Good morning, Unconscious bias is a human condition (Mihal Emberton, 2021). Not one of us, no matter how loving, kind, empathetic, educated, and self-aware we are, isn’t impacted by our biases. Bias doesn’t make us bad, it makes us human. But, what separates humans from the rest of the animal world is our ability to reason and expand our consciousness. Understanding our biases, then, becomes a way to create a more loving, kind, and equitable society. An important part of our society is our healthcare workers, specifically our nurses. Nurses are the heart of healthcare, saving lives every day with skill, compassion, and unwavering dedication. Bias reduction training is essential for nurses because it directly affects the quality, safety, and equity of patient care. Nurses interact with patients from diverse backgrounds every day, often in high-pressure environments where quick judgments are required. Without awareness, unconscious biases related to race, gender, age, disability, or socioeconomic status can influence clinical decisions, communication, and levels of empathy, leading to unequal care outcomes. Through bias reduction training, nurses learn to recognize their own implicit assumptions and understand how these biases can shape behavior. This awareness promotes more objective clinical reasoning and encourages respectful, patient-centered communication. When nurses are trained to pause, reflect, and question their assumptions, they are better equipped to provide care that is based on evidence rather than stereotypes. Bias reduction training also strengthens trust between nurses and patients. Patients who feel seen, heard, and respected are more likely to share accurate health information, follow treatment plans, and engage in their care. In healthcare settings where disparities persist, fostering this trust is especially critical for improving outcomes among marginalized populations. Ultimately, bias reduction training supports ethical nursing practice and advances health equity. By cultivating cultural humility and self-reflection, nurses can help create a healthcare environment where all patients receive fair, compassionate, and high-quality care. I believe supporting HB1147 will directly empower Virginia’s outstanding nurse workforce to be the best it can be. Nurses sit right at the intersection of healthcare and everyday life—nurses don’t stop being nurses when they leave work. Bias-reduction skills like perspective-taking and inclusive communication often carry into families, schools, and communities, providing Virginia with an even stronger social cohesion and commitment to human rights-values.

The attached letter is on behalf of March of Dimes in support of HB 1147. We provide comments in support of the bill as well as recommendations to support sustainable and effective implementation.

To the Members of the Committee: I am a Certified Nurse Midwife and the Inaugural Board Chair for the National Black Midwives Alliance. I am writing in strong support of House Bill 1147, which would require the Virginia Board of Medicine and the Board of Nursing to mandate continuing education in bias reduction for certain healthcare licensees. As a Certified Nurse-Midwife providing maternal healthcare for twenty years, I see daily how bias in clinical settings directly affects pregnancy, birth, and postpartum outcomes. Studies show that implicit bias affects how clinicians interpret symptoms, assess pain, and engage with patients who may not fit the clinician’s own cultural or racial background—ultimately undermining trust and quality of care. These dynamics persist even when access to care exists. Virginia continues to face unacceptable racial disparities in maternal morbidity and mortality, with Black women and birthing people experiencing significantly higher rates of severe complications and preventable deaths. These disparities persist regardless of education or income, pointing to systemic bias within healthcare delivery as a critical contributor. Bias reduction education is an evidence-based, patient-safety intervention. Requiring this training as part of licensure supports clinical excellence, strengthens provider-patient relationships, and improves decision-making during high-risk and time-sensitive maternal health events. Continuing education is already a professional expectation; HB 1147 complements clinical competence with the relational and ethical skills needed to truly improve maternal outcomes — especially for women of color who experience disproportionate risk. This bill is not punitive—it is preventive. It affirms that improving maternal outcomes requires both clinical competence and ongoing self-reflection. House Bill 1147 is a necessary step toward safer births, healthier families, and a more accountable healthcare system in Virginia. I respectfully urge you to support House Bill 1147 as a necessary step toward reducing racial disparities, especially in maternal health, by strengthening trust between clinicians and communities, and fulfilling Virginia’s commitment to equitable, life-affirming care for all families.

My name is Karen Kelly, and I am the president of The Virginia Affiliate of the American College of Nurse-Midwives. I’m writing to voice support of implementation of the bias reduction continuing education requirements This policy appropriately recognizes bias in health care as a system-wide issue and establishes shared responsibility among maternal health clinicians regulated by the Boards of Nursing and Medicine. Implicit and structural bias, particularly racial bias, continues to affect clinical decision-making during pregnancy and the postpartum period and contributes to persistent disparities in maternal and neonatal outcomes. Requiring evidence-based bias reduction training as part of license renewal is a reasonable and necessary mechanism to promote individualized clinical assessment and reduce reliance on race-based assumptions. VA ACNM believes this policy supports Virginia’s broader efforts to reduce preventable maternal morbidity and mortality and eliminate disparities in care. We urge full implementation and continued collaboration to ensure these requirements result in measurable improvements in maternal and neonatal health across the Commonwealth.

