CA Requires Implicit Bias Training for All New Grad Nurses

In February 2021, the California legislature passed Assembly Bill 1407, which requires implicit bias training for all new nursing graduates. Despite the law initially passing over six months ago, it went through several revisions in the California assembly and finally passed in the Senate in August. It was finally enrolled in law on September 3, 2021.

Other important aspects of the law include,

• New RNs take implicit bias training within two years of passing nursing boards
• Hospitals must develop a new graduate training program
• Include implicit bias training in prelicensure nursing program instructional content

The bill was sponsored and spearheaded by Assemblymember Autumn R. Burke. She currently represents the 62nd District in California which includes all of Los Angeles city and surrounding suburbs. The district is 43.07% Hispanic or Latino, 6.83% Asian, 23.18% Caucasian, and 21.49% Black or African American. According to her official biography, Assemblymember Burke does not have a background in healthcare, and her family has no ties to the nursing profession.

History of Implicit Bias Training in California

Interestingly, in January 2020 California had previously passed Senate Bill 464, known as the California Dignity in Pregnancy and Childbirth Act, which required California hospitals to educate their perinatal care staff about implicit bias. This was the initial focus of implicit bias training to help improve overall maternity care especially because there are strong racial disparities in maternal mortality and morbidity.

Senate Bill 464 was groundbreaking legislation because it marked the first state to require implicit bias training for perinatal healthcare professionals.

The implicit bias training showed promising results in perinatal care, which prompted California to pass the most recent bill. Furthermore, because of the overwhelming diversity in California, there was a need to enact a more widespread formal implicit bias training.

What Is Implicit Bias?

According to the American Association of Critical-Care Nurses (AACN), implicit (or unconscious) bias refers to “positive or negative attitudes or stereotypes, activated automatically and involuntarily, that influence our understanding, decisions, and behaviors without our awareness or voluntary control.”

Research shows there is a direct correlation between implicit bias and healthcare disparities. According to the Centers for Disease Control and Prevention (CDC), health disparities can be caused by poverty, environmental threats, inadequate access to health care, individual and behavioral factors, and educational inequalities. Those most at risk for implicit bias in healthcare include,

• Advanced age
• AIDS
• Disabled
• Drug and alcohol addiction
• Female gender
• Low socioeconomic status
• Mental Illness
• Non-English speaking
• Nonheterosexual
• Nonwhite race
• Obese 

Implicit bias is also commonly seen in the critical care setting including those patients diagnosed with acute coronary artery disease, coronary syndrome, myocardial infarction, and trauma.

The Institute for Healthcare Improvement recommends the below strategies to reduce implicit bias:

• Counter-stereotypic imaging
• Increasing opportunities for contact with individuals from different groups
• Individuation
• Partnership building
• Perspective-taking
• Stereotype replacement

Michigan Follows

After the continued success of training in California, Michigan became only the second state in the country to require implicit bias training for all nurses. Michigan announced any new health care provider seeking a license to practice will be required to complete two hours of implicit bias training. All existing health care providers are required to participate in one hour of training every year. Training programs will be offered by accredited colleges and universities, organizations approved by a state licensing board, and other organizations specializing in diversity, equity, and inclusion.

Unlike California, Michigan requires implicit bias training for ALL healthcare professionals. Many believe that this will continue to lead to positive changes because all medical professionals should have the same type of training and approach their patients in a similar manner.

The Future of Implicit Bias Training

While Michigan is only the second state to require implicit bias training, Illinois and Maryland introduced similar bills in 2020. Currently, the bills are stalled and there are no additional updates. The continued stories that have emerged during the COVID-19 pandemic have continued to shed light on the disparities and implicit bias in healthcare.

Implicit bias has long been a part of healthcare even before the current pandemic. However, communities are taking note of the disparities, especially regarding morbidity and mortality. 

Supported by the California Nurses Association and National Nurses United, this new bill will help shape the future of nursing education but more importantly change the future of healthcare. By identifying our own biases, nurses have the ability to ensure that all patients require safe, effective, and the same care.