APRNs: Overcoming Clinical Bias

Rebecca H. Bryan, DNP, AGPCNP, APN


Nurs Econ. 2021;39(3):144-145. 

In This Article

Abstract and Introduction


Regardless of discipline, our interprofessional colleagues are acculturated into an implicit hierarchy with nursing low on the chain, thereby diminishing the value of our education and experience. Conversations, rather than confrontations, are needed so next-generation nurses gain the professional respect and recognition nurses have long deserved.


A recent New York Times opinion piece by Theresa Brown (2021) resonated deeply with my professional nursing experience. She lamented the price of invisibility paid by nurses during the pandemic: short staffing, furloughs, layoffs, salary reductions, and lack of recognition for their novel solutions to unprecedented challenges. While I don't take it personally (anymore), I see invisibility as a valid, tenacious problem. This obstacle has haunted me since 1984 as a newly minted registered nurse during a nursing shortage, through being one of the first nurse practitioners (NPs) in my state. Nurse invisibility is seen in insurance reimbursement, service providers, specialists…the list goes on.

Bias, in part, is to blame. McLaren (2019) writes of myriad biases, creating walls that prevent us from seeing. Three resonate with me for nurse invisibility: confirmation bias, community bias, and competency bias.

Confirmation bias. Judging new ideas as they align with old beliefs, framing, and paradigms. Nurses are seen as less educated; their services incur indirect, yet substantial, charges; and they have been viewed as inferior, rather than complementary, to physicians.

Community bias. If the community doesn't, can't, or won't see, it is difficult for us to see. Some healthcare systems have long treated nurses as second class – it is an example of groupthink.

Competency bias. We don't appreciate what we know (or don't know) because we don't appreciate the level of competence (or incompetence) others have. Without realizing it, my interprofessional colleagues objectify me as "nurse" and then can't quite explain what I'm able to do. Nurses are interchangeable, generic, anonymous.