Ohio Nurse - March 2017

March 2017 Ohio Nurse Page 5
The Realities of Nurse Bias
Heidi Shank
Logan Walker
Effective nurses may recognize their nurse bias if
they possess a good understanding of their personal
moral limitations. When a nurse understands how bias
corrupts care, they can increase their effectiveness
of care and improve patient outcomes, safety, and
overall quality of care. This article briefly describes
some key benefits, concerns, and suggested changes
for the nurse who recognizes bias and the impact it
has.
Patient safety and the quality of care should always
be the highest regard on a nurses’ mind. Yet every day
nurses’ go to work and put themselves as well as their
patients in harm’s way without even realizing. When
a nurse does not realize their bias may corrupt the
quality of care for each patient, whether it’s conscious
or subconscious, they are unable to make appropriate
decisions regarding treatment. To offer the best safety
and the highest quality of care, the nurse must be
able to identify their own limitations and develop ways
to modify them. When the nurse develops ways to
understand their limitations and what triggers bias,
they are then able to make appropriate decisions
that will benefit each patient. Nurses should be
accountable for themselves and consciously objective
to care when it hinders their ability to act without bias.
According to a recent article by Odell, Abhyankar,
Malcom, & Rua, the definition of conscientious
objection in nursing includes the objection of an
action, by a nurse, because the action would violate
deeply held convictions about what is right and wrong.
By consciously refusing care, the nurse does what is
best for the patient and may eliminate corrupt care.
Thus, eliminating bias from care benefits the patient’s
safety and quality of care.
Concerns may arise with patient safety and the
quality of care when personal bias corrupts care
and the nurses do not object. Many nurses’ feel
professional duty to care for patients, even though
they have major internal conflicting interests. What’s
concerning is when nurses’ act out of obligation
without raising awareness of their bias; a nurse might
believe that the sanctity of life trumps all. Research
shows potential risk is especially critical in situations
where nurses’ professional duty to care for patients
comes into direct conflict with their personal wellbeing
and safety. In these situations, the nurse
should understand themselves and question their
accountability and responsibility for that patient. That
does not mean refusing care due to the patient’s
acuity; it must be a conscious objection based on
developmentally ingrained convictions that are morally
profound in that nurses’ beliefs.
Current experts agree that to ethically object to
participating in an intervention, the intervention must
challenge the moral integrity, and not be based on
false motivation. It really has to violate a deeply held
conviction of what’s right or wrong. The American
Nurses Association (ANA) upholds that determinant
and does not allow nurses to refuse care based on
prejudice, discrimination or dislike. For example, they
can’t refuse to take care of someone because the
patient abuses alcohol just because the nurse doesn’t
like alcoholics.
Another concern would be not understanding
the difference between objecting to provide care
based on false motivations versus deep convictions.
If alcohol holds a deep conviction then the nurse
has the right to refuse care. For example, the nurse
who lived with an alcoholic spouse who was abusive
may not be equipped to cope with a similar patient.
Serving a patient who abuses alcohol may trigger
a response of her past causing personal bias in her
care. It is never a nurse’s duty to act on anything that
may cause them personal harm including emotional
harm. Painful experiences such as abuse can cause
frightening memories and the sense of constant
danger. So, in this case, the appropriate action for the
nurse is to discuss this with someone in charge and
refuse care due to deep convictions. The ANA states
that the nurse has the professional right to accept,
reject or object in writing to any patient assignment
that puts patients or themselves at serious risk for
harm. In situations, where limitations are threatened,
the appropriate action for a nurse to take is to
examine the underlying issue and act accordingly.
Having moral dilemmas is a part of life but, learning to
manage them is a part of professionalism. At the end
of the day, it is the job of a nurse to be a professional
and offer what is best for the patient.
