square bulletThe Pandemic Exposes Serious Risks and Challenges for Melanated Nurses and Allied Healthcare Workers

From Steffanie Roache, MS, LPC

The coronavirus continues to have a devastating impact on the health of many Oregonians, but especially for communities of color, who are 30 times more likely to experience the most serious risk from exposure to the virus [1]. These same communities are already reeling from healthcare disparity, historical trauma, and past unethical experimentation at the hands of some in the healthcare system. The pandemic has also exposed a tremendous burden felt by many Black, Brown, Asian, and other healthcare workers of color who face the same risks as people within their own communities, but also the additional risks of exposure in health care settings, and high risks for stress and burnout [2] as melanated people working in this industry.

There are difficult intersections between culture and the pandemic for melanated healthcare workers who spend 8-, 10-, and 12-hour shifts working within settings that directly expose them to the coronavirus plaguing our world today. While this is true for all essential workers who function in these types of hands-on, in-person roles, workers of color who often live in households with a similar cultural make-up experience an even greater dilemma. As previously noted, people of color are statistically at greater risk of experiencing the harshest health risks and potential for death from this virus, and healthcare workers of color understand the potential to accidentally expose their unvaccinated children or elders through no fault of their own.

In addition to fears of exposure risks, melanated healthcare workers also have first-hand or general knowledge of 1) people from their cultural groups who may be unwilling or unable to become vaccinated, 2) people with limited access to the most effective treatments or preventative care [2], and 3) the overarching disparity and inequality in the healthcare system as a whole.

The Impact for Healthcare Professionals; Patient-Centered

A new trend of dangerous and unruly behaviors was exposed after the reemergence of people in shared spaces post-pandemic lockdowns. This trend has mainly been reported in recent news for passengers on domestic airline flights or guests at restaurants; however, the healthcare system is not exempt from these same types of interactions with people seeking services.

Being people of color caring for patients who exhibit unruly and even racist behaviors can create an existential battle for melanated workers. Their role as healthcare professionals is to provide competent and compassionate care to all patients and clients; even those who may hold racist beliefs. Racist interactions that become more extreme or are experienced over time can have traumatic effects that impact the emotional well-being of healthcare professionals. The outcome of these interactions is not limited to the workplace and does not disappear when their shift ends.

Some healthcare workers describe an increase in seemingly rude, unkind, and racially biased behaviors, while others believe there is only more awareness and attention paid to challenging behaviors but deny an increase in frequency or severity. Over time, these events can increase stress levels and impact overall quality of life for the healthcare worker. Healthcare professionals are often forced to maintain composure, professionalism, and compassion towards patients exhibiting racist and at times belligerent behaviors. While this is true, there are seemingly no known proactive programs or training that focus on how to maintain emotional safety for healthcare workers of color when providing care for an individual who is overtly racist.

Some professionals share a similar strategy of intentionally reminding themselves that the patient exhibiting racist behaviors is also in physical, psychological, or emotional pain. This is the main tool used by many to help maintain composure while suppressing their own feelings during these racially charged interactions. Similar to the lack of proactive training programs for emotional safety, it seems there are no known culturally specific supports for debriefs after these types of interactions.

“If I Were White, They Wouldn’t Say that to Me.”

Common themes from conversations with some professionals of color about their experiences at work included interactions with patients or clients who used overtly racist language; patients requesting a different provider who was not a person of color; and patients engaging in racialized sexual harassment. Some nurses described disturbing fetishized and suggestive comments alluding to both sexuality and the worker’s ethnicity.

Interactions with Staff, Colleagues, and the Healthcare Organization

It is important to note that many professionals have positive experiences with white colleagues considered to be trusted allies who supported the rights and needs of their melanated co-workers. They also describe experiences with white colleagues who were willfully or unknowingly biased. Conscious and unconscious bias was a consistent theme with all participants. Some Asian American professionals noted experiences of bias directly related to the characterization of COVID-19 as a disease originating from one Asian country, and of colleagues making direct or indirect correlations between the worker’s ethnicity and the coronavirus. Some Black and Latino professionals described times when they were asked to speak with a “nurse” by colleagues who assumed they were not a nurse or were employed in positions with less authority, education, or training.

“Was that Racist or Am I Just Being Overly Sensitive?”

Melanted healthcare workers commonly described the emotionally exhausting experience of questioning one’s own judgment regarding racism in the workplace. Several workers described a sense of fear of drawing attention to oneself, being seen as problematic, as well as fear of not being taken seriously and the potential for incidents to be minimized if reported.

Trauma Informed Care (TIC)

In most cases, there is minimal familiarity with Trauma Informed Care among healthcare professionals, though most professionals work in systems that report use of TIC practices as an organization. Their TIC trainings are conducted annually and are structured similarly to other trainings completed individually online through an electronic training system. It is uncertain if TIC is taught with fidelity or as a requirement by their healthcare organizations.

What is the Healthcare System Getting Right?

When talking with professionals, it seems many feel certain they could find support from their HR department or union if any serious or overt incidents of racism from other staff were to occur. In addition, most believed they could potentially qualify for staff leadership roles within their organizations if they had a strong desire to seek out more responsibility. This can suggest that their workplaces share common anti-bias and anti-racism statements as an organization. It may also suggest that some organizations have opportunities for professional development in general; it is unknown if they specifically target people of color.

Final Thoughts and Observations

Talks with healthcare professionals of color indicate an overwhelming need for culturally specific spaces to discuss the specific needs of melanated healthcare professionals, and for a means to find support from others who understand the challenges faced by Asian, Black, Brown, and other healthcare workers of color/culture.

Melanated healthcare workers are at greater risk of significant stress and burnout. Addressing the needs of these workers can help decrease forms of trauma they may experience and can potentially decrease the exodus of melanated healthcare workers from a system that seeks to reflect the diversity of the communities they serve.

There is also a need for (1) promotion of principles found in TIC specific to healthcare settings; (2) promotion of formal policies and procedures that address the needs of professionals of color experiencing racist behaviors from those they serve, including racialized sexual harassment; (3) increased research into the impact of the pandemic for workers who are centered in communities most impacted by its effects; (4) creation of affinity spaces within healthcare organizations; and (5) intentional creation of avenues within organizations for people with authority to hear the needs of melanated workers and implement systematic change.


Thank you to all who shared your wisdom and experiences.


[1] Was Oregon’s COVID-19 pivot enough to address racial inequities?

[2] Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study.

[3] Summary Report: Listening Sessions on Racism in Nursing (June 2021)