No one enters the health care profession because they want to discriminate against their patients. You don’t sacrifice years of time and energy, tears and sweat, just to indulge your biases and serve your stereotypes.
But the simple truth is that health care providers aren’t just healers, they’re human. And that makes them every bit as vulnerable to unconscious bias in their practice. This shapes not only caregivers’ relationships with their patients, but it also threatens to severely undermine equity and quality of care.
This article examines gender bias in health care and discusses strategies for preventing it.
What Is It and Why Does It Matter?
Gender bias in health care is, of course, nothing new. For centuries, women’s health care was far different — and often far inferior — than that given to men. This was often driven by sometimes breathtaking misconceptions (and stereotypes) about women and women’s bodies, such as the infamous diagnosis of the “wandering womb” and of various forms of “hysteria” and nervous exhaustion that for so long were blamed for nearly every symptom a woman might experience.
To be sure, we’ve come a long way since those days, but we’ve still not come far enough. There’s increasing evidence that gender bias continues to impact most every domain of health care, from patient diagnosis and treatment to the training, hiring, and promotion of female health care providers.
For example, a recent study from the National Institutes of Health (NIH) found that male patients receive appropriate care 85% of the time, compared with 82% for women. This may seem like a relatively small difference, but it is one that can — and has — claimed untold numbers of lives.
This is especially true when it comes to issues such as the early detection and effective treatment of heart disease. Although cardiovascular disease is the number one killer of women, just as it is for men, the research shows that care providers are still notoriously slow to recognize the signs of heart disease in women.
For women of color, the problem is especially significant. For instance, a recent COVID-19 survivor, Karla Montessero, describes how unconscious biases nearly cost her her life. Despite the fact that Montessero had recently traveled, despite the prevalence of the virus that was already sweeping across the US, and despite the symptoms that should have set off a symphony of alarm bells, Montessero was repeatedly dismissed by the emergency care team at Alameda Hospital in California. Her concerns were downplayed and discounted — the result of panic and fear, of a Black woman’s overwrought emotions, rather than being recognized as a respected patient’s accurate reporting of her symptoms.
A Lack of Knowledge
It’s not only unconscious gender bias, however, that leads to the inaccurate or delayed diagnosis of women. Historically, women have been grossly underrepresented in medical research. Clinical trials on disease and disease treatment have traditionally excluded or limited the number of women included in them. This was particularly true for women of childbearing age, as researchers feared potential risks to fetuses in the case of unexpected pregnancy.
What this means, ultimately, is that this lack of data is hurting women and claiming women’s lives simply because clinicians do not understand how disease may manifest or progress differently in women than in men. Women, for example, typically do not experience the tell-tale signs of heart attack that men do. Rather, their signs are often far more subtle and systemic, making it far easier for clinicians to miss, or dismiss, them unless they know precisely what to look for.
What Is to Be Done
As persistent and pervasive as bias in the health care system may be, the situation is not hopeless. There are proactive measures that can be taken to reverse this trend.
One of the most important, perhaps, is to promote equity in hiring and promotion practices. Despite the heavy presence of women in nursing, the fact remains that men disproportionately occupy leadership positions in the health care industry. Increasing the number of women at the highest levels of the health system will offer an essential depth of experience and understanding of women’s unique health care needs.
It is also essential that reforms and regulations be introduced to eliminate the marked cost inequities that female patients suffer. Studies show that women’s health care costs are significantly higher than those of men, even for the same or equivalent services. This isn’t just unfair, it’s also dangerous, a potential disincentive for women to seek care for concerning symptoms or to pursue routine and preventative health services.
It is also essential to revamp training and clinical practices to support more informed, gender-appropriate care. For example, studies suggest that gender biases have filtered even into the nursing education system, with scorers tending to grade female nursing students more generously than their male counterparts. And that bias can all too easily lead to a compromising of the quality of female students’ education.
In addition to ensuring gender equity in education, it is also imperative that students and clinicians alike be trained in practical strategies to recognize and eliminate gender bias in patient care. This would include strategies such as checklists, the use of open-ended questions in patient interviews, and the inclusion of more female practitioners.
Health care providers are society’s true heroes, but they’re not perfect. Unconscious gender bias does exist, but that does not mean clinicians, or their patients, are hopeless. There are strategies that can be taken to optimize the quality of care for female patients. These include promoting gender diversity in health leadership, increasing the representation of women in medical research, and training practitioners to recognize and eliminate their own biases.
This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a nurse who participates in online studies and focus groups.
As his full-time job, Charles Prendergast, BSN, RN, works as a registered nurse in the Medical Intensive Care Unit of Thomas Jefferson University Hospital. But in his spare time, he has a side gig, participating in online studies and focus groups.
We asked him about his part-time work so that other nurses can learn about it too.
