Health-care workers of color report a dual pandemic in new study by Rutgers researcher

As a young Black nurse, Charlotte Thomas-Hawkins saw it all.

Staffers of color denied leadership roles and promotions, and believing that they were being held to higher standards. The automatic assumption that they had a lesser education. Patients assuming that a nurse of color was not really a nurse, or complaining to a manager that they wanted a different nurse.

Years later, nothing seemed to have changed. But this time, Thomas-Hawkins could do something about it. As director of the Center for Health Services Research and Policy at the Rutgers School of Nursing, she led a study showing that combined effects of COVID-19 and workplace racism resulted in a “dual pandemic” that disproportionately affected nurses of color.

The study, recently published in the journal Behavioral Medicine, is a novel effort to quantify these effects. Thomas-Hawkins, who received her doctorate in nursing from the University of Pennsylvania School of Nursing and now works as the associate dean and associate professor of nursing science at Rutgers, spoke to us about it.

Racist experiences in hospital settings had been in the back of my mind as an area I wanted to explore. Then, two things happened that brought it to the forefront for me. The first was COVID. In the beginning of the first surge in the Northeast, we all learned that COVID disproportionately affected persons of color. But I also learned that COVID disproportionately affected health-care workers of color.

The second was George Floyd’s murder. Concurrently with this COVID pandemic, there was a global outcry about racism. So I wondered about the racial trauma that nurses of color were experiencing in the workplace — because of the stories I heard — and how the combined impact of the psychological distress due to COVID affected their overall emotional health.

We sent an email invitation to licensed professional nurses who worked in New Jersey hospitals; 800 nurses completed the electronic survey.

We asked them about the extent to which they were worried about COVID — if they were worried about it overall, worried about getting sick themselves, worried about someone close to them getting sick. We also asked about their emotional stress — if they felt burned out, down or distressed.

Then we asked them about two types of workplace racism experiences. One was racial microaggressions they had experienced in the past six months. The other was their perception of the racial climate in their workplaces. We asked whether they agreed or disagreed with statements like “the opinions of people of color are respected here” or “it’s just as hard for a white person to get ahead here.”

I was not surprised that, compared to white nurses, nurses of color reported multiple experiences of racial microaggressions — three times higher, in fact — and more negative racial climates.

We already knew that COVID was affecting persons of color at a higher rate, so I also was not surprised to find that nurses of color were more worried personally about getting COVID and taking COVID home to their loved ones.

What was surprising to me was striking differences in how nurses of color and white nurses responded to some of the racial climate questions. In one, they were asked to agree or disagree with the statement, “My organization goes out of its way to make people of color feel welcome here.” Some 58% of white nurses agreed. But only 34% of nonwhite nurses did. That’s a big gap.

Another big gap was in the response to “organization-wide racism is a problem here.” Only 11% of white nurses agreed, compared to 35% of nonwhite nurses.

When it came to the statement “people of color get the promotions they deserve,” 62% of white nurses agreed, but only 32% of nonwhite nurses did.

For me, the difference in those perceptions is striking.

We looked at the effect that COVID worry and workplace racism have on nurses’ emotional well-being — their emotional distress. We weren’t surprised that COVID worry had the biggest effect. But an important finding was that workplace racism had an additional significant impact.

Nurses who experienced racial microaggressions were twice as likely to experience high levels of emotional distress. Nurses who reported negative racial climates were 1½ times more likely to experience high levels of emotional distress.

These things worked together and they amplified nurses’ emotional distress to severe levels. We called it a dual pandemic.

The CDC has indicated that racism is a public health threat. And as other public health threats come and go, racism will continue to exist. The study shows that when employees of color who experience workplace racism experience additional public health threats or crises, they will be disproportionately affected.

So one of the lessons learned is that racism has to be acknowledged and named by hospital leadership. People are averse to addressing it or even openly discussing it. Acknowledgment of it is then avoided. So employees talk about it among themselves, but they don’t report it because of their experience of reprisal.

Then, addressing it and mitigating it requires a multi-strategic approach. It has to address individuals, interpersonal conversations, and institutional policies and procedures. These need to be well-thought out and long term. Racism has existed for centuries. It is not going to be mitigated in the short term.

One of the strategies should include bias self-awareness training, so people learn to recognize their biases — we all have them — and not let them enter interpersonal interactions.

There needs to be training for midlevel managers. They need to be trained to recognize racial microaggressions, to listen effectively and to engage in the difficult but necessary conversations. It takes skill to create a safe environment.

Institutionally, hospital leaders have to work to identify policies and practices — hiring and firing, for instance — that may unfairly advantage some racial groups and disadvantage others. They need to address how diverse their leadership is.

What I hope for is workplaces that are equitable and inclusive. Right now, the persons who are served by hospitals are more racially diverse than the nursing workforce. We need to attract nurses of color to the profession, and when we hire them, we need to retain them. If racism in workplaces is not addressed or mitigated, health-care organizations may lose talented nurses of color.