March2017OhioNurse 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 OhioNurses 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, OhioNurses Association, 4000 E. Main St., Columbus, Ohio 43213-2983. Phone: 614-448-1030; Fax: 614-237-6074; E-mail: firstname.lastname@example.org or ddowden@ ohnurses.org. The OhioNurses 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.