Human nature contributes to bias by allowing us to use psychological “shortcuts” to reduce complexity and ambiguity in the world. We all wish that life were simpler, and our brains try to accommodate this wish by finding shortcuts to decisions by relying on past patterns of thinking. This enables us to provide a rational response within the context of a simpler and less-threatening world. The two main types of bias related to human nature are personal bias and group bias.
Personal bias has two aspects: emotion and thought. These biases come from our view of the world that is created by the sum of our individual experiences: where we grew up, our parents’ values, how our friends act, and how we were trained. Although we might make conscious efforts to overcome personal bias, we all retain some degree of it as part of our individuality.
Personal bias is more likely to affect peer review when individuals are not accountable for their decisions. This is not because these are bad people—they are simply good people in a flawed system. The case studies in this book provide several examples of peer review structures and procedures that, prior to redesign, increased the likelihood of personal bias, such as having a department chair conduct the entire case review process from case screening to decision. To reduce personal bias in peer review, consider requiring reviewers to provide a written rationale for their findings (even on care-appropriate cases), having a committee make the final decision on all cases, and implementing clear conflict of interest practices.
Group bias occurs when a group of individuals has a shared set of beliefs or experiences that result in a relatively predictable way of thinking or responding. This concept of “groupthink” results in the group tending to accept information that meets its common paradigm and reject, or at least not consider, information that doesn’t fit within it.
Lack of diversity in a group can create this bias. Therefore, to avoid group bias, structure the group to ensure that other views are included. There are two types of group bias that tend to affect peer review: professional bias (e.g., physicians think differently than nurses) and specialty bias (e.g., surgeons think differently than internists). One of the main reasons that medical staffs implement some form of multi-specialty peer review committees is that such committees reduce the likelihood of groupthink by bringing all perspectives to the table.
Source: Peer Review Benchmarking
With the time-crunch worse than ever, it can be difficult to find the time to keep up with the latest in your facility, let alone the wider world of nursing. Early research conducted by Critical Care Nurse (CCN) suggests that blogs can be an effective means of communicating the latest hospital policies and best practices.
The cardiac intensive care unit at Brigham and Women’s hospital found that while many of their nurses attended professional educational opportunities, the staff had difficulty sharing information with the entire nurse staff. The staff simply did not have the time for peer-to-peer sharing of educational information. To facilitate educational sharing, the nursing practice council at the facility set up a simple private blog where staff could share what they’ve learned from various educational opportunities, such as professional conferences and panels.
After fifteen months, the hospital conducted a survey to measure the effectiveness of this approach. They found that 86% of their nurses thought the blog was an effective way to share professional education, 81% felt the blog kept them up-to-date on evidence-based practices, and 59% thought the blog led to changes in their practices. While the results are anecdotal and early, the authors of the study suggest that more rigorous research is required.
Does your facility use blogging tools or social media for education and professional development?
Nurses at Methodist Health claim that the hospital docks lunch pay for breaks they aren’t able to take.
Robert Straka, a nurse at Methodist Health in Dallas, filed a collective action lawsuit in August against his employer. The issue in question is the hospital policy that dictates that nurses should be allotted 30 minutes every shift to take an uninterrupted break. He argues that nurses are still expected to care for patients during their break, and would often get pulled away to perform duties. Straka filed on behalf of almost one thousand nurses across Methodist’s five facilities.
Meanwhile, Methodist argues that this is not the case, and questioned the plaintiff’s interpretation of the rules. They’ve requested that the charges be dropped in a response sent last week. The judge in the case has mandated that each party meet and produce a report next month, that would outline settlement options and hopefully come to a resolution.
There are many hurdles for women pursuing executive roles. Normally a male-dominated field, many women struggle to get the opportunities and resources they need to obtain leadership and executive positions. Unfortunately, things don’t get much easier once they get there, according to a new study.
The Harvard Business Review published a study by the Yale School of Management that investigated gender stereotypes in executive evaluations. The study gave participants a scenario where a police chief misused resources and let a protest get out of hand. In one scenario, the police chief was male, in another the chief was female. The female chief received significantly more criticism than the male; some participants suggested that she get demoted, while none of the participants suggested that for the male chief. This pattern continued: “A decision that backfired led to harsher scrutiny for female leaders.”
The study concluded that women in positions that are traditionally occupied by men—which are often leadership roles, unfortunately—were criticized because they were going against gender stereotypes. For nurse leaders looking to transition to executive positions, this is yet another hurdle to overcome.
