Practice Tip of the Week | Raising Nursing Awareness of Racial Implicit Bias

By Bridgett Anderson-Wright, DNP, APRN, FNP-C

There is an uncomfortable truth about the extent of bias within the United States health care system. Implicit bias significantly impacts patient-provider interactions, treatment choices, adherence, and health outcomes. American history is at a critical tipping point for bringing awareness to implicit racial bias. Despite efforts towards progress, Black Americans continue to face disparities and inequities in access to healthcare, health outcomes, and quality of care. Systemic racism, disenfranchisement, and healthcare disparities can lead to unequal access, poor quality, and intermittent absence in care experienced by Black persons in America, contributing to poor outcomes (Williams & Cooper, 2019; A. Owens, personal communication, December 3, 2020; Hall et al., 2015; Chapman et al. 2013; Penner et al., 2014).

What is implicit bias? Implicit biases are thoughts and opinions that often involve unconscious awareness associations, leading to a negative evaluation of a person. In other words, implicit bias is when you exhibit racist behaviors without the intent of being racist and without awareness of your behaviors being discriminatory. Implicit bias is challenging to acknowledge and control consciously. Healthcare providers' implicit attitudes and behaviors contribute to health disparities and inequities in health access and outcomes in the United States, impacting the nurse-patient relationship. Black Americans are simply not receiving the same quality of health care their White counterparts receive, revealing the uncomfortable reality, second-rate health care is shortening their lives.

To be aware of our own unconscious biases begins with educating ourselves. Giving attention to our thoughts and assessing our beliefs can help us identify assumptions we already hold. Awareness and education could help facilitate changes to address racial implicit bias and healthcare disparities among Black persons within the nursing profession. To facilitate those changes, we have to consider the following questions.

Where are we now?

There is a low level of awareness among nurses about how implicit racial bias directly impacts healthcare access, outcomes, and quality.

Where are we going?

We need to bring awareness of the impacts of implicit racial bias on nursing practice.

How are we going to get there?

Providing education and collaboration to initiate professional discussions and create organizational policy.

And once we get there, how do we stay there?

By creating sustainable impacts by increasing awareness, inclusive learning, and positive interaction to nursing practice.

The following steps will help bring awareness while improving health outcomes:

• Supporting nurses in reflecting on how their attitudes may affect patients and providing education and resources to make the practice environment more welcoming to Black persons may help bridge the gap in practice and improve health care outcomes. The racial IAT is the measurement of choice to measure implicit bias.
• Examining structural, historical, and organizational factors can provide a holistic picture of how implicit bias in healthcare contributes to health disparities.
• Educating the nursing profession on culturally responsive and unbiased care through implicit bias education and training.
• Creating a safe space to disarm unconscious biases, to speak to shared values and experiences to address implicit racial bias.
  • Conversations can be difficult and uncomfortable
  • Avoiding conversations about race and racism can arise from our fears of vulnerability.
• Turning knowledge to action. Taking awareness, education, and training and translating it to increase awareness of nurses' implicit bias and further inspire initiatives on implicit biases in nursing practice.

Nurses often take the lead when communities face healthcare-related health issues. Therefore, taking the lead on implicit bias awareness and education can help nurses address it and its impact on the nurse-patient relationship and health-related outcomes.

REFERENCES

Chapman, E., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28(11), 1504-1510. doi: 10.1007/s11606-013-2441-1

Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E.,

Day, S. H., & Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American journal of public health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903

Penner, L., Blair, I., Albrecht, T., & Dovidio, J. (2014). Reducing Racial Health Care Disparities: A Social Psychological Analysis. Behavioral and Brain Sciences, 1(1), 204-212. doi: 10.1177/2372732214548430

Williams, D., & Cooper, L. (2019). Reducing racial inequities in health: Using what we already know to take action. International journal of environmental research and public health, 16(4), 606. https://doi.org/10.3390/ijerph16040606