So I recently wrote a paper for a class this summer and initially I chose my topic based on what I thought would be easy pickings for smacking out a paper that would be long enough to get me a B+....or a B, whatever. So, after researching and doing a large literature review (srsly, I did), I ended up with a lot of material from the last 7 years that was fairly eye-opening. I'm a fairly unassuming guy and I'm not prone to letting others suggest to me when I have and haven't been 'wronged' but the body of research I read gave me a definition for the nagging uneasiness and situations of perplexity I have felt and experienced ever since I started my nursing training:
Gender bias.
Now, please understand that I'm not upset. I'm not mad at anyone, and I'm not holding any one person accountable for what I've learned; but I am determined to fix what I see as broken in any way I can.
I would give you the rundown of my paper here in the post but I feel my paper can stand on its own so I will let you all peruse it at your leisure. Apologies for the length!
Mursing and the Struggle for Equality
Men entering the nursing field not only encounter the
unique challenge of learning, working, and thriving in a profession that is
numerically dominated by females, but also face a nursing education system that
is geared toward female learners. In a
nursing program, men have the rare distinction of being a visible minority and,
as a result, their needs are often overlooked and consciously or unconsciously
ignored by faculty members who often represent the white, female majority of
the profession (Keogh & O'Lynn, 2007; Taylor, 2010). Attrition rates of males in nursing programs
are high and have been recorded at an estimated 40-50%, which is well above the
average faculty attrition rates (Stott, 2006). Additional qualitative studies have found that
isolation, discrimination, and exclusion are common themes expressed by male
nursing students (Bell-Scriber,
2008; Stott, 2006; McLaughlin, Muldoon, & Moutray, 2010). It is of serious concern to the nursing
profession that this cycle of negative inputs and outcomes involving male
nurses is occurring in an age and society where gender issues are thought to be
an issue of the past. Moreover, these inequities
are occurring in the faculties and workplaces of a profession that prides
itself on being a leader in health education.
The Large Male Elephant in Pink Scrubs
Recalling personal experience, I have not found that my
experiences in nursing have been tainted by any overt gender bias. However, upon further researching this topic
I found that there were a number of issues that I had thought to be normative
where, in fact, they were half-truths or omissions. The most significant of these realizations
was the seemingly complete omission of the historical contributions of men in
nursing. The title of this section
exemplifies my current feelings toward being a male in the female-dominated
profession of nursing. Specifically, men
have been academically accepted into nursing faculties and many have succeeded
in completing their programs; but we, as men, have been ‘clothed’ in a
feminine-based model of nursing and somehow nobody is even discussing the odd
fit. We no longer have the ‘luxury’ in this day and age to identify issues of
gender bias simply by their superficial characteristics as was possible in the
past. Instead, we have moved into an era where the overt biases have been
eliminated but the deeper, more subconscious biases are only beginning to be
discovered.
Nursing has never been a more important issue in society
than it is in this modern age. With
almost every healthcare model in the world relying on nursing in some capacity
to function, the recruitment and retention of skilled nurses has never been a
more pressing issue (Bell-Scriber, 2008).
As Canada faces an all-encompassing shortage of nurses, the fact that
men make up such a small percentage of the nursing workforce is of particular
concern to both society and the nursing community itself (Bell-Scriber, 2008). The provinces have been proactive in pursuing
strategies to mitigate the shortage; with some even attempting to meet the
demand in their nurse staffing levels by ‘importing’ trained nurses from other
countries. From a bystander’s view, however, it is curious to see the
astronomical effort expended in obtaining these out-of-country nurses when the
option of tapping into the underrepresented 49% of males in Canada seems to
have gone untested (Meadus & Twomey, 2011). In 2009, males accounted for just 6.2% (16,475)
of registered nurses in Canada and had an average provincial representation
rate of 6.04% (CNA, 2011). This rate is below that of the United States
(6.6%) (HRSA, 2010)
and Australia (9.6%) (AIHW, 2011). Additionally, the Yukon employed the highest
percentage of male RN’s with 10.6% while Prince Edward Island had the lowest at
2.4% (CNA, 2011). From 2005 to 2009, the proportion of male
RN’s in Canada grew by only 0.62% and the average provincial growth rate was
0.15% (CNA, 2011). These numbers serve to quantify the glacially
slow increase of male nurses in all Canadian provinces but do not give light to
the mental and emotional state of males in nursing.
