Leadership and Remuneration: Role of Nursing profession in reducing inequality

1. Leadership and Remuneration: Role of Nursing profession in reducing inequality Florence F Folami PhD, MSN, MPH, IBCLC,RLC, RN Department of Nursing Science Faculty of Clinical Sciences College of Medicine University of Lagos

2. ?? EXERCISE • A boy and his father are in a car accident. • The father is taken to one hospital. • The boy is taken to another hospital. • The surgeon says, "I can't operate on this boy. He is my son!“ • Who is the surgeon?

3. Learning Outcomes • By the end of this class you will be able to • Define leadership • Outline oppressed group behaviors in nursing • Explain various inequalities that exist in nursing profession • Identify role of nursing profession in reducing inequality

7. Structural Inequality in Nursing • Various inequalities exist in nursing profession • Unequal power balance • Hierarchical pressures • Gender Discrimination • Racial discrimination • Lifestyle discrimination • Disability discrimination These groups of people are marginalized and face discrimination .

8. Nursing in a male-dominated world • From a global perspective, nursing has been regarded as an oppressed profession, largely due to the fact that it is female dominated. • Historically, before the late 19th century, women who provided nursing care were either nuns or domestic servants. “Nursing was then an unskilled occupation, poorly paid, and disreputable,” a position held only by women of low social status.

9. Nursing in a male-dominated world • When discrimination against a group of people is encouraged and consistently exercised by those in power, it causes unequal access to opportunities, thus leading to oppression. • As power structures in society become more established, oppression becomes the norm. • Thus, oppression occurs today not because society actively seeks to disempower some groups of people, “but rather because of the effects of societal norms, laws, and unchallenged assumptions.”

10. Nursing in a male-dominated world • The unequal power balance between physicians and nurses has resulted in nurses keeping their voices silent while in the workplace. • Nurses may not challenge physicians in the workplace, fearing conflict, stress, or reprisal. • This could become problematic, especially if nurses have concerns about harm to the patients.

11. Churchman and Doherty, 2010 • Churchman and Doherty conducted a qualitative research study in the United Kingdom on nurses’ views of challenging doctors’ practice in an acute hospital • They found nurses still lack the confidence to question doctors’ decisions. • When dissent was warranted, nurses played the “doctor-nurse game” • This “game” refers to the hidden manner in which nurses have influenced physicians’ decision making by providing information

12. Gender discrimination • Gender discrimination refers to distinction, exclusion, or restriction made based on socially constructed gender roles and norms, those that prevent individuals from experiencing full human rights. • In reviewing the literature, two types of gender discrimination in nursing were found. • The first type refers to the preferential treatment of men in nursing— specifically with regards to career advancements • The second type refers to society’s view of male nurses, potentially leading to unequal educational opportunities for males.

13. Gender Discrimination and Role-Strained among Male Nursing Students in Selected Nursing Institution, Illinois, USA

14. What is Role strain ? Role strain has been defined as when an individual is likely to experience tension in coping with the requirements of incompatible roles (Stroshine & Brandl, 2011).

15. Objectives • The study examined gender discrimination and stereotypes in relation to male student nurses. • It also discussed role restrained among male student nurses in selected nursing institution

16. MATERIALS & METHODS Simple random sampling to select nursing institutions Study population is male nursing students A questionnaire including measures of gender role identity and perceived gender appropriateness of careers was administered to 105 male student nurses from four nursing institutions.

17. 32% of the participants did not experience gender bias RESULTS 68% reported gender bias

18. 50% inequitable treatment by nursing faculty 58% nursing educators refer to nurses using the word “she” and there is no discussion of the history of men in nursing 68% Psychological Problem Barriers Encountered in Nursing School 56% Experiencing difficulties in their nursing education 52% difficulties during clinical posting

19. More Barriers Poor Eye Contact Viewed as “muscle” by female colleagues Communication issues and problems with female colleagues Isolation Lack of role models Issues with touch and caring Differential treatment

20. Implications Displaced Isolated Hopelessness Angry Students Blot out gender

21. Horizontal Violence • Failure • Join Gang • Disruptive Behavior

22. RECOMMENDATIONS

23. Transforming Nursing world: the 2030 • There are many different indicators and metrics to align nursing objectives with global expectations • We (Nurses) must identify where we can most successfully contribute towards the global development agenda. • Identify your uniqueness as a leader

24. Oppressed group behaviors in nursing • According to Matheson and Bobay (2007), there are five • salient dimensions of oppressed group behaviors: • Assimilation • Marginalization • self-hatred and low-self esteem, • submissive-aggressive syndrome • horizontal violence

25. Oppressed group behaviors in nursing • Oppressed groups assimilate the values and norms of the dominant group, believing they will gain acceptance, recognition, and power if they become more like the oppressor. • For example, nurse leaders tend to adopt the values and norms of the dominant group in an attempt to achieve those goals. • Successful assimilators become marginalized from both groups

26. Oppressed group behaviors in nursing • The oppressed group develops low self-esteem and self-hatred as they continue to internalize the values of the oppressor group. • Submissive-aggression syndrome occurs when the oppressed group feels anger towards the oppressor group but is unable to express those thoughts and feelings freely for fear of reprimand.

27. Oppressed group behaviors in nursing • This occurs when nurses constantly complain about hospital policies or the physicians they work with but rarely confront the oppressors. • The nurses, feeling powerless but still attempting to exert some form of control, engage in destructive behaviors toward one another, such as bullying and sabotage. • This phenomenon is called horizontal violence, an issue that plagues nursing today.

28. Oppressed group behaviors in nursing • Can result in behaviors such as • physical violence • Gossiping • eye rolling • belittling or criticizing colleagues in front of others • isolating colleagues during group activities. • Horizontal violence is prevalent in nursing, and it negatively affects patient outcomes.

29. Role of Nursing Profession in Reducing Inequality • Empowering each nurse is a crucial starting point. • Change must start with working toward developing the critical consciousness of nurses • This would involve allowing issues to be brought to the forefront • Reflecting on the basis of generalizations and biases that inform thoughts and actions, and openly examining them. • In this manner, individuals develop critically reflective skills and becoming aware of the extent to which they hold power, knowledge, and privilege in relation to other

30. Role of Nursing Profession in Reducing Inequality • Inter-professional collaboration must occur • This is important to foster trust, respect, openness, and a positive attitude to other health care professions • Policies to address discrimination and eliminate abuse and disrespectful behavior in the workplace • Learning to overcome hierarchical pressures to achieve Safer Patient Care • Lastly, nurses need to resist the oppressive status quo • If individual nurses question and resist the status quo, then, as a group, our voices become stronger

31. Transform nursing world and Be the patient’s experience

32. References • Ellis, D., Meeker, B., & Hyde, B. (2006). Exploring men’s perceived educational experiences in • a baccalaureate program. Journal of Nursing Education, 45(12), 523-527 • Fisher, M,J. (2009). Being a chameleon: labour process of male nursing performing • bodywork.Journalof Advanced Nursing, 65(12):2668-77. • Grady, C., Stewardson, G., & Hall, J. (2008). Faculty notions regarding caring in male nursing • students. Journal of Nursing Education, 47(7), 314-323. • Hepzibha, A. (2010). Upper secondary male students’ perceptions of nursing as a career • choice.InternationalJournal for the Advancement of Sciences & Arts, 1(1), 46–62.