Nurses' Use of Race in Clinical Decision Making.
To examine nurses' self-reported use of race in clinical evaluation.



This cross-sectional study analyzed data collected from three separate studies using the Genetics and Genomics in Nursing Practice Survey, which includes items about use of race and genomic information in nursing practice. The Racial Attributes in Clinical Evaluation (RACE) scale was used to measure explicit clinical use of race among nurses from across the United States.



Multivariate regression analysis was used to examine associations between RACE score and individual-level characteristics and beliefs in 5,733 registered nurses.



Analysis revealed significant relationships between RACE score and nurses' race and ethnicity, educational level, and views on the clinical importance of patient demographic characteristics. Asian nurses reported RACE scores 1.41 points higher than White nurses (p < .001), and Black nurses reported RACE scores 0.55 points higher than White nurses (p < .05). Compared to diploma-level nurses, the baccalaureate-level nurses reported 0.69 points higher RACE scores (p < .05), master's-level nurses reported 1.63 points higher RACE scores (p < .001), and doctorate-level nurses reported 1.77 points higher RACE scores (p < .01). In terms of clinical importance of patient characteristics, patient race and ethnicity corresponded to a 0.54-point increase in RACE score (p < .001), patient genes to a 0.21-point increase in RACE score (p < .001), patient family history to a 0.15-point increase in RACE score (p < .01), and patient age to a 0.19-point increase in RACE score (p < .001).



Higher reported use of race among minority nurses may be due, in part, to differential levels of racial self-awareness. A relatively linear positive relationship between level of nursing degree nursing education and use of race suggests that a stronger foundation of knowledge about genetic ancestry, population genetics and the concept "race" and genetic ancestry may increase in clinical decision making could allow nurses to more appropriately use of race in clinical care. Integrating patient demographic characteristics into clinical decisions is an important component of nursing practice.



Registered nurses provide care for diverse racial and ethnic patient populations and stand on the front line of clinical care, making them essential for reducing racial and ethnic disparities in healthcare delivery. Exploring registered nurses' individual-level characteristics and clinical use of race may provide a more comprehensive understanding of specific training needs and inform nursing education and practice.
*Associate Dean for Undergraduate Education and Professor, Department of Family Studies and Social Work, Miami University, Oxford, OH, USA. sellersl@miamioh.edu.
Sherrill L
SL
Sellers
*Postbaccalaureate Intramural Research Training Award (IRTA) Fellow, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
Melissa E
ME
Moss
Senior Nurse Specialist, Research, National Cancer Institute, Center for Cancer Research, Genetics Branch, National Institutes of Health, Bethesda, MD, USA.
Kathleen
K
Calzone
Research Analyst, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
Khadijah E
KE
Abdallah
Clinical Advisor, Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
Jean F
JF
Jenkins
Associate Investigator, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
Vence L
VL
Bonham
D000328:Adult; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D015403:Nursing Evaluation Research; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D014481:United States
RACE (Racial Attributes in Clinical Evaluation) Measure; clinical decision making; clinical use of race; nurses
J Natl Black Nurses Assoc. 2011 Jul;22(1):43-56
21888150
J Nurs Scholarsh. 2014 Jul;46(4):235-44
24758549
Ethn Health. 2015;20(4):354-64
24870971
J Nurs Scholarsh. 2015 Nov;47(6):496-504
26470020
J Nurs Meas. 2016;24(1):54-68
27103245
J Nurs Scholarsh. 2013 Mar;45(1):96-104
23368636
J Community Health. 2012 Apr;37(2):265-9
22205327
J Nurs Scholarsh. 2012 Dec;44(4):428-36
23205780
Mod Pathol. 2011 Feb;24(2):157-67
21076464
Int J Nurs Stud. 2014 May;51(5):726-33
24128374
Int J Nurs Stud. 2011 Nov;48(11):1330-8
21596378
ABNF J. 2014 Fall;25(4):110-5
25612397
Genet Med. 2009 Apr;11(4):279-86
19265721
J Nurs Regul. 2014 Apr;5(1):40-47
25343056
Clin Pharmacol Ther. 2015 Mar;97(3):263-73
25669658
Nurs Outlook. 2013 May-Jun;61(3):164-73
23419839
J Am Coll Surg. 2015 Jun;220(6):1077-1086.e3
25998083
J Pers Med. 2014 Mar 26;4(2):115-36
25563219
Am J Public Health. 2015 Jul;105 Suppl 3:S368
26039545
J Nurs Scholarsh. 2013 Mar;45(1):1-2
23368676
J Health Care Poor Underserved. 2009 Aug;20(3):896-913
19648715
Per Med. 2013 Sep 1;10(7):null
24363765
J Pain. 2010 May;11(5):454-61
20015702
N Engl J Med. 2011 Jan 20;364(3):193-6
21158652
J Adv Nurs. 2015 May;71(5):1005-18
25656511
J Natl Med Assoc. 2002 Aug;94(8):666-8
12152921
Circ Cardiovasc Genet. 2015 Feb;8(1):216-42
25561044
J R Soc Med. 2010 May;103(5):178-87
20436026
J Eval Clin Pract. 2013 Aug;19(4):664-73
23216876
BMC Health Serv Res. 2011 Aug 05;11:183
21819597
ANS Adv Nurs Sci. 2012 Jan-Mar;35(1):25-38
22228388
BMC Health Serv Res. 2014 Oct 02;14:456
25277068
J Clin Oncol. 2015 Nov 1;33(31):3621-7
26371147