Date of Graduation

Fall 12-15-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Psychiatric Mental Health Nurse Practitioner

First Advisor

Dr. Trinette Radasa

Second Advisor

Dr. Erica Hooper


Background: Implicit bias in healthcare delivery refers to the unconscious mental associations healthcare providers make about patients from various social groups. Numerous studies suggest implicit bias contributes to health disparities primarily amongst marginalized groups. Furthermore, patients report a lower quality of communication from healthcare providers with higher implicit racial bias. In 2021, Assembly Bill 1407 (Nurses: Implicit Bias Courses Act) was passed to address the negative impact of bias on patient outcomes and requires California nursing schools to provide implicit bias training for nursing students.

Problem: All graduate nursing programs do not provide implicit bias (IB) training. As a result, graduate nursing students cannot manage IB during clinical rotations and, thus, are at risk for contributing to culturally insensitive care and adverse patient outcomes.

Context: The academic institution is located in an urban setting in northern California. The school’s mission is established in the Jesuit tradition of justice and diversity. They offer graduate and undergraduate nursing programs ranging from Bachelor of Science in Nursing (BSN) to Doctor of Nurse Practice (DNP). The school receives a large grant from the US Human Resources and Services Administration (HRSA) to financially support clinical training for the doctoral education of advanced practice nursing students to work in the California Central Valley and Northern California areas, treating marginalized patient groups. The grant aims to increase diversity in healthcare and the number of healthcare professionals working in medically underserved areas.

Intervention: Doctor of Nurse Practice (DNP) students received a two-hour IB training to increase awareness of IB in healthcare delivery and to enhance comfort in managing personal and institutional bias.

Measures: The outcome measures for DNP students to achieve were (a) to increase knowledge of implicit bias by 80%, (b) to increase comfortability managing bias by 80%, and (c) to provide a toolkit to reduce bias. The live IB training was evaluated with pre and post-surveys to detect if there was a relationship between DNP students’ knowledge of IB and comfortability managing bias and the provided IB training.

Results: Student’s knowledge scores increased by 89.9% after the implicit bias training intervention. Most students felt less confident managing or discussing bias after the training.

Conclusion: Implicit bias training must be sensitive to the learner’s needs considering that previous research indicates that the training can cause defensiveness. Use of evidence-based IB training in nursing education can be used to promote health equity. Implementing practical IB training was an effective intervention with associated cost avoidance to decrease unconscious bias held by advanced practice registered nursing (APRN) students.