1/14/20141 The Male Experience in Nursing & Nursing Education ( plus my masters thesis on male RN rates of discipline in Minnesota) Keith Rischer RN, MA,

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The Male Experience in Nursing &

Nursing Education(plus my masters thesis on male RN rates of discipline

in Minnesota)

Keith Rischer RN, MA, CEN

04/10/23 2

Todays Objectives…

I. Recognize the historical legacy of men as caregivers and resultant gender bias perpetuated in the modern era

II. Identify current barriers to men in nursing education

List approaches & interventions to support men in nursing education

III. Presentation of my thesis findings related to MN Board discipline rates of men vs. women over last 15 years

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Cultural Competence

Definition• Process where the nurse becomes respectful,

appreciative, sensitive to the values, practices, and problem solving strategies of another’s culture

• Need to obtain factual knowledge about the culture, engage in encounters from those of other cultures

• Strong personal desire to bridge these knowledge gaps

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Barriers to Cultural Competence: Ethnocentricity

Individual assumes that their values, beliefs, way of doing things is only and best way they can be done

Prejudicial feelings to those of different culture or gender

Typically applied to cultures & ethnic minorities

Applies to nursing

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Timeline of Men’s Historical Contributions

400 BC• Ancient Greece & Rome-Nosocomi

250 BC• India

First century AD• Good Samaritan

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Timeline continued

300 AD• Parabolani

330-1453 AD• Byzantine Empire

300 AD-1600’s• Monastic movement• Saint Benedict-Benedictine nursing order of

men• Military (knight orders), religious and lay orders

of men continued to provide nursing care throughout middle ages

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St. Camillus de Lellis: 1550-1614

Founded the Congregation of the Servants of the Sick (the Camellians) who cared for the sick both in hospital and home

Order expanded with houses in several countries in Europe

Developed first ambulance service

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Modern Era: Nightingale 1859-1910

“Every woman is a nurse…if, then, every woman must, at some time or other of her life, become a nurse…how immense and how valuable would be the produce of her united experience if every woman would think how to nurse”

Notes on Nursing, 1859

“Nursing is inherently suited for women and has no place for men except where their physical strength is required.”

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Consequences to Men in Nursing

End of men's association with nursing correlated with the establishment of the modern era led by the reforms of Florence Nightingale in the 1860's

Nightingale’s vision of professional nursing Marginalization of men …practice in

insane asylums Majority of men exited profession-

subjected to bias and discrimination because of their gender

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Consequences: cont.

Men refused admission to Nightingale schools of nursing

Men as "Male Attendants" Men in nursing school received no formal

instruction in bodily diseases• Length only eighteen months compared to

three years for women in Nightingale’s Schools of nursing

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Institutionalized Bias: England

1919 established the Nurse Act Created professional entry into nursing -required

all nurses to be registered with Royal College of Nurses

Men were confined to a separate register and allowed entry to part two until as late as 1960

Nursing became first self-determining, all female profession… matriarchal

435 (0.004%) male nurses registered 1921 and 1938 compared to 97,028 women in England

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Institutionalized Bias: United States

American Nurses Association (ANA) • Men not allowed to be members 1898-1930

In 1901, the Army Nurse Corp was formed only women were allowed to serve as nurses

This discriminatory policy continued until 1955

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Application of Feminist Theory (feminism)

Attempts to understand the nature of gender bias

Tenets: Gender discrimination and bias Oppression Stereotyping Patriarchy vs. Matriarchy

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Benefits to Men in Nursing

Token male Leadership/managerial positions Credibility with physicians

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Percentage Participation of Men in Nursing:US

1% of RN's from 1949-1966 2.7% in 1980 5.7% in 2004 7.1% in 2005 Minnesota

vs. Medicine 5.7% residents female 1950 9.4% residents female 1970 28.2% residents female 1980 39.2% residents female 1990 51% of residents female 2005

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Educational Bias

Late 1800's• Asylum based schools for men only

1930• majority of male graduates of nursing programs were

from state mental hospital vs. 1% in general nursing programs

1960’s• 15% nursing schools accepted male students

1981• Mississippi University for Women

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Current Nursing Textbook Bias

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Current Barriers to Men in Nursing

Gender stereotyping• Female profession

Gender role conflict• Conflict between behavior and perceived

gender roles Sex stereotypes

• Effeminate/homosexual Economic

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Survey of Male Nurse Graduates O’Lynn, 2004

Barriers Present No history men in nsg Lecture only format Need to prove self No male faculty No guidance on app. use

of touch

Barriers Important Not welcome in clinical

setting Nervous that female pts.