As a physician, we are taught and take an oath to do no harm. We pledge to be advocates for our patients. Sadly as physicians, health care providers we are taught to accept and beliefs that are untrue simply because of an unconscious bias that we all carry and often times are unaware that we posses. Asking us to take a moment to reflect on what we may believe true and not true will allow us to identify where we can improve in the care of patients. Without reflection there is no growth And without growth we cannot improve.

Good morning Senators, Delegates, and members of the subcommittee, thank you for the opportunity to provide testimony today. My name is Dr. Jamela M. Martin, Associate Professor and Chair of Nursing and Allied Health at Norfolk State University. I am here today to speak in support of House Bill No 1147, which directs the Virginia Board of Medicine and the Virginia Board of Nursing to require bias reduction training as part of existing continuing education and continuing competency requirements. In 2020, I spoke on Virginia Humanities’ show “With Good Reason” about health inequities and the need for targeted policy action in the Commonwealth. I understand that conversation resonated with Senator Head and helped bring attention to the need for policy action in this area. I testify today not only as a healthcare professional, but as a patient whose mismanaged care in Virginia resulted in permanent blindness in my left eye at age 42. This legislation represents a full-circle moment—where lived experience, evidence, and policy intersect. I appreciate the bipartisan support for this bill, particularly because its focus is ultimately about saving lives. Bias reduction training should be understood as an expected professional competency—no different in purpose than annual training on ethics, patient safety, or infection control—because it shapes clinical judgment, communication, and decision-making. This bill directly advances priorities already embedded in Virginia’s licensure framework- Patient Safety, Quality of Care, and Workforce Standards-each supported by clear evidence. Bias in healthcare is not a matter of technical skill. It influences how symptoms are interpreted and how clinical decisions are made— areas that patient safety data consistently link to adverse events. High-quality care requires clinicians to deliver consistent, evidence-informed care across all patient populations. Differences in communication and clinical interpretation—not access alone—contribute to measurable differences in outcomes, even among similarly insured patients. Patient trust and adherence—two of the strongest predictors of clinical outcomes—rise or fall based on whether patients feel heard and understood during care encounters. Finally, this bill does not create undue hardship for practitioners. It modernizes existing continuing education requirements to reflect the current evidence on a factor that directly affects safety, quality, and professional performance. House Bill 1147 strengthens Virginia’s licensure framework by aligning continuing competency requirements with what the evidence tells us about safe, high-quality care. I strongly urge the subcommittee to support its passage.

My name is Teresita Hammond. I am a nurse in Virginia, and I am writing in support of HB1147. I once cared for a pregnant patient who was in recovery from substance use. She had done the hard work. She was attending treatment, staying sober, and preparing to bring her baby home. But instead of feeling supported, she felt judged. She told me she felt watched, whispered about, and assumed to be an unfit mother before anyone took the time to hear her story. She worried constantly that one wrong word, one misunderstood moment, or one biased assumption could cost her the chance to take her baby home. That fear shaped her entire hospital experience. She hesitated to ask questions. She downplayed her pain. She felt like she had to prove she deserved compassion. This is what implicit bias looks like in real life. It is not always loud or intentional. Sometimes it shows up in tone, body language, rushed decisions, or assumptions about who is “responsible” or “trustworthy.” But the impact is heavy. It affects trust. It affects care. It affects outcomes. And it affects families at their most vulnerable moments. Implicit bias training is not about blame. It is about awareness. It gives professionals the tools to pause, reflect, and treat every patient with dignity, fairness, and respect. It helps ensure that recovery is seen as strength, not suspicion, and that motherhood is not judged through the lens of stigma. Patients should feel safe, not shamed. Supported, not stereotyped. Heard, not dismissed. HB1147 is an important step toward more equitable, compassionate, and accountable care in Virginia. I urge you to support this bill. Thank you for your time and consideration.

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On behalf of the NAACP, we support HB 1147 as an important step toward advancing health equity in the Commonwealth. The bill helps address systemic barriers that contribute to health disparities and promotes fair, equitable access to health-related resources and protections for all Virginians.

This topic is already covered in medical school and most physician ACGME and AOA residency programs in their curriculum. Is there excellent evidence that the proposed implicit bias curriculum effective? Is the proponent of this bill have a bias? Do we need to be piling on more on overworked physicians?

It is disturbing and disheartening to read that a VCU nurse thinks it’s okay to hurt people like law enforcement officers like because they are abiding by the laws and/or have different political views. President Obama was a big supporter of ICE.

It is important for physicians and nurses to receive training on bias reduction if we are to effectively address discrepancies in the provision of healthcare due to implicit bias. Most immediately this will help address discrepancies in maternal morbidity and mortality linked to pregnancy. Black women continue to have increased morbidity and mortality linked to pregnancy. While many factors contribute to this increased mortality, physicians and nurses can have an immediate impact by addressing implicit bias in the provision of healthcare.

As a member of the PUSH coalition, Voices for Virginia's Children supports this bill to better address disparities in maternal health. -Liz Nigro, Voices for Virginia's Children