Gender bias has been defined as “behaviour that results
from the underlying belief in sex-role stereotypes” (Cudé & Winfrey, 2007). This volatile issue is particularly
contentious to female nurses in general as their history, since the inception
of modern nursing, has been forged in its flame. The effects of nursing’s history are visible
even in the current state of the profession; in a recent newsletter from the
Manitoba Nurses Union (2012) a smiling, middle-aged white female is pictured in
a report as a ‘profile’ of a typical Manitoban nurse. While picturing a middle-aged female was
likely a conscious decision on the part of the editor(s), there is no
indication that the race of the model is intentional. This small window into the collective mind of
a nurse union shows us that the lack of representation of society’s makeup in
the nursing ranks is in plain sight but gives no indication that it is being
remedied or that it is even viewed as a problem (Taylor, 2010).
This has a personal effect as it shows to me that unions,
staff nurses, managers, nursing faculty, and other students can plainly see the
issue of misrepresentation before them but nobody in the schools (where I have
the bulk of my nursing experience) seems to have acknowledged it as an
issue. To say nothing of other visible
minorities in nursing, this realization has stripped away some of the rose
colouring from my view of nursing as a profession and given me a small taste of
being a minority. This has ultimately
been a positive experience as it has given me a new sense of purpose within
this profession. My original purpose was
to complete nursing school and work hard as a nurse for as many years as I was
able; now, however, I have added the desire to further this profession by
making the road to nursing a little more navigable for men entering nursing
after me.
Historical Analysis
Nursing is a profession with roots in antiquity; the first
nursing school in recorded history was located in India in approximately 250 BC
(Cudé & Winfrey, 2007). The earliest nursing structure resembling
modern nursing models staffed wards of the hospitals of the Byzantine Empire
around 330 AD (Bullough, 1994). The majority of the nurses in
both instances were male (all-male in India), and it was not until the 19th
century that this tradition would take a historic gender-based shift at the
hands of one Florence Nightingale (Cudé & Winfrey, 2007). The effects of her contributions to nursing
can be seen in almost every textbook dealing with nursing history, but the most
telling of her contributions may lie with the pieces of history not included in
the texts (McLaughlin, Muldoon, & Moutray, 2010; Meadus
& Twomey, 2011).
Nightingale: The Destroyer
According to Cudé and Winfrey (2007), Nightingale was the
first to declare nursing as “women’s work” and actively opposed the involvement
of men in the practice as, “their ‘horny hands’ were detrimental to
caring.” Nightingale’s statement has had
an indelible effect on the nursing profession in the time since she first gave
voice to this view because, by wholeheartedly embracing the ideals Nightingale
embodied and advocated for, nursing was transformed into “a profession for
single women of impeccable moral standards” (Cudé & Winfrey, 2007). Furthermore,
Nightingale’s proclamation that nursing was a natural fit for women due to
their ‘inborn’ caring and mothering characteristics was, itself, a stereotype
that did a disservice both to men who wanted to nurse and to women who did not (Cudé & Winfrey, 2007). From this point in time forward (arguably,
even today), it was nearly impossible to distinguish the image of a ‘good nurse’
from that of a ‘good woman’ or a ‘good mother’ (Keogh & O'Lynn, 2007). These views,
in addition to the advent of structured nursing training, were eventually
successful in ostracizing males from nursing (Keogh & O'Lynn, 2007). Unfortunately, the feminine conquerors (women
of the period who were shedding Victorian ideals of female subservience) were
also successful in another form as the history of men and their contributions
to nursing were ultimately forgotten (Cudé & Winfrey, 2007).
While Nightingale certainly represented a new standard in
women’s liberation of that era, the ingraining of an anti-male ideal among
generations of nurses has created a modern problem that was likely impossible
to foresee and difficult to imagine. Perhaps, then, it is not so difficult to
see why the current nursing environment is so unwelcoming towards men as the
touted “mother of modern nursing” was also its most vocal chauvinist.
Socio-Cultural Analysis
The culture within nursing has been depicted by current literature
to represent a treacherous pathway sown with hostility, contempt, selfishness,
and even violence (MNU, 2012; Keogh & O'Lynn, 2007). This environment has led to difficulties in
recruiting and retaining nurses in general and has likely had a hand in the
premature end of many nursing careers (McLaughlin, Muldoon, & Moutray, 2010). To fully grasp the gravity and breadth of the
causes behind the low numbers of males in nursing, this negative culture must
be explored with a gendered lens.