Accuse of inapp. Touch Not supported in decision

to be nurse Anti-male remarks by

faculty Not prepared to work

w/women No content on

communication differences between men & women

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Men’s Perceived Experiences in BSN Program Ellis,

2006 Survival

• Found school much more difficult than expected Differences

• Female faculty seen as “moody & over dramatic” and tend to “complicate content”

• Fail to see relevance of psychosocial aspects of nursing• Enjoy “harder” side nsg-pharm & sciences• Frustrated by curriculum, test questions as “set up by women for

women” Positive experiences

• Friendships made• Enjoy ED, ICU clinical settings

Negative experiences• OB-awkward for most• Communication differences between men & women• Lack of positive feedback• Clinical assignments-often receive male pts. consistently

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Male Perceptions of Nursing Education Bell-Scriber, 2008

Nurse educators behaviors• Non-verbal cooling behaviors• Faculty prejudice

Meaningful experiences• Men chose all interactions w/clients• Women chose interactions w/faculty

Additional education environmental factors• Female pronouns in texts

Factors outside education environment• Lack of social support from friends/families

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Implications for Nurse Educators

Be aware of any prejudices or subtle attitudes towards men or minorities

Be aware that the male experience in nursing and nursing education very different in comparison than women• Isolation• Role strain

Role violation (OB)

• Age of male students Younger need more support than non-traditionals

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Practical Strategies Curricular

• Presentation of historical legacy of men in healthcare• Communication/working w/women…HH• Caring: masculine vs. feminine approaches• Touch: appropriate use• Make clinical assignments w/o regard to gender of student

Incorporate male learning pedagogies• Kinesthetic case studies with lecture

Isolation/role strain• Male students should be grouped in same clinical groups• Male students placed w/male faculty in clinical as much as possible• Men in nursing student club• “Men in Nursing” journal

Recruitment• High schools• School counselors

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Research Question

“Is there a difference between the rates of discipline for men and women by a state board of nursing and does the gender composition of the board influence rates of discipline towards men in nursing?”

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Research Methods Data collected from

Minnesota Board of Nursing (n=1784)

Board members who served during this time period

Categorized into two categories of discipline based on ability to continue practice (severe/less severe)

Statistical presence of each gender by year compared to percentage of discipline in each category

Less Severe (potentially more subjective):

Reprimand Conditional license

Severe (less subjective) Revocation Suspension

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Total Percentage of All Discipline by Gender: 1990-2005

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Research Results

Total percentage board disciplines towards men• 18.2% though men made up only 6.0% of nurses

(p=.01) 10% presence of men on Board reduced LESS

SEVERE discipline 34% towards men (p=.02)• SEVERE-no impact (p=.96)

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Research Results cont.

Study Variables Gender of RN Severity of Board

discipline Time trend: 1990-2005 Gender composition of

Board of Nursing

All variables of study…regression analysis of rates/severity discipline between genders & gender composition of Board• LESS SEVERE (p=.05)• SEVERE disciplines

(p=.43) Each 1% increase of men in

nursing decreased reporting of LESS SEVERE offenses 4.6% (p=.03) SEVERE 1.62% (p=.37)

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Implications

Ongoing gender bias vs. higher rates of CD among men?• Why would higher percentage of men in

nursing decrease less severe discipline rates? Men practicing in higher acuity

environments vs. women?

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Final Thoughts Related to Study…

Nursing shortage Can no longer afford to be primarily one

gendered profession Men as well as other ethnic minorities

must be actively recruited and retained Barriers that limit or prevent men’s

participation in nursing must be broken down and eliminated

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Appendix

History of men in nursing Evans, J. (2004). Men

nurses: A historical and feminist perspective

Mackintosh, C. B. (1997). A historical study of men in nursing

Men & nursing education O’Lynn, 2004-Gender

based barriers for male students

Ellis, 2006-Exploring men’s perceived educational experiences in a baccalaureate program

Bell-Scriber, 2008-Warming the nursing education climate for traditional-age learners who are male

Anthony, 2004-Gender bias and discrimination in nursing education: Can we change it?