COVID and racism cause nurses of color to face 'dual pandemic'

In a phenomenon that researchers are calling a "dual pandemic" because of the severity of the impact of coupled factors, a Rutgers School of Nursing research study has found that non-white nurses are suffering disproportionately from emotional distress, induced by a toxic stew of fears engendered by COVID-19 and reactions to workplace racism.

The work, published in Behavioral Medicine, is one of the first of its kind to quantify such effects and points to a critical need to address the issues of frontline health workers as the pandemic continues.

"We found that variations in nurses' emotional distress were determined, in part, by direct and complex interactions among COVID worry, race and workplace racism experiences," said Charlotte Thomas-Hawkins, an associate dean and associate professor of Nursing Science who led the study. "For nurses of color in our study, workplace racism and COVID-19 represented a dual pandemic; that is, their experiences and worries were synergized to the detriment of their emotional well-being."

Thomas-Hawkins, who is also Director of the Center for Health Services Research and Policy, has long wanted to explore the effects of racism in the healthcare sphere due to her own adverse experiences over decades working as a Black nurse. But key events in 2020 focused her thoughts on their outsized impact on populations of color—the advent of COVID-19 in the New York metropolitan area in March of that year, and the tragic murder that May of 46-year-old George Floyd by a police officer in Minneapolis during an arrest.

Health statistics also guided her, showing that Black, Hispanic and Asian people in the U.S. experienced the highest rates of COVID-19 cases, deaths, and hospitalizations. Studies also showed that nearly half of all confirmed healthcare worker cases of COVID-19 infections, deaths and hospitalizations were occurring among workers of color. In addition, nurses were the hardest hit among all healthcare workers.

The interplay of these two forces in American life and their impact on people, she believed, necessitated investigation. "COVID-19 and race in both the U.S. general population and the healthcare workforce are inextricably linked," Thomas-Hawkins said.

In September 2020, during a lull in the COVID pandemic, the researchers surveyed nearly 800 nurses working in acute care hospitals in New Jersey. Participants completed online questionnaires that inquired about indicators of emotional distress, COVID-19 worry and concerns, workplace racial climate, workplace racial microaggression experiences and demographic information.

Participants were asked how worried they were, generally, about COVID, how concerned they were about becoming infected, and how likely it was that someone they knew might become sick from the virus. Questions on experiences with racism focused on whether there were limits to advancement on anything from work opportunities to unwelcoming climates. They were also asked about microaggressions and bias incidents, such as insults, slights and discriminatory behaviors.

The study concluded that:

• Non-white nurses reported significantly higher levels of emotional distress and overall worry about COVID.
• A higher percentage of non-white nurses (61%) were very worried about COVID compared with the percentage of white nurses (41%) who were very worried.
• Non-white nurses perceived more negative racial climates, with Black nurses reporting the most negative climates.
• Non-white nurses experienced more racial microaggression experiences, and Black nurses experienced the highest number of racial microaggressions compared with all other racial groups.

If the healthcare industry is going to be successful in diversifying its workforce, the pressures examined in the study are important to understand and address, Thomas-Hawkins noted. "The psychological effects of nurses' workplace COVID exposure and worry will likely last far into the future," Thomas-Hawkins said. "And the persistence of workplace racism will continue to inflict individual-level psychological harm among nurses of color unless it is effectively ameliorated."