Why is Implicit Bias Training Important?

• Learn about implicit bias training and the difference between implicit and explicit biases.
• Explore the implications and benefits of training against biases in nursing.
• Discover which states require this training and the resources available to nurses.

Before understanding why there is a need for implicit bias training, it is important to define the word bias. Bias is a human trait that stems from a person’s need to make sense of the world by classifying others into categories.

This classification is based on personal experiences and occurs on a subconscious level. Stereotypes are when a person categorizes another by age, gender, race, or other means. Attitudes, however, are positive or negative feelings that are directed toward a person or group. Bias involves a combination of stereotypes and attitudes.

Explicit bias is conscious – the person is aware of their attitudes towards certain groups, for example, in the case of overt racism. However, implicit bias is subconscious.

Both implicit and explicit biases are problematic and can lead to discriminatory decision-making. Nurses must be aware of their own attitudes and feelings about other people or groups so that culturally sensitive patient care may be provided.

What is Implicit Bias Training for Nurses?

The goal of implicit bias training is to challenge nurses to address their own biases and provide culturally sensitive care through cultural competency. There may be an assumption that cultural competency is about health equity. Although equity is the ultimate goal, cultural competency focuses on self-awareness and understanding other people.

There are tools that can be used to assess implicit bias. Implicit Association Tests (IATs), for example, help people to understand their own biases by asking a series of questions that challenge belief systems. IATs may be used by employers but should only be for educational purposes to bring awareness to implicit bias.

Research shows that people who are made aware of their biases may be motivated to ensure that their behaviors are bias-free. Implicit bias training may help nurses become aware of the biases they may be unaware of when caring for patients from various backgrounds.

The Benefits of Implicit Bias Training

Implicit bias training has been shown to increase awareness and reduce implicit preferences. The Federal Judicial Center evaluated several studies in an attempt to determine the effectiveness of implicit bias training.

In a 2012 study, researchers provided all participants with IATs to assess if implicit bias could be reduced through bias awareness and the use of strategies to reduce the biases. Half of all participants (control group) were provided with video training while the other half were not. The results showed that implicit bias was reduced in the control group – leading to a change at least two months later.

However, another study showed that the effects of this training declined after just two weeks. A final study revealed that the level of bias reduction varied based on the ethnicity of the participants.

Ultimately, researchers suggest that the best form of bias reduction involves not only implicit bias training at work but also a provision of strategies that employees can apply in everyday life.

Implicit Bias Training by State

Although implicit bias training has been proven to be effective, there are only a few states that require the training for nursing license renewal. The COVID-19 pandemic fueled many of these legislative changes. This type of training had already been in place for perinatal care nurses since 2020 for a few states as an attempt to address infant mortality rates and maternal health (for example, California and Maryland).

Some states only require training for certain professionals (like physicians). However, the states that extended the training to all nurses, addressing health disparities and improving outcomes for all patients were at the forefront.

Here are the states that require implicit biases CEs for all of their nurses, regardless of specialty:

California

As of January 2023, California law requires that all nurses in the state complete at least one hour of implicit bias training for license renewal. The law also requires that nursing schools provide at least one hour of implicit bias training to students as a requirement for graduation.

Visit our California nursing license renewal page for more information about the current continuing education requirements.

Illinois

As of January 2023, Illinois law requires that nurses in the state complete at least one hour of implicit bias training for license renewal.

Visit our Illinois nursing license renewal page to learn more about the current continuing education requirements.

Michigan

As of June 2022, Michigan law requires that all nurses in the state complete at least one hour of implicit bias training for license renewal.

Visit our Michigan nursing license renewal page to read about the current continuing education requirements.

Maryland

As of April 2022, Maryland law requires that all nurses in the state complete at least one hour of implicit bias training for license renewal every two years.

Washington

As of January 2024, Washington law will require that all nurses in the state complete at least one hour of “health equity training” at least once every four years.

The Bottom Line

Implicit bias training serves as a way to improve health disparities. Training against biases has been shown to heighten awareness of the biases that have the potential to lead to discriminatory care. If a nurse works in a state that does not require this training, there are CEU courses that are available for self-learning.

Nurses can also assess their own biases by taking IATs on their own. Various versions of these tests can be found by doing a basic internet search. When nurses address their own personal biases, they have the potential to improve health outcomes for all patients.

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