DiversityNursing Blog

When you first meet someone, do you automatically judge that person based upon their weight, skin color, clothing, piercings, hairstyle, disability, speech, etc? Many people automatically infer a stereotype based on someone’s appearance. This is known as unconscious bias.

Recognizing and addressing biases is not only crucial for Nurses to uphold the highest standards of care, but it's also a moral necessity in providing equitable and compassionate treatment to every patient. With commitment to self-reflection and continuous growth, Nurses can truly embody the principles of empathy and understanding in their practice. 

According to Project Implicit, "Implicit bias is an automatic reaction we have towards other people. These attitudes and stereotypes can negatively impact our understanding, actions, and decision-making."

Here are several approaches Nurses can take to evaluate their biases:

Practicing Reflection

Engaging in reflective practice is a powerful tool for Nurses to delve deep into their thoughts, emotions, and actions during patient interactions, especially with individuals from diverse backgrounds. By taking the time to step into the shoes of their patients and see the world from their perspective, Nurses can gain valuable insights into their own biases and prejudices. Picturing themselves in the patients' situations allows Nurses to foster empathy, understanding, and a heightened awareness of how their biases may influence the care they provide. This introspective practice not only promotes self-awareness but also cultivates a more compassionate and equitable approach to patient care.

Implicit Bias Tests

Taking implicit bias tests, such as the Implicit Association Test (IAT), is a valuable step for Nurses to uncover unconscious biases that may unknowingly influence their patient care. These online tests, like those offered by platforms such as Project Implicit, provide a glimpse into the subtle biases that can impact healthcare interactions. By shedding light on these hidden prejudices, Nurses can actively work towards addressing and mitigating them, ultimately fostering a more inclusive and equitable healthcare environment for all patients.

Feedback from Colleagues and Patients

Seeking feedback from colleagues and patients is an essential aspect of self-reflection. By seeking input from those around them, Nurses can gain valuable insights into their communication styles and interactions. Colleagues can offer a different perspective on how biases may manifest in their behavior, while patients can provide direct feedback on their experiences during care. This feedback loop allows Nurses to continuously evaluate and adjust their approach, ultimately leading to a more empathetic and unbiased practice. By fostering open communication and a willingness to listen, Nurses can create a supportive environment that encourages personal growth and professional development.

Cultural Competency Training

Participating in cultural competency training programs can help Nurses become more aware of their biases and develop strategies for addressing them. These training programs offer valuable insights into different cultural practices, beliefs, and norms, allowing Nurses to better understand and respect the unique perspectives of each patient. Additionally, these programs provide practical tools and techniques for navigating cross-cultural communication challenges. Embracing cultural competency training not only benefits patients but also enriches the professional growth and development of Nurses.

Journaling

Keeping a journal of patient interactions and reflecting on them regularly can be a powerful tool for Nurses to gain deeper insights into their own biases and assumptions. By documenting their experiences and emotions during patient care, Nurses can pinpoint any recurring patterns of biased behavior that may be impacting their practice. This self-reflection allows Nurses to not only recognize their biases but also actively work towards addressing and overcoming them. 

Seeking Diversity in Education and Experience

By actively seeking out opportunities to learn from and work with individuals from diverse backgrounds, Nurses can not only challenge their biases but also expand their perspectives in profound ways. Immersing themselves in a multicultural environment allows Nurses to gain a deeper understanding of different cultures, beliefs, and traditions, fostering a sense of empathy and appreciation for the unique experiences of each patient. 

Mindfulness Practices 

Engaging in mindfulness practices, such as meditation or deep breathing exercises, can help Nurses become more aware of their thoughts and emotions in the moment, making it easier to recognize and address biases as they arise. By incorporating mindfulness into their daily routine, Nurses can cultivate a sense of inner peace and clarity allowing them to approach patient interactions with a clear and unbiased mindset. Through mindfulness, Nurses can develop a heightened sense of self-awareness, enabling them to identify any negative thought patterns or biases influencing their behavior. 

Using Bias Checklist 

Utilizing bias checklists or prompts during patient interactions can serve as a valuable tool for Nurses to actively assess and address any unconscious biases. By incorporating these checklists into their daily practice, Nurses can create a structured framework for self-reflection, allowing them to consciously evaluate their thoughts, emotions, and behaviors for any signs of bias. This proactive approach enables Nurses to identify and challenge any preconceived notions or stereotypes influencing their patient care.

