Patient Prejudice: The View From Nurses

Laurie Scudder, DNP, NP; Stephanie Cajigal

Disclosures

October 18, 2017

A recent popular novel by Jodi Picoult, Small Great Things,[1] explored the painful topic of a nurse who was the subject of patient bias. In the story, a well-qualified black labor and delivery nurse is shunned by a white family, despite her education and training.

This situation happens in real life too.

Anecdotes about prejudiced patients and clinicians abound in healthcare. A sizeable amount of research has been directed toward clinician bias and its effect on patient care. Less is known, however, about how often the clinician is on the receiving end of prejudice.

What do we know about how often this occurs, and what does it mean for patient care? We addressed these and other questions about bias 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 we heard from physicians and nurses dovetailed, there were some differences. The results of the physicians' survey are reported separately. Here is what nurses told us.

Nurses and Patient Prejudice

Over half of RNs (53%) and NPs (55%) reported that within the past 5 years, they've been on the receiving end of a patient's offensive remark, most commonly about their age or gender. A sizable number of respondents reported having been subjected to remarks about their race, ethnicity, or accent (Figure):

The absolute numbers of male nurses who responded to our survey were low, and definitive conclusions therefore cannot be drawn. On the basis of the results, however, 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 was 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 instances, 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%).

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