Navigating Implicit Bias As A Nurse
As a nurse, you help others heal and stay healthy. But what if you realized your upbringing and life experiences might be causing you to treat some patients and coworkers differently?
That kind of bias, called implicit or unconscious bias, is something that every nurse and every human being lives with — you may not even be aware of it. But it can impact the health care you provide and keep you from fully connecting with your patients, families, and colleagues.
What Is Implicit Bias?
Implicit bias describes the unconscious associations and feelings that affect how you process information and engage with others. Everyone has implicit bias stemming from the different layers of their identity, such as their gender, age, language, values, religion, race, and culture. These layers make you who you are, affect how you see the world, and create a way of being that feels normal.
“Think about your upbringing and the different layers of your identity. You may have learned things from loving and caring people that may hinder you from seeing somebody else’s humanity,” says Bart Bailey, owner and principal consultant for Courage to Care, a firm that focuses on justice, equity, diversity, and inclusion.
Based on your identity markers and the world events that shaped you, you unconsciously generate a story, positive or negative, about every person you engage with. That story guides your interaction with that individual — even though the story has nothing to do with the person you just met and is more about who you are and the experiences that shaped you.
How Unconscious Bias Can Impact Patient Care
Unconscious bias can be offensive and hurt someone’s feelings, even though it’s unintentional. But studies show it can sometimes also affect the health care patients receive.
Personal biases often reveal themselves in stressful or traumatic times — we tend to revert to our normative behaviors (what feels comfortable) in those situations. Sometimes, a patient’s default behavior — language, volume or tone of voice, or body language — might make you uncomfortable. And that disconnect can impact how you engage with your patient, your care decisions, and the patient’s adherence to the care plan.
“The disconnect can happen very quickly and have a significant impact on health outcomes,” Bart says. “You may start to treat this person as ‘other.’ You might want to dismiss what they’re saying. The interaction might feel more like a transaction than building a relationship to see how you can help your patient.”
Even if you don’t work in a stressful environment, you still unconsciously create a narrative about each person you encounter (just as they are creating a story about you). That narrative you create can dictate how you’ll navigate that patient-caregiver relationship — but it doesn’t have to if you know how to handle it.
How to Recognize and Manage Your Implicit Bias
If you notice a personal bias, especially as it presents itself, you can move past it and be fully present with your patients. Bart suggests these steps:
Do some pre-work
When you have some downtime, break down the different levels of your identity. Consider what you believe or were taught about each of those identity markers — think about the acceptable actions, expected behaviors, and values you associate with your gender, race, religion, and so on. Bart suggests asking yourself questions such as: Where and when did you learn this was important? What are the behaviors associated with it? What’s the impact?
There’s no need for blame, shame, or guilt, Bart adds. Instead, honor what you learned from people who had good intentions while recognizing that it may hinder your ability to connect with others.
Pay attention to your body
We’ve all been in a situation where something doesn’t feel right. Before your brain knows what’s happening, your body tenses, your chest tightens, and your blood pressure rises. The same can occur when an implicit bias causes you to feel uncomfortable with a patient or situation.
“My body tells me when I’m feeling discomfort,” Bart says. “Pay attention to what your body is telling you and simply breathe.” You’re experiencing your brain’s automatic, unconscious, and emotional response to the person or situation. Taking a deep breath can bring you out of that immediate reaction.
Disrupt the story
Remember that whatever you think about the person in front of you is not about them. It’s about a story you created based on your upbringing and implicit bias. Own the story and release it, recognizing the person in front of you as an individual and patient who needs your help.
“You created a story because of past experiences,” Bart says. “Well, this is a different human being, and this is a different day and different moment. When you disrupt the stories you have, you can be present in the moment and see this person’s humanity.”
Reacting to the Personal Biases of Others
Health care brings all types of people together, often in stressful situations. You may see acts associated with implicit bias taking place around you. When that happens, you can move from being a bystander to an upstander, says Bart. How you choose to react may depend on the context of the situation and your relationship with the person involved.
Bart recommends taking one of three actions:
- Call out: When you see something offensive, walk over and tell the individual to stop the behavior. Make it clear that they are causing harm to someone.
- Call in: Use “I” statements to invite the person to understand how you are experiencing the situation. Say, “I heard you say this, and I feel this way about it.” Stop and let them react. See if they’re open to discussing it further or if they dismiss your concern. Then navigate the situation from there.
- Call to: Encourage the person to be aware of their actions by asking them to help you understand what they meant by what they said or did.
Taking action is not easy. Like anything else, it requires practice. “You should be doing this at home, too,” Bart says. “Once you get the reps in, it will become intuitive. And then imagine the ripple effect that 4 million nurses could have on the remaining 330 million Americans. Just imagine.”
How do you prevent implicit bias from affecting your work? We’d love to hear what works for you. Share with us in our discussion.
Not a member of Healthy Nurse, Healthy Nation (HNHN) yet? Join today!
Join our monthly challenges at hnhn.org/challenges.