One Faculty Researcher Studies the Impact of Racism and Microaggressions on Nurses
It was 1970, and Charlotte Thomas-Hawkins (PhD, RN, FAAN) was at the beginning of her career. She had earned her nursing diploma at Temple University Hospital School of Nursing that spring and was starting her first RN job at the Hospital of the University of Pennsylvania. So, when she walked into a patient’s room and was asked to “fetch the nurse,” she felt a sense of deflation she remembers to this day.
Thomas-Hawkins is Black, and even now, minority nurses are still facing racism, both subtle and overt, including the assumption that, because of their color, they couldn’t possibly be “the nurse.” That experience set Thomas-Hawkins to asking questions about the effects of bias that would one day impel her to become a researcher. And one of her research topics would be nurses’ experience of racism and how it impacts their emotional health.
She completed a phase of that research in fall 2021, as the U.S. was starting to emerge from the COVID-19 pandemic lockdown. In fact, it was the pandemic, and nurses’ experience of it, that originally inspired this study.
In the spring of 2020, New Jersey was grappling with the third highest number of COVID cases in the Northeast, and Thomas-Hawkins—associate professor and interim associate dean of Nursing Science at Rutgers School of Nursing—began to wonder how nurses were handling the effects of a uniquely grueling year.
“I was interested in the level of worry that nurses had regarding COVID,” she says. But the past year had been marked by yet another consequential event—the killing of George Floyd, an African American, at the hands of white Minneapolis police officers. “My experience as a minority nurse is that we constantly live with this subtle level of interpersonal racism,” says Thomas-Hawkins. She wondered how the entwined stresses of COVID and workplace racism affected nurses, particularly nurses of color.
She surveyed 778 nurses in New Jersey hospitals who worked closely with patients. It was a diverse sample—60 percent white and the remainder nonwhite or multiracial. The results revealed a high level of what Thomas-Hawkins called “emotional burnout,” which was reported by 68 percent of the nurses overall, though minority nurses reported a higher level of emotional distress compared to their white counterparts.
More than half of respondents overall felt that work was hardening them emotionally; 43 percent were depressed; and a third reported dissatisfaction with work/life balance. A majority worried about COVID; almost half were dissatisfied with their jobs; and nearly 20 percent planned to leave their jobs.
It was her questions about racial climate and racial microaggressions—small-scale comments or actions, intentional or unintentional, conveying racial bias, hostility, or disrespect—on which respondents were clearly divided by race. Black nurses experienced more negative workplace racial climates and a higher number of microaggressions, especially from coworkers and patients. “To my knowledge,” says Thomas-Hawkins, “the quantifiable and harmful experiences of workplace racism by nurses is a new finding, and it’s not something that can be ignored.”
She’d never set out to do groundbreaking research—in fact, she’d never set out to do research of any sort. That changed back when she got her master’s degree in nursing from the University of Pennsylvania School of Nursing and moved from an inpatient floor to the outpatient dialysis unit at the Hospital of the University of Pennsylvania. There, she was struck by the fact that nurses did the lion’s share of the work, and there never seemed to be enough of them. She began to wonder how that low level of nurse staffing affected patient outcomes and decided to start researching the question.
As an advanced practice nurse, however, she found she didn’t have time for research. So as much as she mourned leaving clinical practice, she decided to get her PhD and, in 2000, joined the faculty at Rutgers School of Nursing.
She adapted quickly. “I learned how to teach,” she says, “and discovered that I liked it.” A great pleasure is helping students surmount their academic struggles, as a professor once did for her. “When I see the lightbulbs go on in their heads,” she says, “that’s what keeps me going on.”
With 27 studies under her belt, research continues to be a driver. At the time of this writing, Thomas-Hawkins was preparing the first of three manuscripts to report her findings on how racism impacts nurses’ emotional health. She hopes at some point to study how nurses’ experience of racism also affects patient care. As a researcher, she says, “you always have more questions.”