How did you get interested in doing online studies and focus groups? When you do an online study, what exactly does that involve? With a focus group, same thing.
I have been participating in online studies and focus groups for five years. I became interested in online studies and focus groups when a nurse colleague of mine introduced me to Focus Insite, and I started following them on their social media platforms.
When I am chosen to do an online study, I am contacted through email with very detailed, but clear, instructions on how the study will be performed. Once I receive and reply to the initial email, the next steps are given to me on how a study will be carried out.
Online studies are very reliable and easy to do because they are done at your convenience at home.
With a focus group, they start with a similar email and are followed up with a time that you choose and a date that works for you! The locations are convenient and are in or close to metropolitan areas. Once a date and time are agreed upon, I travel to the location and complete the survey.
How often can you participate in online studies and/or focus groups? How much time does each tend to take up? For focus groups, are they being done virtually right now?
I can participate in multiple online studies and focus groups in a year. How many studies I participate in depends upon if you fit the criteria the surveyor is looking for. This past year I have participated in about 10 studies and have made a considerable profit. Each study takes roughly one hour to complete. Some studies are two-day surveys and usually are less than two hours total. Some studies are being done at home due to the Covid-19 pandemic and they are very easy to do! All supplies are shipped to your home and all you need is your computer to hook up the camera they supply and a video Zoom call takes place walking you through each step.
What types of surveys do you do? Can you give me a ballpark idea of what they’re about? What kinds of topics they cover?
Primarily, I complete medical studies. Qualitative market research is my focus. They range from numerous topics from injection devices, nursing concepts and ideas, to new drugs on the market. Comparing new products to the medical field to products in use now is a fun and easy way to make money for your own opinion!
If nurses are interested in getting involved in this kind of work, what would you suggest they do? What kind of fee can they expect to make for each survey or focus group?
If you are interested in getting involved with focus groups and surveys I would suggest following @focus_insite and @getpaidmedical on Instagram and Facebook. Go to their web page www.focusinsite.com and sign up to part of their mailing list to hear about new and innovative market research studies. Once you sign up for their mailing list and complete your profile, they will reach out to you via email and/or phone call. Compensation is very generous for these surveys and each study pays roughly $250+ for an hour’s worth of your time. They will also compensate you for parking costs if needed.
Why do you enjoy doing online surveys/focus groups? What do you get out of it beside the money?
Besides earning some serious cash, I enjoy participating in market research studies because it keeps me up-to-date on the latest new equipment and nursing concepts that will be coming to our field. Being able to give you opinion on how a product looks, feels, and performs before it is distributed to the market is incredible, and you can say you had a lasting impact on products that you and your colleagues will use every day.
Lastly, I would like to recognize Focus Insite Group for giving me an opportunity to express my ideas and opinions on products I use in my professional career. The Focus Insite employees are always professional, helpful, reliable, and respectful. They are a pleasure to work with to get you set up with making a little extra income and provide you with a pleasurable experience. A relationship with Focus Insite is key to long term success!
People tend to think of the New Year as a time to ponder—about ourselves, our lives, and our careers. It’s also a great time to think about your personal career goals.
While it may seem difficult during the pandemic to think about what’s next in your nursing career, it’s still important to consider. After all, with the vaccines being administered, there is a proverbial light at the end of the tunnel.
Kiley Griffin, RN and Andrea Hipolito, both Talent Advocate Leaders at Incredible Health, took time to answer our questions about how nurses can set career goals for themselves.
What are the first steps nurses should take in order to outline their career goals for the New Year? Should they have one, five, and ten-year plans? If not that way, then how?
Griffin: It’s always important to have career goals and be ready to adjust and adapt given the changes COVID-19 is having on health care. Nurses should continue to outline their goals for the next year as well as long-term—where they want to be in 10 years. COVID-19 will have an impact on health care, and it may create more opportunities for nurses, so identifying future career goals now is important to plan.
Should they be based on their dream jobs, money, educational goals, etc.?
Hipolito: The motivator for why to switch jobs or why to choose a specific job is different for everyone. It is a very personalized decision based on what is important to that person, at that time in their lives. I tell my candidates to take the time to evaluate what terms are most important and why.
Suppose they feel overwhelmed don’t know how to start? What are some tips they can use to start defining what they want to do?
Hipolito: The first step is to figure out not only where you want to be right now, but where do you want to be in 1 year? Or in 5 years? 10 years? Are you comfortable in the role or specialty that you are in now, or do you want to make a change?
Once you have the answer to those questions, you can choose a facility that aligns with those career goals. For example, you can choose an academic medical center that pays tuition for career advancement and offers a culture of learning if you plan on going back for your BSN or MSN. Or, if you decide that you are settled in where you live and are not looking to relocate, you can find a facility that is close to your home that offers great perks within your community.