For more articles about women in health care, check out some of our articles in the Strategies for Nurse Managers Reading Room:
In just about every field, there are discrepancies between leadership positions and the population they represent; health care is no different. The American Hospital Association’s Institute for Diversity conducted a national survey that found that minorities made up 31 percent of the patient population, but only 17 percent of first and mid-level management positions. There’s even less representation in upper management roles, with 14 percent of hospital board members and 12 percent of executive leadership roles filled by minorities.
As the hospitals’ population get more diverse, so should its leadership. This doesn’t just mean racial diversity, but gender, experience, and cultural diversity as well. Hospitals that have a multitude of perspectives will serve their population better and make the hospital more successful.
In terms of diversity of experience, nurses can bring a useful perspective to executive leadership. Many hospital executives come from a business background and don’t have the kind of on the ground experience nurses can bring to the table. Medical staff generally prefer leadership that is familiar with their experience, that can relate to how big-picture decisions can effect day-to-day practices in hospitals. Additionally, nurses have more racial diversity compared to executive leadership, so they would bring that experience to the table as well.
However, there are a lot of barriers to nurses trying to obtain leadership positions. As a nursing student, nurses are much more focused on learning patient care than management techniques. Nurses don’t get much formal training in finance or business, so staying competitive might mean seeking a time-consuming and expensive degree on the side. There is also a possible stigma against nurses from executives, so much so that the American Nursing Association reports that RNs seeking executive work often leave that off their resume. As one nurse told them: “Well, I don’t want to put RN after my name because some people might not think that I know as much about business, or that might be a detractor when I’m competing with others in the C-Suite, especially men in the C-Suite.”
While perspectives are slowly shifting, along with diversity numbers in hospital leadership, nurses taking on larger leadership roles can help hospitals and their patients.
This may seem like an unusual question to ask nurse managers and nurse leaders, but it’s one that is worth thinking about. Is your job too comfortable? Is it not stimulating enough? Are you stuck in a rut?
Being in your comfort zone is comfortable, but it may not be the best place for you. If your goal is to have a more joyful existence, then take some risks. [more]
Last week I promised a downloadable version of the whistleblower flowchart. For those who are interested, you can access the file here.
When I read about the fallout on Kim Cheely, the nurse whistle-
blower I wrote about last week, I had to ask myself:
Why do nurses risk their jobs to blow the whistle? Why speak out, when there is danger of ostracism, marginalization, and damage to one’s career? I did a bit more research on the subject, and ran across a thought-provoking study published “down under” a few years ago in the Journal of Advanced Nursing. You may find it interesting also.
Using a qualitative narrative inquiry design, the Understanding whistleblowing: Qualitative insights from nurse whistleblowers study looked into the reasons nurses decided to become whistleblowers, and gathered insights into nurses’ experiences of being whistleblowers. I doubt any nurses reading this will be surprised to learn the primary reason behind the decision to blow the whistle.
It’s simple, nurses are patient advocates. Of course there’s much more to the study, and it makes interesting reading for many reasons, not the least of which is that it used face-to-face data collection methods, and based queries on real experiences and not hypothetical scenarios.
In other words, the questions didn’t ask “what would you do” if you faced with wrongdoing. The subjects of this study had worked through the tough decisions and lived through actual whistleblowing events. You can access the report on this study here.
Congratulations to all Certified Nurses out there! Obtaining a national board certification in your specialty takes hard work and a commitment to professional excellence. It demonstrates that you have advanced skills and knowledge that enables you to provide a deeper level of patient care and ensure improved patient outcomes.
In your time in nursing, have you seen an increase in the number of nurses who obtain their professional certification? If you have a certification, how has it changed your practice?
Leave a comment below and let us know.
Every nurse can play a part in elevating the public perception of the nursing profession. The table below shows you how email, evidence-based research, reasonable work schedules, a diverse workforce, preceptorships, interprofessional communication skills, and name tags can promote the professional image of nursing. This table was adapted from the HCPro book, The Image of Nursing, by Shelley Cohen, RN, MS, CEN and Kathleen Bartholomew, RN, MN.
At HCPro, we offer extensive resources designed to help the nursing community build evidence-based practice (EBP) skills and refine strategies for incorporating EBP in daily practice.
What we lack, however, is a musical EBP score to accompany those resources… For that, you’ll have to visit YouTube and view James McCormack’s Viva La Evidence, a parody of Coldplay’s Viva La Vida that sings the praises of evidence-based practice. Enjoy!