As the U.S. population becomes more racially and culturally diverse, having a workforce that mirrors the diversity of your community can improve the quality of care offered at your facility.

Ensuring diversity is incorporated in healthcare hiring practices requires understanding and combatting unconscious biases.

Bias is a prejudice in favor of or against one thing, person, or group compared with another usually in a way that’s considered to be unfair.

Unconscious biases are social stereotypes about certain groups of people that individuals form outside their own conscious awareness.

An example of unconscious bias during the hiring process is when you form an opinion about a candidate based solely on first impressions, such as their LinkedIn photo, their first or last name, or their hometown.

There are methods healthcare institutions can use to identify and reduce biases within their hiring process.

• Clearly define what Diversity means to your organization. It is important to understand which groups are underrepresented. Then set measurable goals that work toward building Diversity.
  
  
• Most hiring processes are designed from one perspective (e.g., level, function, identity). When creating your recruitment process, make it a group effort using input from different perspectives and identities. 
   
• Ensure Diversity exists within all levels of your organization, especially Leadership roles. The top healthcare organizations leading the way for Diversity, Equity, Inclusion, and Belonging (DEI&B) usually have a leadership position solely focused on Diversity, such as Chief Diversity Officer or a similar title.
  
  
• Offer awareness programs, training, and unconscious bias resources for staff. It's a great opportunity for everyone involved in the hiring process to understand what hiring prejudices are and how they can influence decision making. This allows people to identify their own biases and actively improve their behavior. 

With leadership support, clear communication both internally and externally about your DEI&B initiatives, awareness resources, and a motivated workforce, you can successfully reduce biases and increase Diversity, Equity, Inclusion, and Belonging within your organization. 

The Nursing profession has long emphasized its commitment to social justice and health equity. Nurses are known for advocating policies and regulations that are inclusive and lead to positive patient outcomes. However, an essential component of promoting health equity is acknowledging individual unconscious biases and understanding how they may impact the care that's provided.

According to the Institute for Healthcare Improvement, implicit bias, also known as unconscious bias, is “the bias in judgment and/or behavior that results from subtle cognitive processes (e.g., implicit attitudes and implicit stereotypes) that often operate at a level below conscious awareness and without intentional control.” 

Social Psychologists theorize that the content of our unconscious biases are learned from the society in which we live. From a very early age, all of us are repetitively exposed to certain ideas from our family, friends, neighbors, teachers; and, from the constant input of various forms of media. Over time, these ideas become embedded in our belief system and are activated automatically and unconsciously.

In the context of health care, unconscious bias can lead to health disparities such as the under treatment of conditions like pain, cardiovascular disease, asthma and mental health in racial and ethnic minorities. One of the things that accounts for health disparities is unconscious bias in health care providers. Not only does unconscious bias contribute to under-treatment, but studies have shown that providers with more implicit biases are more likely to have negative interactions with patients. This impacts trust and the likelihood that patients will seek health care. 

There are ways we can prevent this.

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.

Follow the National CLAS Standards

The National CLAS Standards are a set of 15 action steps intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health care organizations to implement culturally and linguistically appropriate services.

Explore awkwardness and discomfort

It’s okay to feel outside your comfort zone or to be unsure of what to feel, do or say. In a world in which people mostly back away from discomfort and awkwardness, that could be the source of the greatest learning.

Training

Rather than making changes from the top of the business and hoping it trickles down into every area, unconscious bias training provides each individual employee with an understanding of the impact they can have by changing their way of thinking.

Unconscious bias training is geared around three things: awareness, impact and action. We can build awareness about why biases exist (and individual ones we hold), demonstrate the impact they can have on our decisions, actions and working patterns, and finally, agree how we can take action to ensure they are not expressed in a way that could negatively impact the work environment.

Although many healthcare providers don't see themselves as being biased, it's a common and persistent problem. If left unrecognized and unmanaged, unconscious bias can lead to health disparities, resulting in potentially negative consequences for patients. The strategies above can be used by Nurses and other healthcare professionals to overcome unconscious bias and provide optimal patient care.