Society has taken cues from the history with which the
nursing profession has aligned itself and widely holds many beliefs about
nursing, such as nursing as a feminine profession and that men who pursue this
career are gay or ‘unmanly’ (Meadus & Twomey, 2011; Bartfay, Bartfay, Clow, & Wu, 2010;
McLaughlin, Muldoon, & Moutray, 2010; Dyck, Oliffe, Phinney, &
Garrett, 2009). These beliefs lie at the core of the issues
that see many males leaving nursing training and many more deterred from
entering nursing school at all.
I Care, Therefore I am Female Male
Another issue that has been realized recently with the
re-integration of men into nursing is the long history of caring being marketed
as a distinctly feminine trait (Grady, Stewardson, & Hall, 2008). The concept
of caring is core to the profession of nursing and, as such, is imparted at
every level of nursing training as a common denominator to each action and role
of the nurse (Grady, Stewardson, & Hall, 2008). The claim that caring is a feminine trait
that is always better exemplified by females is a view that has created role
strain and anxiety among male nursing students and has been identified as a
factor that directly contributes to attrition among this same population (Bartfay, Bartfay, Clow, & Wu, 2010).
Continually passing off caring as a feminine trait in
nursing curriculum has placed a barrier in the path of males in nursing
faculties (Meadus & Twomey, 2011). Faculty members may be unconsciously
contributing to this problem as the majority of these members are middle-aged,
white women who were taught and socialized in an era where the feminine
qualities of nursing were highly valued (Cudé & Winfrey, 2007). Nurse educators, as is the same with all
educators, have the unique opportunity to teach and influence a large number of
impressionable soon-to-be colleagues. If
an educator is teaching a discriminatory message to their students (even
unconsciously), it serves as a veritable oil spill of discrimination whose
source continues to sully until plugged, the cleanup is tedious and never quite
fully successful*. However, blame is not
so simple to lay in this case as nursing professors are often precluded
(through no fault of their own) from offering bias-free teaching as they are operating
within systems and curricula that were designed to educate women (Grady, Stewardson, & Hall, 2008). Surveys have identified that one of the most
significant hurdles faced by males in nursing school is being viewed as
“uncaring” and that men’s caring behaviours have been associated with fear,
inappropriateness, and sexuality (Grady, Stewardson, & Hall, 2008; Meadus &
Twomey, 2011).
Men are Ninja Forklifts
Another aspect of society’s effect on men in nursing is
the view that men are always to be called upon when physical strength is
required. In a number of qualitative
studies, male participants identified experiences where they felt they were the
focus of discriminatory actions when they were conscripted to move patients or
control potentially violent situations (Meadus & Twomey, 2011). These actions could definitely be viewed as
discriminatory as they only take the nurse’s gender in account while ignoring
the individual and their strengths and weaknesses. In one situation, a male student nurse was
pushed into a room with an agitated patient and, after the fact found that it
was upsetting as he felt he was singled out simply based on gender and no
consideration was made for his comfort with being asked to control the patient (Meadus & Twomey, 2011). Students have also experienced unfair
treatment from instructors where their patient assignments were decided using
patient size and level of dependency to decide which patients the male student
would be caring for (Keogh & O'Lynn, 2007). Additionally, other students related that
they were called to assist with patient moves in areas where they were not
assigned and where no regard for their current workload was given (Keogh & O'Lynn, 2007).
The opposite side of this issue could also be argued that
men are typically physically stronger than women and, as such, should be
expected to assist colleagues in tasks that require a greater level of physical
strength. However, this issue could
likely be mitigated if nurses took the time to consider the individual they are
asking for help, male or female, instead of assuming compliance and making
demands of that individual. Nurses, as a
profession, are called to a higher standard of consideration in their interactions
with both their patients and their colleagues; there is simply no room for
nurses to treat gender with flippancy.
This sort of conduct leads into the legal-ethical considerations that
will be discussed in the next section.
