, entering all four predicting variables simultaneously to the model. The three scales of the OSI-R were dependent variables; thus, three regression analyses were conducted. Standard multiple regression was performed to determine whether racial identity, level of education, and experience of mentoring would predict the level of occupational stress. Regression results of three multiple analyses revealed that only the model for role stress was statistically significantly, [R.sup.2] = .12, adjusted [R.sup.2] - .07, F(4, 71) = 2.5, p = .05. The other two regression models were not statistically significant: for personal resources, [R.sup.2] = .11. adjusted [R.sup.2] = .06, F(4, 71) = 2.2, p = .08; and for psychological strain, [R.sup.2]= .10, adjusted [R.sup.2]= .05, F(4, 71) = 1.99,p = .11. A summary of regression coefficients is presented in Table 2 and indicates that racial identity contributed significantly to psychological strain (t = 2.20, p = .03) and role stress (t - -2.13,p = .04), whereas level of education contributed significantly to personal resources (t = 2.20, p = .03).


Racial identity and occupational stress are significant variables that affect African American women's lives and their ability to thrive (Lazarus & Folkman, 1984; Niles & Harris-Bowlsbey, 2013). The major finding in the present study was that racial identity did have a strong significant relationship with occupational role stress. The higher a woman's racial development (Internalization status), the less likely she was to experience occupational role stress. Decreased role stress means a woman may experience less role overload, greater access to resources, and greater self-efficacy as these relate to her work (Osipow, 1998).

In addition, results of our study showed that the higher a woman's racial development, the less likely she was to experience psychological strain. Decreased levels of psychological strain resulted in participants reporting less depression and anxiety and better responses in routine situations (Osipow, 1998). This finding supported the findings in previous studies in which students in the Internalization status had lower levels of stress and greater motivation toward problem solving (Jones, Cross, & DeFour, 2007; Neville et al., 1997).

Helms (1990) characterized the Internalization status as crystallizing a person's Black identity. Furthermore, crystallizing is where individuals blend their personal identity with their Black identity, and the internalized person rejects racism and any form of oppression while able to establish relationships with diverse individuals. Internalized individuals are also described as having more freedom regarding connecting with diverse individuals (Helms, 1990). The internalized students in Neville et al.'s (1997) study were able to have more motivation and positive appraisals of their problem-solving capabilities.

The higher the level of education, the greater the women's ability to utilize personal resources. Utilizing personal resources may indicate that individuals are able to develop support networks at work and participate in a planful way to solve problems by accessing existing resources. Various studies confirm the value of social support in coping with work stress for African American women (Catalyst, 2004; Holder & Vaux, 1998). Women with higher educational levels were more likely to know how to utilize the existing resources than women with lower levels of education.

Catalyst (2004) suggested social support as a key factor in managing occupational stress for African American women. Therefore, having a mentoring relationship can lead to positive outcomes at work for African American women. However, in the present study, there was no significant difference between African American women in mentoring relationships and those women who were not in mentoring relationships. Mentoring was not significantly related to any of the occupational subscales, probably because of the low number of women who had a mentoring relationship. Unfortunately, the lack of mentoring relationships for African American women has been a consistent theme within many work environments (Catalyst, 2004; Schwiebert, 2000).

Implications for Career Development Professionals

This study found that African American women with higher racial identity seemed to have less occupational role stress and personal strain. In addition, a low number of African American women had a mentor in the study. With these findings, opportunities exist for career development professionals to embrace the role of social justice advocates on behalf of and with African American women to ensure that opportunities exist for career development, advancement, and meaningful opportunities that are inclusive of a diverse workplace (Casey-Cannon, Nguyen, & Velazquez, 2005; Toporek, 2005-2006). Opportunities for career development interventions exist on an individual, group, organizational, and industry level for African American women.

According to Helms (1990), when a woman is exposed to varied experiences within anti outside her race, then the opportunity for movement through the racial identity process becomes greater. Career professionals who are able to intervene and "act with" African American women by using a racial identity framework will he providing services that are inclusive of a salient aspect of identity for many African American women (Niles & Harris-Bowlsbey, 2013). Individual interventions may include access to the workplace Employee Assistance Programs to address race-related issues, concerns related to occupational stress, burnout, role conflict, and other career-related issues. Even though our study did not find significance with mentoring and African American women, we continue to suggest mentoring as an effective career intervention based on the findings of Catalyst (2004) and other researchers (Lach, 1999; Schwiebert, 2000; Thomas, 2001) who have reported positive outcomes such as promotion, visibility, and increased pay. The career-related benefits that are available need to be easily accessible to employees who have less education and who may find it difficult to navigate the system to access individual resources.

Group interventions for women in general and African American women in particular may be helpful considering the efficacy of social support (Casey-Cannon et al., 2005; Hackett & Byars, 1996; Osipow, 1998). Group interventions may be easier to access because of multiple opportunities to participate. Affinity groups and brown bag education meetings that focus on diversity, inclusion, and occupational stress (especially role conflict stress and self-care) could be appropriate interventions for African American women (Cook et al., 2005).

Race is a salient construct for many employees, but organizations have not found a consistent and effective way to integrate racial identity development into the career development process for African American women (Pope-Davis & Hargrove, 2008). It may be useful for career development professionals to advocate for the integration of race in the context of work. If race is integrated in the workplace, this could mean that every new employee will benefit from the experience. There are several ways to attend to race in the career development process of the organization, for example: (a) exploring racial identity statuses within the hiring process by acknowledging within-group differences for African American women and others, (b) implementing the employee orientation with a diversity education component addressing racial development, and (c) including the discussion of race/ethnicity in the executive and management trainings of the organization (Casey-Cannon et al., 2005). In the Catalyst (2004) study, 56% of African American women somewhat or strongly believed that stereotypes existed about women regarding their race/ethnicity. Thus, the training and education may be useful for demystifying stereotypes and normalizing racial development for African American women and others.

