Human Centered Service

Dear Nurse Practitioner,

I am a human. It is funny how much your lasting impression can come from what we hear at the conclusion of a conversation. I heard – we’ll see what the insurance will allow for and really, throughout the conversation, I felt more like an appointment than a human. Meaning, rather than looking at my tests and asking deep questions, I was sized up but not through the correct lens.

The nurse practitioner displayed the type of bias that my not have occurred if she were looking at me as if in my (real) shoes. This makes sense given the demographic that is served by the rural location of the office. That being said – we did address my main concern but, as a first appointment it did not seem to be as comprehensive as I might have hoped.

Me being me, I explored the program outcomes at the university she attended. This is the communication specific one:

“Demonstrate the ability to effectively communicate using audience-specific oral, written, and information technology for professional delivery of specialist nursing care.”

My question is do they educate prospective NP’s on bias in “audience-specific” oral communication?

Here’s why:

• Right from the beginning I stated I had a severe migraine – thus I was not good at steering the conversation except toward my immediate pain (stemming for cervical spine nerve impingement) and I completely overlooked pointing out the US of my abdomen where the impressions of two different doctors indicated the need for a pelvic MRI.
• As the conversation progressed there were some assumptions inherent in the advice I was given where open ended questions over advice would have been more helpful in terms of problem solving and relationship building.
• I felt ushered out the door while I knew that we hadn’t covered certain items with, “when we get the MRI back we can figure out next steps – depending on what your insurance will allow for.” I did not have time to enquire if my past medical history would help with that.
• Overall, I just felt that open-ended questions and deep listening skills were not put into practice.

The resulting research & conclusion

This short document summarizes my findings, Understanding Bias in Communication for Nurses, on these topics:

• Types of Bias
• Impact on Patient Care
• Manifestation in Clinical Practice > the most alarming and what I feel I experienced: Stereotype-driven assumptions influencing diagnostic reasoning
• Strategies to Mitigate Bias

In my perspective, it seems that there is a need for more education and emphasis – both for practitioners and for the public – on bias-aware communication. Here are some notable existing courses and programs:

Name / Provider	Format / Duration	What It Covers (Bias + Communication)	Notes & Fit for Nurses / NPs
Addressing Implicit Bias in Healthcare (Walden micro-course)	Online micro-course	Explores bias (personal, institutional, structural), uses simulated interactive dialogues to test communication in bias scenarios, includes creating an audit/action plan. (Lifelong Learning at Walden University)	Strong candidate since it uses simulated dialogues (role-play style) and is from a nursing-aligned institution.
Implicit Bias Training for Nurses and Other Healthcare Professionals (Wild Iris / CEU)	Online CE course (~2 contact hours)	Defines implicit bias, examines impact, provides strategies to mitigate bias in healthcare settings. (Wild Iris Medical Education)	Good for nurses needing CE / bias awareness foundation
Implicit Bias in Health Care (NetCE)	Self-study, CE/Continuing Education	Covers implicit/explicit bias, measurement (IAT), mechanisms, outcomes, mitigation strategies in health care. (NetCE)	Strong foundational overview; less hands-on but useful for theory + strategies
Implicit Bias and Cultural Competency Nursing CE Course (NursingCE)	CE course (2.0 ANCC contact hours)	Reviews history of health disparities, how bias affects outcomes, strategies to mitigate bias including communication, inclusive language. (Nursing CE)	Good mix of content; less emphasis (from description) on active role-play
Implicit Bias Course for California Nurses (Quality Interactions)	1-hour CE / state-mandated module	Meets CA requirement, includes interactive modules, case scenarios, focus on bias in nurse communication and patient interaction. (qualityinteractions.com)	Very applicable, especially for nurses in CA, though duration is short
Addressing Implicit Bias: A Primer for Healthcare Providers (Chamberlain CPE)	Micro-course	Defines bias, shows how bias shows up in conversations, actionable steps to mitigate, personal/professional application. (cpe.chamberlain.edu)	Useful for communication-focused bias interventions in clinical conversations
Unconscious Bias in Medicine (Stanford CME)	CME / CE course	Geared to clinicians and academics; focuses on recognizing & addressing unconscious bias in medicine. (Stanford Online)	May suit nurse practitioners especially in mixed clinical settings; less “nurse-specific” but valuable
March of Dimes “Awareness to Action: Dismantling Bias in Maternal & Infant Healthcare”	E-learning + live training	Focused on perinatal / maternity care settings, includes bias + communication strategies (e.g. CARES Framework) in maternal settings. (March of Dimes)	Highly relevant if your NP interest includes women’s health, perinatal care

These are all good educational opportunities but the subject seems to be a side note. For example, according the CA licensing rules: “In accordance with AB 1407 (Burke, Chapter 445, Statutes of 2021), starting January 1, 2023 a licensee still within the first 2 years of holding their license, immediately following their initial licensure, must complete one hour of direct participation in an implicit bias course offered by a continuing education provider that has been approved by the Board of Registered Nursing. Approved CE Providers can be verified using the DCA License Search. This new requirement is codified in California Statute under Business and Profession Code 2811.5.”

Yep one whole hour is required. I am sure that is pretty rigorous. :-/

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MY BIAS/Context Disclaimer!