Certain facilities are great at promoting from within so they are a good option for a nurse who is looking to enter into a leadership position as the next step in their career path or switching into a specialty like the OR.
Once they have their overall goals, what should they do then? Come up with a timeline to achieve them? Break each down into manageable pieces?
Hipolito: Once you have pinpointed what your personal and professional goals are, the next step is to do your research on the facilities in your area (or the area you desire to be in). Go to their websites and visit the “about” and the “career” pages. Check out their mission and values. These resources give great insight into what makes this hospital a place where you would want to work. They highlight the benefits and culture along with any impressive awards or accolades that the hospital is known for.
Don’t fall into desperation mode and choose the first offer that comes along. Be patient and flexible with your timeline for the right position.
What are the biggest mistakes nurses should be aware of when they begin to outline their careers?
Hipolito: Being money motivated sometimes excludes nurses from fantastic opportunities to advance their career or live a happier and more fulfilled life. When it comes to career satisfaction, there is more involved than money alone. The culture of the facility, the alignment of the facilities mission and values with your own, and work/life balance are very important factors in choosing one’s “dream job.”
Is there anything else important for our readers to know?
Griffin: Goals need preparation. Work on your resume and cover letters. Practice interviewing skills so that when you do find your dream job, you will be confident and prepared. Obtain any certifications or qualifications that will help you achieve your career goals. Network and seek out opportunities in the specialty or field you want to be in and use other nurses as resources and support.
My wife, Sally, is an infusion nurse at Lurie Children’s Hospital and is now in her 43rd year on the front lines. She received the COVID-19 vaccine on January 2nd.
I have been working from home as the NICU Quality Improvement neonatologist for Comer Children’s Hospital at University of Chicago and came down to get my COVID-19 vaccine #1. I have had the opportunity to see a number of frontline providers, friends, and colleagues and spend some time in my office. As I walked by the NICU and the Emergency Department in the Children’s Hospital, I have a lot of mixed feelings. Practicing clinically was always my favorite part of my “job” and I miss it. At the same time, I am now 69 years old and am still also teaching, editing, writing, and helping nurses, nurse practitioners (NP), medical students, residents, fellows, faculty, and physician assistant (PA) students with their education, research, and writing. But I am now also in a high risk group for severe COVID-19 disease having had a four vessel bypass in 2013.
I have so much respect and admiration for all of the nurses, PAs, NPs, and physicians at every level of training and practice who are on the front lines during this COVID-19 pandemic. My feelings are so much greater when I am on site and seeing the challenges you all face to protect yourselves and still provide care for the children and their families.
One of the great challenges we face during this pandemic is figuring out which of our patients is at greatest risk for developing severe SARS-COV-2 infection or COVID-19 disease. Using epidemiological and descriptive studies we have been able to identify some high risk groups including older adult patients, those pediatric and adults patients with chronic disease, are pregnant, and/or who are immuncompromised. Children, in general, unless they have an underlying disease, tend to have milder clinical courses, unless they develop multi-inflammatory systemic disease (MIS-C). So, we have to be concerned about every one of our patients when we see them and follow them closely. Around 30% of adults may have ongoing clinical manifestations including fatigue, dyspnea, joint pain, and chest pain as long as 6 weeks after their acute course. The fact that there are viral variants and evidence from other studies about immunity post other coronavirus infections suggests that we will not have lifelong immunity post having the clinical infection. We are not sure how long the immunity will last post clinical infection or with the vaccine as well. The pandemic and our knowledge base continues to evolve.
We also have the challenge of encouraging our patients and their families to get the COVID-19 vaccine(s) when they become available and are determined to be safe for children and pregnant women.
And what looking after ourselves? As I talk with Sally after she comes home from caring for her pediatric patients, most of whom have chronic disease including cancer, autoimmune diseases, inborn errors of metabolism, the stress on her and all of you who are on the front lines is increased to levels that are exhausting. As a former intensive care pediatrician for 30+ years, I can only empathize and imagine what you are all dealing with during this pandemic.
So please continue to follow the newest, evolving clinical recommendations from the Center for Disease Control and Prevention (CDC), after careful review. Please also realize how much all of us who are watching all of you care for patients on the front lines respect and admire you for your dedication. But please, take care of yourselves!
The Medscape 2020 nurse job satisfaction survey dove into fears, PPE woes, and other highs and lows of life in the workplace during the pandemic. Medscape surveyed 10,400 nurses across all regions of the US and analyzed responses from 5130 RNs, 2002 NPs, 2000 LPNs, 500 clinical nurse specialists (CNS), 401 nurse-midwives (NMs), and 391 CRNAs. Most respondents fell within the 35-54-year-old age group.
