The Influence of Race on Pain Management Among Registered Nurses

This study aims to determine the impact of racial bias on nurses' clinical decision-making related to pain management.

A cross-sectional survey was conducted using clinical vignettes of registered nurses (RNs) working at four healthcare systems across the United States.

RNs working in adult inpatient settings and emergency departments were recruited to participate in an online survey. The survey included four clinical vignettes describing a patient in pain. Blinded to the research questions, participants randomly received one of two survey versions that were identical except for the patient's race (White/Black) in the four vignettes. Participants were asked to read and review each vignette and respond to the clinical questions about the clinical situation. Statistical analysis examined the main and interaction effects based on the nurses' and patients' race. Nurses were informed of the research question and deception after data collection.

A total of 563 nurses responded to the survey. Only respondents identifying as White (n = 401) or Black (n = 44) were included in the analysis. Across vignettes, results were mixed, with some evidence of differences in pain treatment and perceptions of therapeutic relationships in racially discordant pairs.

Clinical decisions impacted by race were noted in nurses' assessments of pain, nurses' decisions to administer medication, stigma toward substance use, and perceptions of the ability to form therapeutic relationships.

Management of pain in the setting of diversity remains a complex challenge. Clinicians must recognize how bias can influence pain management. Pain assessment policies, procedures, and guidelines must explicitly address race and ethnicity in their development.