Combating Implicit Bias in Nursing

Implicit or unconscious bias is not intentional, but it has a detrimental impact. Implicit bias in nursing affects nurses’ quality of life and patient outcomes.

In a Robert Wood Johnson Foundation study, researchers found that 79% of nurses experienced or observed racism or discrimination from patients and 59% saw or experienced it from colleagues.

Asian and Black nurses are particularly likely to have experienced racial aggression, and 94% of Asian and 93% of Black nurses report that it has affected their mental well-being.

Explore more about implicit bias, including how it impacts nurses and patients. Discover some components of effective implicit bias training for nurses.

Implicit and even explicit bias in healthcare is not new, as a history of racism in nursing can tell us. Even though many schools try to address the issue, bias affects every aspect of healthcare: healthcare delivery, public health, workplaces and learning environments, and workforce diversity.

Bias results in worse health outcomes for people of color, such as higher maternity death rates among Black women or racial and ethnic disparities in treatment and outcomes among Black and Hispanic heart attack patients.

Implicit bias is visible in work satisfaction, morale, and career development. Bias such as racism in nursing can affect:

Bias also causes healthcare disparities for patients based on their race, ethnicity, sex and gender, sexual identity, weight, socioeconomic status, and age:

Even the best-intentioned clinician, educator, or colleague may hold implicit and unconscious biases. Fortunately, awareness and training can help make those biases conscious, allowing them to take action to limit the harm implicit bias can cause, whether by unlearning the biases or putting practices in place that protect their patients and colleagues.

Effective implicit bias training for nurses can improve nursing school curricula, continuing education, and workplaces. However, ineffective training, such as suggesting that it can’t change because implicit bias is everywhere, can have negative effects. This ineffective training tacitly justifies the harmful effects implicit bias has in nursing and other healthcare environments.

Effective implicit bias training for nurses introduces the concept and teaches people to recognize and manage their biases, change their behavior, and measure their progress in fighting discrimination in nursing. While it creates discomfort, especially among people unaware of their biases, the right kind of discomfort leads to learning and change. These steps can make training effective and ensure that change and learning last.

People may be uncomfortable for many reasons during implicit bias training for nurses. Often, people do not want to think of themselves as biased. They may often feel uncomfortable describing their experiences either as holding or being subjected to bias or overt racism in nursing.

It can be important for training to emphasize honesty, respect, and creating safer spaces for genuine inquiry and learning. It may also be important to determine whether potential participants can agree that the main outcome of training is learning and changing together to reduce discrimination in nursing.

Hierarchy can create environments in which any existing biases can have more intense consequences because of power differences in an organization. Employees may be uncomfortable describing experiences if they feel that their managers or leaders will judge them.

Leaders can set examples by describing their biases and vulnerabilities to bias, displaying consistent behavior that builds trust, and avoiding using their privilege in retaliatory ways.

Especially in healthcare, most of us think of ourselves as good people who treat others fairly and equitably and strive for the best patient outcomes. This mentality creates cognitive dissonance and discomfort whenever we learn how our implicit biases could cause harm.

Accepting our biases can challenge a self-perception that we are “good.” Programs and initiatives can reduce the sense of denial, blame, or self-blame by explaining that implicit biases are mental shortcuts with evolutionary and biological roots and that reducing implicit bias can be hard work that everybody shares.

Implicit bias training for nurses is not a one-and-done session but the start of learning and developing skills to identify and address bias. We need to develop skills in managing bias in the same way that it can be difficult to follow a healthy diet when surrounded by biological promptings to eat too much junk food.

Role-playing and real-world scenarios let learners develop their skills for the bias and racism in nursing that they will encounter in themselves and others. Learning how to respond can include bystander training. The more familiar people are with analyzing behavior and responding to bias, the more likely they will use these skills in real settings.

Implicit bias training for nurses must include active participation and discussion. Elements of reflection, self-reflection and open discussion can help learners understand the concepts and their own experiences and role in combating implicit bias.

Acting on implicit bias training for nurses requires ongoing learning and reinforcement. Even the best intentions can be made irrelevant on busy workdays with urgent tasks when those who have received training forget to apply the changes they’ve learned. Consider making ongoing implicit bias reflections part of regular meetings or communications.

Finally, make sure those who implement training follow up on and address responses and requests. The follow-up should integrate feedback into ongoing additional training and communication. Those in leadership can make it clear that they expect progress and action by modeling these changes.

Addressing implicit bias can be challenging. Surfacing your biases can be painful, especially when it involves acknowledging health disparities and implicit biases.

For members of historically excluded groups, reliving experiences of bias and discrimination in nursing can be especially disturbing. The important work of addressing biases to improve workforces and patient outcomes should not come at the cost of those who are already most vulnerable.

Understanding and combating implicit bias in nursing is vital to recruiting and retaining an increasingly diverse workforce, building workplace engagement and belonging, and improving patient outcomes.

Encountering discrimination and racism in nursing causes burnout and disengagement among nurses, whose work and well-being are keys to better patient outcomes. By fighting implicit bias in nursing, you can make a measurable change in your staff, community, and population’s health.

Page last reviewed on September 8, 2023