Health care is only going to become more diverse in clientele, and so will the health care professionals who are treating the clients (Betancourt, Beiter, & Landry, 2013). Many health care positions will continue to experience better than average growth rates in the future (Sommers, 2011-2012). The general landscape in health care has been to infuse diversity throughout the system of care by providing language interpreters, diverse spiritual practices for prayer 24 hours a day, and a patient advocacy system to rectify any conflicts (Betancourt et al., 2013). The focus on quality of care for clients means to simultaneously care about health care workers and professionals by assisting with creating an inclusive workplace and managing the occupational stress that is inherent in the workplace (Betancourt et al., 2013).


Our findings should be generalized with caution because our nonrandom sample consisted of African American women in an urban, hospital setting in the Midwest. Limitations exist when comparing the results with other individuals who are not a part of the demographics in this study. In addition, the sample selection was purposeful, targeting African American women who participated on a voluntary basis; it is likely that some individuals excluded themselves by not responding. Ironically, some women may have been too stressed or busy to respond to the request.

The measurement of mentoring experiences needs to be improved; more important, the inclusion of additional African American women who are in mentoring relationships would have been useful. The RAIS-B and OSI-R are both self-report measures, and there may be a desire by the women to appear more or less favorable.

African American women's participation rates in the workforce have remained steady for the past 20 years (U.S. Department of Labor, 2012). In 2012, African American women's participation rate for full-time employment was the highest of all the groups of women at 78%, with an unemployment rate almost twice as high as the lowest for all women at 12% (U.S. Department of Labor, 2012). Historically, research studies have not included African American women as primary participants; therefore, many of the career interventions are not based on the present population (Niles & Harris-Bowlsbey, 2013; Ward & Bingham, 2001). Including studies with African American women and investigating culturally specific career interventions are warranted, as is research that addresses unemployment issues for African American women. It is a concern that, during the Great Recession from 2007 to 2009, the unemployment rate practically doubled for African American women, and therefore an investigation addressing the unemployment concerns seems warranted (U.S. Department of Labor, 2012). Again, mentoring was not found to be significant in this study, but it would be helpful to use an experimental design to control for mentoring for African American women to isolate and evaluate the impact of the mentoring experience as it relates to career development. Finally, the addition of a qualitative design will provide a more detailed analysis of the women's experiences and will add depth to the study by giving greater voice to the participants.


African American women's racial identity development, the impact of occupational stress, and the women's personal resources are important factors to consider in these women's work experiences. It would he beneficial for career development professionals to proactively advocate for the incorporation of these elements in their interventions for decreasing work stress and improving access to mentoring opportunities and other occupational resources for this population. This would not only be beneficial for African American women but could also be a model for career development in diverse work environments.

Received 03/28/14

Revised 06/26/14

Accepted 06/30/14

DOI: 10.1002/joec.12024


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Rhonda L. Norman, Department of Counseling, Xavier University; Mei Tang, Counseling Program, College of Education, Criminal Justice, and Human Services, University of Cincinnati. Correspondence concerning this article should be addressed to Rhonda L. Norman, Department of Counseling, Xavier University, 2347 Francis Xavier Way, Cincinnati, OH 45207-2336 (e-mail:
Descriptive Statistics and Correlations of the Examined Variables

Variable                     1        2        3      4       5

1. Racial identity           --
2. Occupation              -.01       --
3. Level of education       .10      .76 **    --
4. Mentoring                .13     -.12       .17      --
5. Role stress             -.28 *    .23 *    -.24     -.13     --
6. Psychological strain    -.30 *    .05       .15     -.14    .62 **
7. Personal resources       .19     -.12       .29 *    .09   -.27

Variable                      6      7      M      SD

1. Racial identity                         3.77   0.58
2. Occupation                              2.28   0.81
3. Level of education                      2.79   0.93
4. Mentoring                               1.32   0.93
5. Role stress                            25.39   4.15
6. Psychological strain      --           23.97   6.62
7. Personal resources      -.63 **   --   31.01   6.12

Note. N = 76.

* p < .05. ** p < .001.

Regression Coefficients for the Model Variables

Variable                  B     [beta]    t(71)     P

Personal resources
  Racial identity        1.60    1.51     1.34     .19
  Occupational group     1.05    1.39     0.87     .39
  Level of education     2.22    0.35     2.20 *   .03
  Mentoring              0.18    0.03     0.24     .81
Psychological strain
  Racial identity       -2.85   -0.25     2.20 *   .03
  Occupational group    -0.60   -0.07    -0.46     .65
  Level of education    -1.06   -0.16    -0.97     .34
  Mentoring             -0.67   -0.09    -0.82     .42
Role stress
  Racial identity       -1.70   -0.24    -2.13 *   .04
  Occupational group     0.86    0.17     1.06     .29
  Level of education    -0.31   -0.07    -0.46     .66
  Mentoring             -0.29    0.07    -0.58     .57

Note. N = 76.

* p < .05.
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Author:Norman, Rhonda L.; Tang, Mei
Publication:Journal of Employment Counseling
Date:Mar 1, 2016
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