Despite the hardships of 2020, most respondents are still quite happy with their choice of career. A full 98% of NMs and CRNAs are glad they chose nursing, closely followed by 96% of CNS, 95% of LPNs and NPs, and 93% of RNs.
Given the chance of a do-over, though, some are not sure they would make the same choice. 85% of NMs and CNS say they would pick nursing again. Among RNs and CRNAs, 76% and 78% would stick with nursing.
The Impact of Covid-19
Among CRNAs, 73% have treated Covid-19 patients. Midwives came in second, with 60% of NMs saying they had treated Covid patients, followed by NPs (57%), RNs (53%), LPNs (50%), and CNS (38%). Have they had sufficient PPE? Responses were almost evenly divided, with a majority of LPNs (59%) and RNs (56%) affirming that they have enough PPE.
Who was furloughed? CRNAs were at the front of the line, with 34% saying they had been furloughed during the pandemic. NPs came in second, at 18%, followed by LPNs (15%) and RNs (14%). On average over 30% of the nurses surveyed lost income last year, but CRNAs took the biggest hit, with 59% saying they lost money in 2020.
Telehealth is becoming routine for nurse-midwives and NPs. In the 2020 survey, 77% of NMs and 75% of NPs told Medscape that they met with patients online or by phone, and 53% of the LPNs surveyed made virtual visits.
Fears and worries during this scary year were to be expected, of course. Nurses’ greatest concerns during the pandemic were concentrated on the fear of transmitting Covid to family and oneself, but 38% singled out the discomfort of wearing extra PPE as their main woe, and 23% worried most about higher patient loads.
Best and Worst Parts of the Job
Asked about their main source of job satisfaction, nurses offered a range of answers, but helping people and making a difference in their lives was the top choice for RNs, LPNs, and APRNs (click charts to enlarge).
Least satisfying aspect of the job: Workplace politics ranked first for RNs and LPNs at 23% and 21% respectively, and for 26% of CNS’s. LPNs also pointed to their paychecks as a source of dissatisfaction.
See the full report on Medscape.
If you like innovation, you’ll love working at VA. We have adopted and continually promote a culture of innovation among our team. One of the ways we do this is by encouraging employee-developed and implemented innovations and promising practices that lead to better care and services for our nation’s Veterans.
This culture of innovation was recently celebrated at the virtual VHA Innovation Experience (iEX) annual conference organized by the VHA Innovation Ecosystem. It’s just one example of the many initiatives championed by VA to improve health care services and delivery.
The iEX conference showcased solutions and practices created by employees and honored top innovators with an Innovator of the Year Award and VHA Innovators Network (iNET) Awards.
Eighteen employee innovators from the iNET Spark-Seed-Spread Innovation Investment Program participated in iEX demonstrations. These frontline employees designed innovative products or programs over the past year, while being trained in innovation-related competencies. The event also featured 15 Diffusion of Excellence Shark Tank competition finalists who pitched their promising, evidence-based practices to tough health care challenges. These solutions were presented to VA leaders, or “sharks,” interested in replicating these practices at their facilities.
From the Army to VA nurse and employee innovator
Terri Ohlinger, a Cincinnati VA Medical Center (VAMC) nurse, has been creating health solutions for her patients throughout her 30-year nursing career. She developed a sense of resourcefulness while serving in the Army, caring for her fellow soldiers. That ingenuity followed Ohlinger to VA – it’s how she approaches caring for her fellow Veterans. Luckily, the Cincinnati VAMC is part of iNET. Her latest quest is called “Drop Ease.”
Ohlinger developed the Drop Ease device to measure eye drops efficiently while making it easy enough for all Veterans to use.
“Too many patients were not performing their eye drop treatment regimens because the bottle was too hard to squeeze, potentially leading to poor outcomes,” said Ohlinger. “They were also using too many drops with each dose and needed to reorder drops more frequently, resulting in increased costs.”
Since iNET connects and partners with academia, nonprofit companies and the private sector, Ohlinger was able to get in touch with Quality Life Plus (QL+), a nonprofit focused on fostering and generating innovations that aid and improve the quality of life for those who have served. The company teamed engineering students from the University of Cincinnati with Ohlinger to work on prototyping Drop Ease as part of their senior project.
Empowering employees and Veterans
iNET allows VA employees to innovate and succeed. Its success isn’t based solely on the final innovative solution design or its implementation. Rather, it is measured by the sense of empowerment the employee innovator gets from participating in iNET.
What does it mean to be part of iNET? “That I am being heard,” Ohlinger said. “More importantly, [that] the Veterans are being heard. I asked what the problem was and then strived to find the answer – and then took it back to the Vets so they could tell me how to make it better.”
It is because of the passion and drive of innovators like Ohlinger that VA delivers the best care anywhere.
Work at VA
VA is always looking for talented innovators who want to make a difference in the lives of Veterans. See if a VA career is right for you: