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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


Implicit Bias

Updated: Jul 26, 2023

There is a push in the medical community for patient-centered care. Medicine should not be 1 size fits all, it needs to be customized to the patient's wants and wishes. But our bias about what the patient should be prescribed or what treatment should be given is determined by our biases both explicit and implicit.

Implicit bias is a form of bias that occurs automatically and unintentionally which affects decisions and behaviors. Implicit bias poses barriers to diversity and inclusion. The National Institutes of Health (NIH) has an excellent Implicit Bias training program. They give the following example to illustrate how implicit bias works.

Most people would automatically put the Corgi dog with Queen Elizabeth, the Pomeranian with the fashionable young woman and the German Shepherd with the police officer. These pairings, according to the NIH course, are implicit associations and are done constantly and automatically by our brain. When children were asked to draw a picture of a "scientist" the majority drew a picture of a white man. When asked to assign a gender to a nurse and a teacher, the majority chose female. Our decisions are influenced by our experiences, the media and culture.

Dr. Flanagan in Implicit Bias in HealthCare (2021) tells the story of a group of physicians who were not able to reach a diagnosis of a child's condition. They were examining the child's x-ray when another physician walked by and said, "that's cystic fibrosis". The group of physicians had not considered Cystic Fibrosis because the child is African American and it is less common in that group. The physician walking by had no idea of the patient's race. Implicit biases can start as early as 3 years of age. Dr. Flanagan says that particular social attributes like skin color and names can affect perceptions and behaviors "quietly and insidiously". An example is given of resumes and callbacks for job interviews. The resumes with White-sounding names were 50% more likely to get a callback than resumes with African-American sounding names. Another glaring example is the health disparities in life expectancy. Life expectancy for African-American men is 4.4 years lower than White men and African-American women have 2.9 year lower life expectancy than White women.

Did you know that Band-aids have been the same pinkish color for over 100 years? Johnson and Johnson announced in June of 2020 that they were adding brown and tan colors for different skin tones. This is a perfect example of implicit bias. For 100 years no one at Johnson and Johnson thought that there were any other skin colors than pink? This was an "aha" moment for me. I never thought about the color of bandages. I knew there were cartoon characters and Disney characters on band-aids for children but never thought about colors for adults.

It was the Black Lives Matter movement that was the impetus for the color change to band-aids. Johnson and Johnson said on their Instagram page:

"We are committed to launching a range of bandages in light, medium and deep shades of Brown and Black skin tones that embrace the beauty of diverse skin. We are dedicated to inclusivity and providing the best healing solutions, better representing you.”

Marla Milling on responded by asking if this change in colors was the right response. A better response would be to only make dark colored band-aids for the next 100 years. Right on! for 100 years the bias has been that only "white" band-aids were needed even though people with other skin tones have needed bandages for 100 years.

Milling, M., June 15, 2020 Johnson & Johnson Announces New Band-Aids, But That Can’t Fix Racial Inequality.

So what can we do to stop Implicit Bias?

Dr. Kendra Todt in Strategies to combat implicit bias in nursing says the first step is to understand that we all have implicit biases. If you have dread over taking care of a patient the first question you should ask yourself is, "Am I experiencing bias?" Is there something about the patient's race, gender, age, etc. that is causing the dread? Then you need to stop and think about what is being felt and determine if there is cause for it or is it a stereotype? Look at the patient with "new eyes". Think about how they might be feeling and experiencing their medical disease or condition. Take time to get to know the patient, listen to their story and "embrace them as a care collaborator". And be careful with the words that you use. Is the patient an addict or a person with a substance use disorder? Language can be stigmatizing and can cause a patient to become angry and violent.

(Todt, K. Strategies to combat implicit bias in nursing. July 2023. American Nurse Journal, 18(7) 19-23).

Awareness is key to combating implicit bias. By looking at areas of discomfort with certain patients we can become aware and hopefully change our mind and behaviors. Let's hope it doesn't take 100 years to change our behaviors.

Did this bring up anything in you? Let me know.

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