Based on interviews with 17 Black and Latinx healthcare workers in support roles, researchers noted such concerns as abrupt changes to work responsibilities, increased hours, navigating use of new technology, safety protocol changes, and lack of access to personal protective equipment. Since this is the first study to focus on the perspectives of support healthcare workers from underserved communities during COVID-19, its insights can inform future directions for employers to support staff.
What the Interviews Tell Us
This study was conducted with Black and Latinx healthcare workers in support roles between December 2020 and February 2021, as researchers moved from group interviews after completing two of them to individual interviews based on the challenging work schedules of participants. Researchers found that Black and Latinx healthcare workers in support roles reported that the COVID-19 pandemic contributed to substantial disruptions to their work responsibilities, stress levels, safety protocols, etc. While the perspectives of Black and Latinx healthcare workers in support roles evolved regarding the COVID-19 vaccine, their fears regarding contracting COVID-19 and infecting loved ones persisted throughout. This study included Black and Latinx healthcare workers in support roles in hospital, home, and community settings, but its urbanized sample is a limitation, as research findings may not be as applicable to rural locations.
Not Just Doctors and Nurses
Behavioral health medical director at Community Health of South Florida Inc., psychiatrist Howard Pratt, DO, says, “What needs to be appreciated is that the provision of healthcare is a team effort.” Dr. Pratt explains that there can be an unfair portrayal of only a physician or nurse working long hours to address the demands of the COVID-19 crisis, but that is not the reality. “It’s everyone working together at a healthcare facility that are jointly making an impact against the virus,” he says. That false narrative diminishes the important roles that other healthcare workers contribute, which is why Dr. Pratt notes, “We need to also appreciate the food service, custodial staff, and other service personnel.” Dr. Pratt highlights, “Even before the pandemic, working in healthcare could be dangerous. Now it’s gotten more dangerous. Many in healthcare are being exposed to COVID and there is an uncomfortable dissonance in knowing you’re without question encountering people with COVID.” Even if you are vigilant in protecting your loved ones from COVID-19, Dr. Pratt notes that healthcare workers have had to accept the reality that they likely have been exposed to it. “No one working in healthcare wants to be the reason a family member dies of this virus,” he says. Dr. Pratt explains that COVID-19 has forced people in healthcare to take risks, and many have lost colleagues to the virus. “When it comes to the less recognized frontline workers, they are often hit even harder. They are, for example, among the first asked to put themselves at risk,” he says. The healthcare system was already in a state of shortage before the pandemic, but Dr. Pratt highlights how it has worsened through deaths and resignations. “The risks healthcare workers face is appreciated by those considering working in healthcare themselves. If the risks aren’t lowered, these may act as a deterrent for pursuing work in healthcare,” he says. Dr. Pratt notes, “This research reiterates how dangerous COVID has been and how hard it has hit our healthcare system. I don’t think the full impact COVID is having on our healthcare system is yet known and this study is another piece in filling out that puzzle that is still incomplete.” When in need of medical care, Dr. Pratt wants the public to better understand that there are so many roles that are underappreciated even though they do crucial work. “Please treat everyone working at a healthcare facility with the respect you would like to be treated with,” he says. Dr. Pratt explains, “You don’t know what somebody is going through. Do your part to not become the fulcrum that causes a healthcare worker to say enough is enough and leave the field. A single healthcare worker’s services lost represents a loss for untold numbers of patients who also need care.”
Structural Racism Impacts Support Roles
Mental health equity researcher, psychologist, and director of medical affairs at Big Health, Juliette McClendon, PhD, says, “The takeaway for readers, specifically leaders and employers, is to rethink how we can prioritize the health and well-being of those in health care support roles.” McClendon acknowledges that support roles such as food service, custodial and cleaning staff have gotten minimal attention and recognition throughout the course of the pandemic. “We understand that those who fulfill these roles tend to be people of color and lower income,” she says. To better meet the needs of such workers, McClendon notes that it is critical to provide healthcare that is easily accessible, which addresses their unique challenges related to physical and mental health, as well as social determinants of health, such as financial wellness and child care. McClendon highlights, “Another key takeaway is the importance of providing accessible education around health information, such as COVID-19 vaccines and prevention, that is culturally sensitive and relevant to employees from underserved populations.” Since those in healthcare support roles are disproportionately women and other people of color, McClendon notes that they often come from communities that have high rates of medical mistrust following historical and ongoing experiences with white supremacy in healthcare. McClendon explains, “Working with leaders in communities with higher vaccine hesitancy is crucial to reaching those who are most impacted by COVID-19 but also least trusting of the medical establishment.” Support staff have critical roles in keeping people safe and healthy during the pandemic, yet McClendon highlights that they are often not recognized alongside doctors and nurses. “All roles are critically important and risk their safety each day to keep us healthy and safe,” she says. McClendon notes, “To me, this imbalance in recognition for paid health care support staff reflects structural racism and classism and how we address the impacts of the pandemic on low-wage earners and people of color.” This research highlights the consequences of systemic racism. “Healthcare support jobs are often low-wage, less recognized, and the impact of the pandemic on their lives has been largely ignored,” McClendon says. While this study brings to light the unique experiences of this population, McClendon notes that only 17 women were interviewed for the study, so results may not represent the experiences of all healthcare support workers or the extent of the impact of the pandemic on their lives. Despite this, McClendon highlights that the research provides critical insight and a call-to-action to think more intentionally about supporting these employees. “It’s important to implement strategies now that provide appropriate, equitable and accessible support for workers,” she says. From treating veterans and women of color, McClendon notes, “My experience affirmed how important it is for one’s employer - or whatever entity may be supporting one’s health care - to recognize the double pandemic people of color are facing, and to implement changes within systems by creating practices and policies that ensure equitable access to health and wellness, within mental to physical to social domains.” McClendon explains, “The pandemic has created a microcosm of the broader issue of systemic poverty, systemic racism and income inequality. The pandemic has been a collective trauma, which disproportionately impacts people of color, and particularly women of color.” Since women of color are disproportionately the head of the household, McClendon notes how they must balance work, child and elder care, and ensuring that they keep their family safe from exposure to COVID-19. In addition to experiencing disproportionate losses due to COVID-19, McClendon highlights, “The racial reckoning that occurred after the murder of George Floyd created a double pandemic of COVID-19 and racism. People of color are facing many burdens on top of one another right now, placing them under great stress, which directly affects their mental health.” McClendon explains, “In turn, this adds to the disproportionate stress burden on communities of color which increases susceptibility to chronic physical and mental health conditions. Truthfully, we likely won’t understand the extent of the impact of these years for some time.” It is imperative to mitigate the potential negative outcomes that will disproportionately impact underserved communities. “Making these thoughtful, intentional decisions now will minimize the impact this pandemic has on inequality and can improve the health and wellbeing of our most vulnerable citizens in the long-term,” McClendon says.