Legal-Ethical Analysis
Ethics, more than legalities, apply to the issue of gender
bias in nursing, as it is a self-regulating profession that sets its own
standards of practice to address such an issue. There are very few legal cases
in Canadian nursing involving men alleging discrimination on the basis of gender;
the reason for this is likely that most issues are handled at the provincial regulatory
level. The various provincial nursing
colleges, including the College of Registered Nurses of Manitoba, are mandated
to regulate the nurses who hold licensure with their organization (CRNM,
2009). As license holders with the CRNM, nurses are
bound by the Standards of Practice for Registered Nurses (2009). This document specifically references the
Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses (2008)
as the main standard against which the behaviour of Manitoban nurses is to be
weighed. The Code of Ethics (2008)
contains short but clear guidelines when issues of discrimination are involved. The treatment of men in nursing will be
contrasted with the regulations set out in the Code of Ethics in this section.
Speak Softly
Men in nursing often receive treatment different from that
of their female counterparts and this is also evident in nursing schools. In one case mentioned by a qualitative study,
a male student was singled out of a group being taught electrocardiography
(ECG) in a nursing skills lab and instructed to remove his shirt so that the
group could practice the application of the ECG leads (Stott, 2006). This student described feelings of shame as
they felt that it was assumed he had no qualms about removing his shirt simply
because he was male (Stott, 2006).
This instance is very similar to the aforementioned violent patient situation
where the student felt they were singled out for no other reason than that they
were male. In another situation, male
students were instructed to provide urine samples during a skills lab demonstration
while their female colleagues received no such instructions (Stott, 2006).
These situations bring to light the tendency of educators to treat male
students differently, particularly in the clinical scenario (Stott, 2006).
In response to this type of treatment, I find a sense of
commonality with the male students in these scenarios where, in the moment,
neither the male student involved nor other students contradict or question the
actions of the instructor, leading to the reinforcement of the behaviour. I recall a nursing health assessment class
involving cardiopulmonary assessment and auscultation where we, as males were
told to remove our shirts so that others could hear the heart and breath sounds
more clearly but the females were not instructed to do the same. At that time, it occurred to me that it would
likely be frowned upon to even suggest that female students be asked to do the
same, even if it was only for other females to assess them. There is no doubt that vulnerability exists
more readily in the mind of a female being assessed by a male than vice versa
but again, in a professional setting, it cannot be assumed that men all feel the
same way simply because they are male.
A number of male students involved in nursing studies
expressed concern over providing intimate care to females, fearing they would
be accused of sexual inappropriateness or even sexual assault (Keogh & O'Lynn, 2007; Meadus & Twomey, 2011). This very
real concern has lead to current practices such as the use of chaperones when
doctors are examining a patient of the opposite sex (Cudé & Winfrey, 2007). Oddly
enough, this practice appears to stem more from the doctors’ fear of
allegations of misconduct as surveys have found patient attitudes toward these
chaperones show the majority have no preference regardless of patient age or
gender of the physician (Cudé & Winfrey, 2007). These findings seem to support the notion
that healthcare practitioners are creating a larger issue than that which
actually exists and unnecessary action is being taken as a result.
Carry a Big Stick
The scope of the aforementioned issue is undoubtedly
smaller than that of other gender issues discussed. However, the origin of these thought
processes is likely the lingering social norms possessed in the minds of
faculty and students alike. The Code of Ethics for the Canadian Nurses Association
(2008) contains a broad statement regarding its view on discrimination in
nursing practice:
When providing care, nurses do not
discriminate on the basis of race, ethnicity, culture, political and spiritual
beliefs, social or marital status, gender,
sexual orientation, age, health status, place of origin, lifestyle, mental or
physical disability or socio-economic status or any other attribute. (Emphasis
added) (p. 17)
This statement clearly shows that the nursing profession
is serious about creating an atmosphere where professionalism abounds and its
detriments are spurned. However, the exception to this intention lies within
the labour and delivery wards of hospitals all over North America (Cudé & Winfrey, 2007). In one survey, only 3 hospitals out of 30
surveyed had male nurses employed in labour and delivery (Cudé & Winfrey, 2007). Even though
the unit managers were large proponents of these men in regards to
qualification and performance, many more managers surveyed were skeptical of
men’s ability to nurse in this area (Cudé & Winfrey, 2007). Male students are often escorted in
interactions with patients in labour and delivery wards and, contrary to the
instructor’s belief that they are being helpful to students and protective of
the patients, they may actually be insinuating that there is something wrong
with having a male nurse care for these women (Cudé & Winfrey, 2007). Once again, if nursing is truly a quality,
independently governed profession that prides itself on utilizing
evidence-based standards of care, then why is the focus in this area of nursing
set so firmly on the gender of its care providers when there is currently no research
indicating its importance?
