I am honored to introduce this month’s guest blogger, Kenya V. Beard EdD, AGACNP-BC, NP-C, CNE, ANEF. Dr. Beard is a 2012 Josiah Macy Faculty Scholar and Associate Professor at The CUNY School of Professional Studies, 101 West 31st Street, New York, NY 10001. We met through a mutual colleague a few years ago and immediately began compelling dialogue about racism, diversity and inclusion, implicit bias, and healthcare disparities. Dr. Beard was our invited speaker at the Connecticut Nursing Collaborative-Action Coalition Statewide Summit in November 2016. Her presentation was inspiring, authentic and full of thought-provoking takeaways. Her blog contribution leaves us with thoughts to reflect on. Perhaps you will join the conversation! Dr. Beard can be reached at: kenya.beard@cuny.edu
How Do You Address Unconscious Bias? – Dr. Kenya V. Beard
What would you do if you saw a large dog running toward you? Your response to that encounter would be largely influenced by your beliefs and attitudes (bias) about large dogs. Now replace the large dog with the word friend, enemy, overweight person, homeless person, Black male, elderly White male, Spanish-speaking teenager, or a middle-aged Muslim running toward you? How would you respond? Our brain is wired to make quick associations and categorize information in a way that allows us to quickly process and effectively respond to the environment. However, while conscious biases are dictated and controlled, unconscious biases are quick and automatic. Unfortunately, unconscious biases could trigger responses that deviate from your desire to support difference and respond in socially respectful ways. The National League for Nursing provides an example of unconscious bias in an article entitled Diversity and Cultural Competence. The scenario describes how a swift response could portray one who believes they are empathic and kind as someone who is uncaring and insolent.
Unconscious bias is not totally bad. These thoughts emerge quickly and trigger an emotional response that is designed to prevent your hand from being chomped off by the rather large dog that was mentioned above. However, sometimes unconscious bias results in a response that is harmful, unfavorable to others and fosters “-isms”. One dangerously disturbing and enduring “-ism” that permeates throughout the United States and is sustained by unconscious bias is racism. The devastating effects of race-based biases are well described in healthcare, education, and the criminal justice system. Race-based biases limit academic potential, contribute to poor health outcomes, prevent inclusivity and too often lead to a violent loss of life.
So how do you address unconscious bias if it is not clear, yet, automatically shows up in ways that foster “–isms” like racism, sexism, and ageism? First, unconscious biases must be acknowledged. Self-reflection, an enlightening process, can be used to help recall and address unconscious beliefs and attitudes. Self-reflection creates a space of deep and meaningful thought where you can explore your actions, become more intentional with your responses, and present yourself in ways that align values with responses. Secondly, the brain sees what it wants to see; it looks for affirmation. This means we must listen for a broader understanding rather than listen to uphold our own views or to inform others. Thirdly, it takes great courage to admit that your actions were hijacked by socially undesirable thoughts, albeit unconscious. To address unconscious bias requires bravery that supersedes the fear of sharing your unfavorable and marginalizing responses. And lastly, let’s “out unconscious bias”. Disseminate your narrative about unconscious bias and share what you are doing differently to move the needle towards social justice. While you can’t undo how your brain is wired to protect the body, you can undo racism and the beliefs that dictate how you quickly respond to others. Sharing your narrative will help form new neuronal circuits that are likely to generate an ethos that supports difference and allays fear.
In summary, Acknowledge your biases, seek a Broader understanding, be Courageous, and Disseminate your story. Only then will your actions truly transform homes, communities, institutions, and society in a more meaningful and sustainable way. So, will you share your encounter with bias and how you address unconscious bias in your world?
SundeanRN 
Thank you, Dr. Beard. Just recently I was in a physician waiting room with my son. An older woman came in with who I took to be an aide. The older woman appeared to have dementia. The aide was not giving her any attention. When the woman turned toward me, I smiled. She smiled back. I thought, “Good. Human connection. This is good.” I smiled again and asked, “Are you having a nice day?” She smiled back. I thought, “Good. This woman needs respect and a sense of human dignity.” Then she looked at me and stuck her tongue out. Conversation ended. Later, I mentioned the moment to my son because I felt bad for the woman. My son said, “I don’t want to talk about it. That was awkward. You were talking to her like she was a baby.” In that moment, I was confronted with my very unconscious bias! I had no idea I had done that! I thought I was being respectful and simply exchanging a moment of humanity. I thanked my son for calling out my unconscious bias and I told him I had not meant to treat her that way. I was grateful for his honesty and for exposing something in me that I definitely did not want to convey or demonstrate. Unconscious bias is just that – unconscious. Unless we are willing to sit with it and take accountability for our actions, we cannot begin the hard work of disentangling it from our brains and our actions. Anybody else want to share a story of unconscious bias?
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