A potent “dual pandemic” of COVID-19 worries and workplace racism heightened the emotional distress felt by nurses of color, according to a newly published study of nurses at New Jersey hospitals conducted in fall of 2020.
While all nurses reported some experience of racism in the workplace, nurses of color reported experiencing higher levels of workplace racism compared to white nurses, the study found. They also reported higher levels of overall worry about the coronavirus and emotional distress.
“It was the combined experience, the intersection of COVID worry and workplace racism experiences … that amplified or increased their emotional distress to severe levels,” lead study author Charlotte Thomas-Hawkins, the associate dean for the division of nursing science and a tenured associate professor in the Rutgers School of Nursing, told MarketWatch.
Nurses of color reported experiencing racial microaggressions in the workplace (for example, “an employer or coworker was unwelcoming or unfriendly because of my race,” or “I was treated differently by an employer or coworker than persons of other racial groups”) at a higher level than white nurses, with Black nurses experiencing the highest level.
The same pattern bore out when participants were asked about their perception of a negative racial climate in their organization — that is, the extent to which there were opportunities for promotion, organizational policies that seemed to advantage or disadvantage them, and organization-wide racism.
As for nurses of color showing higher levels of worry about contracting COVID-19 compared to white nurses, Thomas-Hawkins said she wasn’t surprised, given the coronavirus’s devastating and disproportionate toll on people of color and, more specifically, healthcare workers of color. Eight in 10 nurses overall said they had cared for COVID-19 patients, and nearly half said they’d cared for coronavirus patients who died.
“‘Not only should racism be acknowledged and discussed, but the strategies to address it and mitigate it should be well thought out, long-term, and multi-level.’”
— Charlotte Thomas-Hawkins, associate dean for the division of nursing science at the Rutgers School of Nursing
The study was conducted during a period when COVID-19 hospitalizations and deaths in New Jersey were trending downward. While the snapshot of nearly 800 nurses may be difficult to generalize beyond the experiences of hospital-based nurses in New Jersey, the findings are consistent with other qualitative and descriptive work reported in national samples, Thomas-Hawkins said.
This study was also unique in that it quantified the experiences and effects of workplace racism on nurses’ wellbeing, she and her co-authors wrote — an approach that “underscores the need to address the problem,” Thomas-Hawkins said.
“The first step is acknowledging that it exists, and no longer ignoring or avoiding the discussions about racism and the work that needs to be done across all workplaces, not just hospitals, to address it,” she said.
In the midst of concerns about nursing workforce shortages that predated the pandemic, the study said, these findings point to “the urgent need for a sustained investment in a racially diverse nursing workforce.” Having a racially diverse nursing workforce can boost culturally competent care, improve care delivery and help reduce health disparities, Thomas-Hawkins said.
“There’s urgent need to not only recruit but to retain talented nurses of color,” she said. “One of the strategies to do that is to make sure that nurses — all nurses, especially nurses of color — are working in healthy work environments.”
As the U.S. Centers for Disease Control and Prevention points out, racism at both the interpersonal and structural levels negatively impacts mental and physical health.
Thomas-Hawkins said she hopes the findings can lead to hospitals rooting out and addressing workplace racism at all levels. Some strategies should be targeted to the individual, like helping people become aware of their own biases; others should be implemented at the interpersonal level, such as training for managers on how to understand and respond to workplace microaggressions reported by an employee.
But strategies at the individual and even interpersonal levels will likely be short-lived if changes aren’t also implemented at the institutional level, Thomas-Hawkins added. That means hospitals should conduct reviews to ensure policies, practices and procedures don’t favor one group of employees over another, and address diversity concerns in both mid-level and executive leadership.
“Not only should racism be acknowledged and discussed, but the strategies to address it and mitigate it should be well thought out, long-term, and multi-level,” she said.