Confidence without contact: overconfidence bias in undergraduate nursing education

Undergraduate nursing students in demographically homogeneous regions may have limited opportunities to provide care for diverse patient populations, potentially influencing perceptions of preparedness for culturally responsive practice. This pilot quality improvement project examined the relationship between clinical exposure to racial and ethnic minority patients and nursing students' perceived confidence in culturally responsive communication and care delivery.

Final-semester students in an undergraduate nursing program in the U.S. completed an online survey assessing educational exposure, clinical experiences, and self-reported confidence. Descriptive statistics were used to characterize responses, and chi-square tests were performed to explore associations between exposure and perceived confidence.

Most participants identified as non-Hispanic White and reported minimal clinical encounters with racial and ethnic minority patients. Despite limited exposure, the majority reported high confidence in their ability to communicate with and provide care for these populations. Students who reported no direct patient encounters demonstrated higher confidence than those with exposure, suggesting a perception-preparation gap consistent with overconfidence mechanisms.

These findings highlight the need for intentional curricular strategies that support calibration, reflection, and cultural humility development when natural demographic exposure is limited. Approaches such as simulation, virtual cultural encounters, and community-engaged learning may provide structured opportunities to practice communication across difference. Implications for International Audience: Preparing nurses for an increasingly diverse and globally mobile healthcare workforce requires educational environments that foster cultural humility, mitigate overconfidence, and promote culturally responsive care.