In these modern times, we like to think that racial issues are a thing of the past. Yet, it would seem that this is not so. A recent popular novel by Jodi Picoult, Small Great Things, explored the painful topic of a nurse who was the subject of patient racial bias. In the story, a well-qualified black labor and delivery nurse is shunned by a white family, despite her education and training. Sadly, this is not just a fictional incident. It is one that is happening all too often in real life in 2017!Get Small Great Things by Jodi Picoult by clicking here.
Anecdotes about prejudiced patients and clinicians abound in healthcare. Extensive research has been directed toward clinician bias and its effect on patient care. However, less is known about how often the healthcare worker is on the receiving end of prejudice.
What is known about how often this occurs, and what does it mean for patient care?
These and other questions about bias were addressed in a WebMD/Medscape survey, produced with STAT, of 934 consumers, 822 physicians,100 registered nurses (RNs), and 160 nurse practitioners (NPs).
While much of what was heard from physicians and nurses was consistent, there were some differences. The results of the physicians’ survey are reported separately. Here is what nurses revealed:
Nurses and Patient Prejudice
Over half of RNs (53%) and NPs (55%) reported that within the past 5 years, they have been on the receiving end of a patient’s offensive remark, most commonly about their age or gender. A sizeable number of respondents reported having been subjected to remarks about their race, ethnicity, or accent (Figure):
The total number of male nurses who responded to the survey was low, and definitive conclusions, therefore, cannot be drawn. However, on the basis of the results, it is clear that men are not immune from gender-based bias, with male RNs and NPs reporting that they had been subjected to comments about their gender in percentages similar to those of female nurses.
Despite such a large number of nurses reporting that they had experienced patient bias, only a small minority (8% of RNs and 7% of NPs) noted that the situation had been escalated in the form of a written complaint about the nurse.
Over a third of RNs (34%) and almost half of NPs (44%) reported that they have had patients ask to see a different nurse or ask to be referred to a different clinician because of the clinician’s personal characteristics. The most common reasons for the request was the nurse’s gender (21% RNs, 35% NPs) race (21%/11%), ethnicity/national origin (21%/25%), or accent (21%/14%).
In the majority of incidences, nurses report that the request was granted by referring the patient to another clinician at the same facility (44% of RNs, 54% of NPs) or a different facility (6%/20%). However, in a substantial minority of instances, after speaking with the patient, the patient accepted treatment from the nurse (21%/6%) or the nurse’s colleague (21%/13%).
What Do Nurses Do About Patient Bias?
The majority of nurses have never reported a bias incident to management (64% of RNs, 75% of NPs). Large majorities of nurses told us that they had never refused to care for a patient because of the patient’s negative bias toward the nurse. And there may be a reason why. Most RNs (53%) who told us that they had reported a bias incident said that they were asked by management to continue caring for that patient. A smaller percentage of NPs (28%) indicated that they were asked to continue to provide care, while 30% of NPs reported that management transferred the patient to another clinician at the same facility or that the manager took over care of that patient (25%). RNs were less likely to encounter these latter resolutions: Only 11% reported that the patient was transferred to another clinician at the same facility, and only 14% reported that the manager took over care of that patient.
A large majority of nurses also reported that they have never documented a bias incident in the patient’s medical record (79% of RNs, 77% of NPs).
Similarly, large majorities of nurses told us that they had never refused to care for a patient because of the patient’s negative bias toward the nurse (79% of RNs, 84% of NPs). And even larger percentages reported that they had never refused to care for a patient because of that patient’s bias toward a colleague (93% of both groups)
The majority of nurses (60% of RNs, 54% of NPs) reported that they did not know whether their institution had a formal process that clinicians can initiate if discriminated against by a patient, although 25% of RNs and 19% NPs stated that their institution did have such a process. Approximately two-fifths of NPs (41%) and a quarter of RNs (23%) reported that their institution provided formal training on how to handle patients’ biases.
How Does Patient Bias Affect Nurses?
Nurses obviously feel a certain emotion when reacting to patient bias. It thus stands to reason that a large percentage told us that being on the receiving end of patient bias had an emotional impact, although only a minority categorized the impact as strong.
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