Nurses working in nursing homes are among the most likely to face discrimination on the job, with 88% saying in a new survey that they had seen or experienced workplace racism by patients.

When it came to their colleagues, 62% of nursing home and home health workers surveyed by NORC for the Robert Wood Johnson Foundation said they’d seen or been subject to racism or discrimination based on race or ethnicity.

The staggering results published Wednesday show another reason skilled nursing providers may have an uphill battle selling frontline nursing jobs to prospective employees. 

“If we are to truly provide just and equitable care to our patients, we as nurses must hold ourselves accountable for our own behavior and work to change the systems that perpetuate racism and other forms of discrimination,” Beth Toner, RN, director of program communications at the foundation said in announcing the survey results.

The survey included nearly 1,000 registered nurses, nurse practitioners and licensed vocational nurses nationwide. Overall, 79% reported facing racism from patients, with 59% reporting similar behavior among colleagues. In private practices, doctor’s offices and outpatient clinics, those numbers dropped slightly to 74% and 54%, respectively.

While nine out of 10 nurses said diversity, equity and inclusion are stated priorities at their workplace, survey respondents said more education and training is needed.

Although 40% of nurses across all settings represented in the study reported observing or experiencing discrimination from their supervisors, only 23% formally reported or documented such incidents. Just 16% of nurses said they have discussed discrimination or racism they’ve experienced with a human resources leader. Instead most nurses, 57%, talked about those kinds of events with their fellow nurses.

Just four in 10 nurses said they were satisfied with their reporting response; five out of 10 said their relationship with supervisors, senior leaders or fellow nurses was “negatively impacted” by reporting.

There was some good news, however. About 85% of respondents said hiring ethnically and racially diverse nurses is a priority for their organization, and 82% agreed that the nursing workforce hired over the past two years is more diverse than before.

As for solutions, 96% of those polled said they wanted to see more transparent hiring practices, while 92% thought hiring more racially and ethnically diverse nurses in executive leadership and managerial positions would improve the ability to recruit and retain.