When the nurse acts out of false motivation,
objecting consciously, the nursing supervisor needs
to be informed. When the supervisor is involved,
sharing and clarity becomes part of the process. The
nurse may be confused on what deep convictions
are. Proactive discussions with informed leaders may
help. On the other hand, bias care may be observed
especially if the nurse is performing care out of
professional duty with internal conflicting issues and
leadership may need to be involved. The nursing
supervisor needs to be informed and help the nurse
understand biased care. If the education does not
work, then the nurse should seek self-understanding
through various resources including employee
assistance, professional counseling, or discussions
with trusted friends to find the underlying cause of
their bias. It may be due to past painful experiences
or false motivations, such as prejudice, jealousy, or
discrimination. By eliminating bias, the nurse can offer
the best safety and quality of care for each patient and
maximize their full potential.
To conclude, when a nurse knows their bias
corrupts the safety and quality of care for the patient,
the nurse should request reassignment. When caring
for a patient endangers the nurse’s developmentally
ingrained convictions, it is acceptable for the nurse
to consciously object to provide care on the grounds
of moral integrity based on deep convictions. Moral
integrity implies having an internally consistent set of
basic moral ideas and principles, and being able to
live and act in accordance with these. When nurses
live within accordance of their moral limitations they
can recognize bias and make appropriate decisions
that will benefit all. At the end of the day, the nurse
who speaks up is caring for the patient, but they are
also caring for themselves.
Heidi Shank MSN, RN, DNP (c) is the
Undergraduate Program Director and Instructor at the
University of Toledo College of Nursing with 31 years
of nursing and progressive administrative nursing
and organizational leadership experience. Specialty
areas include nursing leadership, organizational
design, joint commission accreditation, and critical
care with a specialty in stroke-related care initiatives
and patient safety. Heidi also serves as the American
Association of Critical-care Nurses, as the Region 9
Chapter Advisor for all of Ohio & Indiana. She is also
a member and committee member of the Zeta Theta
Chapter of Sigma Theta Tau.
Logan C.S. Walker is a BSN 3 senior nursing
student at the University of Toledo & College of
Nursing. He currently resides in Toledo, Ohio but
plans to relocate near his home town of McMinnville,
Tennessee upon graduation. Logan is enjoys delving
into Research and Evidence-based Practice to
enhance his future nursing practice. He is passionate
about using his nursing career to make a difference
for others.
CALL FOR ABSTRACTS
2017 Wellness Conference
The Ohio Nurses Association and The Ohio
State University are planning the First Annual
Wellness Conference to be held on March
24-25, 2017 at the Ohio State University,
Columbus, Ohio. Individuals are invited
to submit proposals for a poster session.
The conference is designed to enhance
the participant’s approach to their personal
healthcare that emphasizes prolonging life and
the prevention of illness.
If you have a program or project that you
would like to present in poster format, please
complete the Request for Proposal forms and
submit by March 10, 2017.
1. Poster presenters must register and be
available to present their poster during the
poster session times.
2. Presenters will be supplied one easel
and one chair per person for each poster
presentation. No tables are available.
3. Posters should not exceed 30” by 39” in
order to fit on the easel.
4. No audio-visual equipment will be
available.
5. The fee for poster presenters is $50.00 for
each presenter. This includes the lunch,
easel, chair and handouts. If you are
attending the conference, you do not need
to pay the $50.00 fee.
6. Please note that participants will be able
to receive contact hours for participating in
the review of the posters and discussions
with the presenters.
For questions or the Request for Proposal
forms, please contact Sandy Swearingen,
Continuing Education, or Dodie Dowden, CE
Specialist, Ohio Nurses Association, 4000 E.
Main St., Columbus, Ohio 43213-2983. Phone:
614-448-1030; Fax: 614-237-6074; E-mail:
sswearingen@ohnurses.org or ddowden@
ohnurses.org.
The Ohio Nurses Association is accredited
as a provider of continuing nursing education
by the American Nurses Credentialing Center’s
Commission on Accreditation. (OBN-001-91)
Seeking qualified candidates for a full-time
Director of the Holzer School of Nursing.
MINIMUM QUALIFICATIONS:
• Doctorate Degree
• Two years of teaching experience in the Nursing field
• Eligibility for Ohio RN License
For additional details about the position visit our
job opportunities page at www.rio.edu.