Implicit Bias in Nursing: Recognition and Reduction Strategies

Introduction: Defining Implicit and Explicit Bias in Healthcare

Both implicit and explicit biases encompass the various associations made by healthcare practitioners that can result in the negative evaluation of a patient on the basis of features including, but not limited to, gender, sexual orientation, and race (Rosa, 2016). Numerous studies have indicated that biases can significantly impact outcomes across nursing practice settings. In one such study, FitzGerald and Hurst (2017) found sufficient evidence indicating that there are no significant differences between the bias levels exhibited by healthcare professionals and those exhibited by the general population. Implicit bias could, for instance, occur "between a group or category attribute, such as being Black, and a negative evaluation (implicit prejudice) or another category attribute, such as being violent (implicit stereotype)" (FitzGerald & Hurst, 2017, p. 21).

It is important to note that, in addition to mismanagement of symptoms, biases can also result in a failure on the part of healthcare professionals to advance preventive care in settings where it is warranted. Further, as Rosa (2016) points out, biases can lead to unrealistic extensions of patient appointment waiting times.

How Bias Affects Patient Outcomes in Practice

When it comes to personal biases and attitudes toward people based on superficial differences, implicit bias tends to be more prominently pronounced than explicit bias. A clear example of bias in a practice setting occurs when more effective interventions — that is, better treatment options — are less frequently recommended for Black patients than for white patients. Understanding how implicit stereotypes operate is essential for any clinician seeking to deliver equitable care.

In some instances, medical practitioners may feel anxious about interactions with certain patients — for example, gay individuals or people of color. In such cases, the time a provider spends with patients who trigger that anxiety may be shortened, effectively diminishing the quality of care and, consequently, patient outcomes.

Recognizing Personal Bias as a Healthcare Professional

Regarding personal bias, it is important to first acknowledge that, as a healthcare professional, I do not view myself as intentionally biased. However, being human, I am not immune to unintentional, implicit bias. For instance, I tend to associate specific clothing styles and mannerisms with certain qualities — such as an inability to make rational life decisions, immorality, or promiscuity. As a result, I could unconsciously assume that a patient dressed in such a way is incapable of following through with a recommended treatment regimen. Recognizing this pattern is a necessary first step, consistent with what researchers and public health bodies describe as the foundation of bias reduction in clinical settings.

Conclusion: Toward an Equitable Healthcare System

In the final analysis, there is a clear need to ensure that the healthcare system serves all individuals equally, regardless of their race, sexual orientation, or economic status. To that end, the healthcare system ought to be made less difficult to navigate and more welcoming for everyone.

References

FitzGerald, C. & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18, 19–24.

Rosa, W. (2016). Nurses as leaders: Evolutionary visions of leadership. Springer Publishing Company.