Marie, a 20-year-old nursing student, continuously puts her head down on the desk during lectures. Her instructor has noticed this and considers her lazy and unmotivated. She plans to reflect this "lack of motivation" in Marie's class grade.

Rita is 67. She has end-stage COPD, frequently calls out "Help!" and is on the call bell constantly. Sally, a nurse on the unit has labeled Rita "needy" and calls her a "pest." She has requested a psych consult.

Dave, a med nurse, has made several medication errors in the past 2 weeks while administering meds on two overlapping units. Dave's supervisor plans to reprimand him for his "lack of concentration."

Nursing is a profession where fast assessment is often needed.  It is based on the individual symptoms of the patient who is the focus of our daily work. We are often observing others, interpreting and explaining behavior. Attribution theory is how we explain someone else's behavior.¹

We often attribute other people's behaviors to their disposition, intelligence, character and personality traits.

As nurses, we focus on symptoms and observable behaviors in our documentation. We chart what we hear and see. But we may be lacking one important factor needed to truly explain another's behavior, i.e., the person and the situation.²

We often overemphasize dispositional or personality related traits in others while overlooking the "situational explanation."

This is known as the fundamental attribution error (also known as correspondence bias). Since our perspective is on the patient or person we are observing we often lose site of the possible situation that explains the behavior.³

In Marie's case, she is seen as lazy and unmotivated. Marie is the only one who puts her head down in class, and she does this consistently. Other students are focused on the instructor. She must not be motivated; it sounds logical.

The situation explaining it indicates Marie's behavior is the opposite, however. She is trying to pursue her education while battling Chronic Fatigue Syndrome, a fact unknown by the instructor. Coming to class and focusing requires a lot of motivation and drive.

Rita's nurse is seeing her behaviors as personality traits. She is needy and inconsolable.

But the situation is that she feels like she is suffocating secondary to her COPD and needs reassurance. Since the CNAs believe she is needy and a pest, they are slow to answer her call light. This becomes a self -fulfilling prophecy as she will call out even more frequently.

Dave's supervisor is overlooking the fact that he is giving meds on 2 units, with multiple interruptions, and has been working overtime to help the shortage of licensed staff on the unit. Dave is aware of this, however, and will not appreciate the reprimand.

The fundamental attribution error in many cases tends to label the person negatively and can lead to conflict with our co-workers and poor nursing care.

What can we do, as nurses, to be on guard against fundamental attribution errors?