Keith Rischer RN, MA, CEN

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

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

3. 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

4. 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

5. Timeline of Men’s Historical Contributions 400 BC Ancient Greece & Rome-Nosocomi 250 BC India First century AD Good Samaritan

6. 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

7. 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

9. “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.” Modern Era: Nightingale 1859-1910

10. 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

11. 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

12. 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

13. 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

14. Application of Feminist Theory (feminism) • Attempts to understand the nature of gender bias Tenets: • Gender discrimination and bias • Oppression • Stereotyping • Patriarchy vs. Matriarchy

15. Benefits to Men in Nursing • Token male • Leadership/managerial positions • Credibility with physicians

16. 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

17. 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

18. Current Nursing Textbook Bias

19. 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

20. 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 Survey of Male Nurse Graduates O’Lynn, 2004

21. Men’s Perceived Experiences in BSN ProgramEllis, 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

22. Male Perceptions of Nursing EducationBell-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

23. 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

24. 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

25. 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?”

26. 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 Research Methods

28. Total Percentage of All Discipline by Gender: 1990-2005

30. 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)

31. 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) Research Results cont.

32. 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?

33. 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

34. 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? Appendix