As an experienced nurse, a new nurse, or a nursing student in 2018, it’s tough to admit you might be biased toward some of your patients. But it happens, and the best approach to fixing implicit bias is to recognize its presence, and then constantly reassess how you feel and your approach.
Why do nurses have inherent bias? It’s a subconscious human trait and frequently interferes with best nursing practices. An inherent bias doesn’t mean you are racist and it doesn’t mean you shouldn’t be a nurse. Recognizing an inherent bias means that you understand you might have certain feelings about populations, appearances, or mannerisms that need to be addressed and dealt with to provide the best possible care.
In 2017, BMC Medical Ethics published a systematic review assessing a decade’s worth of publications for implicit bias in health care professionals. The conclusions stated a need for additional reviews and more homogeneous methodologies, but determined that implicit bias exists in health care settings and impacts quality and equity of care. Authors Mahzarin Banaji and Anthony Greenwald address the issue in books like Blindspot: Hidden Biases of Good People, as does Augstus White, III, MD, in Seeing Patients: Unconscious Bias in Health Care.
Here’s how to pay attention and fix it.
Notice Your Assumptions
Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.
Understand What Assumptions Trigger in You
You might find there are certain accents, specific items of clothing, or ways of speaking that cause you to tag someone with undeserved qualities. A patient’s race, accent, clothing style, or appearance can spark an instant judgment in you. Do you hold back certain levels of compassion for patients who are more short-tempered? Do you assume low standards in a disheveled, unkempt patient? Does someone’s race affect how you see them?
Know Why It Matters
An implicit bias is not only harmful because it is undeserved, but it can also lead to disparities in care. Even if you are unaware of how you are feeling, your body language, your focused attention, and your level of care can be impacted directly by the way you are feeling. Each patient deserves your full care, so understanding what might trigger you to act differently will make you a better nurse.
Know Your Patient
Talking with your patients is a good way to learn more about them. Understanding cultural differences can also help you become aware of any unconscious bias and begin to overcome it.
Talk About It
You have a bias, but you are not alone. Talking about implicit bias in your work setting opens the conversation, removes the taboo, and paves the way for better patient care and outcomes. When nurses are able to address this topic in an open and nonjudgmental manner, everyone benefits. If you are a nurse manager, holding talks, open sessions, one-on-ones, and seminars gives your staff nurses the tools to confront the issue head on and make significant changes.
Everyone knows about overt bias and the harm it causes, but implicit bias is just as dangerous, and many nurses aren’t even aware they may have a bias. Becoming aware of the problem and realizing if you have any bias is a first step toward fixing the problem.