Currently, no
proponents of anti-male or solely pro-female viewpoints have been discovered
(beyond labour and delivery wards) among published nursing literature so it is
unlikely that males will ever face an organized resistance to their presence in
nursing. However, the official
standpoint of the nursing profession as evidenced by the CNA Code of Ethics
(2008) is clear in its expectations for the behaviour of all nursing
practitioners. Nevertheless, males in nursing must be equally respectful and
caring in their handling of sensitive situations in order to avoid repeating
the mistakes of their nursing predecessors (Cudé & Winfrey, 2007).
Barriers to Resolution
“She’s embarrassed because she’s
dating a nurse and I can’t see why.”
- Nurse Paul Flowers
“Well, that’s
because you’re doing a woman’s job, son.”
- Dr. Kelso
Scrubs - “His Story” (2003)
One of the main barriers to men wishing to become nurses
is rooted in the societal belief that nursing is “women’s work” and the fact
that this belief seems to be so entrenched in the psyche of nurses and
laypeople alike (Bartfay, Bartfay, Clow, & Wu, 2010). Mass media
(television, movies, print materials, etc.) and the entertainment industry have
not been judicious or particularly considerate in their portrayal of men in
nursing and the negative effect this has on males who may otherwise prefer to
become a nurse cannot be discounted (Bartfay et al., 2010). Many nurses still deny the existence of a
gender bias in nursing simply because no overt discrimination exists in the
incarnation that such nurses are accustomed to experiencing it (perhaps, even
personally) (Bell-Scriber, 2008).
A sentiment I have heard echoed by numerous practitioners
and laypeople alike is that patients (particularly in labour and delivery
wards) won’t stand to have a male nurse and will ask that their male care
provider be substituted for a female. While there is still a relatively small
pool of qualitative research into the experiences of male nursing students,
current research shows that these students have indicated that nursing
instructors and staff nurses are much more likely to view their presence in
nursing negatively than are the patients (Keogh & O'Lynn, 2007).
Strategies for Resolution
Perhaps the most important aspect in regards to effecting
lasting change is the need for nursing educators to take the lead in teaching
and exemplifying behaviours of acceptance and confidence to their students (Stott, 2006). Recognizing discriminatory treatment and
messaging can be difficult if attempted solely through self-reflection so it
may be helpful for teaching staff to invite outsiders or colleagues to their
teaching sessions in order to obtain feedback (Bell-Scriber, 2008). Including support for men in
nursing by teaching that caring can be accomplished without a rigid adherence
to the feminine model of caring could also assist male learners in identifying
with their newly chosen vocation (Grady, Stewardson, & Hall, 2008). Overall, I believe the nursing profession
would benefit if this approach were extended to all minority learners in its
ranks.
Another strategy that has been echoed in the literature is
the need for male role models within nursing programs and in the workplace (Bell-Scriber, 2008). Male role models (as well as
role models for other minorities) must be sought out to give students individuals
within nursing with which they may more readily identify (Stott, 2006).
This strategy should also include plans to set up formal mentorship programs
within the faculty where any student could be connected with an appropriate
faculty member, volunteer staff nurse, or senior nursing student (Bell-Scriber, 2008). This strategy would give newer
students greater support and greater incentive to stay the course in their
chosen profession by giving them an example of success (Keogh & O'Lynn, 2007).
Reflection/Personal Views
My personal views have been greatly challenged throughout
the course of this assignment and I cannot recall the last instance where I
felt such a close connection to an issue I was dealing with. My opinions have also been changed as a
result of the research I have conducted; where I once viewed these issues with
a mental shrug of my shoulders, I now see a real opportunity to effect change
that could have a significant impact on other men who are deciding their career
path. I believe that the nursing
profession is in a position where it is ripe for change and I feel that I have
a lot to contribute to this change. This
issue extends far beyond gender and I know that nurses can continue to be
leaders in all aspects of the healthcare field if we afford ourselves the
opportunity to change.
Glad you made it to this point! Be kind enough to leave me your thoughts!
Also, references are available on request, ahahaha!
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