Monday, September 26, 2016

Race and Class Biases Among Nurses and Doctors (Research, Video 2:34)

Have you ever become so accustomed to an odor, even a bad one, that you stopped noticing it at all? Sometimes race and class biases are like that. Unfortunately, men, women, and children can be harmed, even killed, as a result. Many people don’t realize how embedded racism and classism are in our society, particularly when they are not victimized regularly themselves. Overt acts are intended, meant to be hurtful. Covert acts are implied, often done unconsciously, but still do damage because the recipients of these actions are mistreated. 

The healthcare industry, like many others, consists of workers who make decisions about people’s lives on a daily basis. Consistently high numbers of disparities related specifically to race and class have existed over many years. Still, most healthcare workers continue to say they treat all patients equally. Ongoing disparities impact, not only patients, but also their families, communities, and ultimately our nation. In addition to generational suffering and repercussions on many levels, illnesses create long-term economic burdens and major losses of productivity. 

This post is based on race and class bias research in which implied preferences for a specific social group are shown that can have adverse consequences for patient care of other groups.  Clinical stories were used and analyzed to determine whether implicit race or class biases among registered nurses influenced their decisions in managing patients. Performed at the Johns Hopkins Hospital, the study involved nurses who were given 8 multi-stage clinical stories to read in which patients' race or social class were randomly altered. In addition, nurses were given implicit association tests about race and social class.

Results of this study involving 245 mostly white and female registered nurses were the following:
1)   Most nurses stated that they had no explicit race or class preferences.

2)   Only 36 nurses demonstrated no implicit race preference as measured by implicit association tests for race and social class.

3)   Only 16 nurses displayed no implicit class preference on the implicit association tests for social class and race.

This research, along with many other examples, concluded that the majority of registered nurses displayed implicit (unconscious) preferences toward white race and upper social class patients. However, unlike published data on physicians, implicit biases among registered nurses did not correlate with clinical decision-making.

In this video, Michelle van Ryn, Ph.D., a researcher at the Mayo Clinic, describes implicit bias in health care and future research underway to understand and further address this critical issue. Keep in mind that this is not only a healthcare issue, but also a moral one.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Implicit and Overt Racism, Overt and Implicit Classism, Nurses and Doctors Racism-Classism, Dr. Michelle van Ryn, Bias in Healthcare Research


  1. Thanks for exposing very common practices.

    1. This comment has been removed by the author.

    2. Delma, thank you for your honest assessment. Much more personal accountability is needed to save lives. Statistics are real people.