What is Anchoring Bias in Nursing

Nurses start their shifts. They get reports on their patients. And in many cases, it is then that they form an opinion about the patient or the treatment plan before meeting them. Sometimes anchoring bias negatively impacts the nurse and patient’s care. So, what is anchoring bias in nursing?

A cognitive bias, known as anchoring bias, plays an important role in decision making. Cognitive biases are patterns of thinking that may limit one’s ability to reason objectively. They affect everyone, even healthcare professionals. Because of this, nurses need to know what anchoring bias is and how it affects nursing. 

So now you are probably wondering how anchoring bias is clouding your judgment. Read on to find out. 

What is Anchoring Bias in Nursing

Imagine your supervisor is briefing you on a new patient and says, “they are an abuse victim.”

Now try this one. You are told your patient is a “drug addict.” 

Do you immediately feel anything toward the person whom you don’t even know? And consider how you will interact with your patients. Could the statements you heard or read skew how you might listen to what the patient tells you?

Every human has systematic ways of thinking, biases that affect how they see the world. Just a few of the factors that affect perception are:

• Temperament
• Mood
• Personal history
• Values
• Belief systems
• Environment

Yet, sound clinical practice is based on making decisions that are grounded in accumulated evidence-based knowledge and nursing experience. And it generally requires rational thinking.

Critical thinking is at the core of good nursing practice. Unfortunately, the perceptions that nurses have and the decisions they make may not always be logical, because of thought patterns such as cognitive biases. Sometimes, nursing judgments can be outright wrong. 

How Anchoring Biases Affect Nurses

Anchoring biases have a powerful effect on many choices we make, from what we buy to what we say to others. 

Psychologists have described it as a tendency to be overly influenced by or heavily reliant on the first information we receive. We become “anchored” there. Anchoring bias is a pervasive phenomenon in which the brain is anchored to a particular idea or thing. As a result, filters any information or cues it receives through a cognitive bias. We can create a reference point to different types of information, whether we came up with them ourselves or they were given to us. 

For example, a doctor’s first impression of a patient may influence subsequent diagnoses. An overweight patient comes in. One could assume that diet is a problem and overlook endocrine disorders. 

The problem with anchoring bias is that it can lead to poor choices or inaccurate conclusions. Nurses and other healthcare professionals are responsible for being aware of biases that affect their ability to provide care. 

Some of the ways nurses may find themselves exhibiting results of an anchoring bias are:

• Paying too much attention to one part of an assessment
• Failing to listen to the patient’s entire story
• Omitting further assessment of some symptoms because they don’t correlate to other findings

In a study of medical students presented with hypothetical patients, they overwhelmingly sought nondiagnostic data that fit their initial impressions. In contrast, only 17% of students correctly looked for further information distinguishing between major diagnostic possibilities.

The anchoring bias suggests that we favor the first bit of information we learn. Anchored to an idea or plan, we end up filtering all the following information we receive through a framework we’ve already created. A potentially distorted framework.

How to Avoid It

The good news is, nurses can avoid the anchoring effect. Research shows that healthcare professionals can reduce bias by identifying the anchor and considering why it may not fit. 

In other words, nurses can acknowledge biased thinking and counteract it with critical thinking.

Here are practical ways nurses can change their minds for the better.

1. Avoid biased words/phrases like “drug seeker,” “frequent flier,” 
2. Reassess the situation when findings are inconsistent, or symptoms are persistent despite treatment
3. Actively seek information that could challenge your initial impression
4. Educate others about potential biases when making decisions about care
5. Be kind

That last one is interesting. See, a recent article in the Journal of Applied Psychology found that rudeness increased anchoring bias. A study was conducted in which resident doctors were asked to diagnose patients. Of course, before the simulation, they were given suggestions about an incorrect diagnosis used as an anchor. 

In some iterations, before the simulation started, a doctor entered the room and acted rudely toward another doctor in front of the residents. The group that experienced rudeness at the start stuck to the inaccurate anchor despite information that the diagnosis differed. Across studies, results were consistent: experiencing rudeness made it more likely that a person would be anchored to the first suggestion they heard. 

Read about how to cope with stress and avoid being the rude one on the job in our post about stress management here.

Conclusion

Anchoring bias is a pervasive cognitive bias that can affect a healthcare provider’s ability to make sound clinical decisions. We have given practical tips on how to acknowledge these thought patterns and even change some biases. If you’ve experienced anchoring bias in your job, share your experience below! We can all learn from each other. 

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