Do male nurses face gender bias in nursing education?

[SafetyNurse1968]

The next time you’re at work, look around. How many of your fellow nurses are men? I teach nursing and in a class of forty students, I have only three students who identify as men. None of the forty faculty members at my school of nursing are male. Back in the 1960s, only 2 percent of nurses were male, but now the number has risen to 13 percent.¹ Why is nursing so female-centric?

History

We were taught in nursing school that the first nurses were male caregivers in Ancient Rome, tending the sick and dying during the Crusades. Male nurses were also found in the Civil War in both the Union and Confederate armies. The shift to an all-female workforce didn’t begin until the Army Nurse Corps (ANC), established in 1901, banned men from serving as nurses. It wasn’t until 1955 that they commissioned the first male officer.²

Media

You may have seen a movie called Meet the Parents, in which Ben Stiller plays Greg Focker, a male nurse who perpetuates stereotypes that women are nurses and men are doctors. If you look at Grey’s Anatomy, Scrubs and ER, the stereotypes continue. We might see a female doctor, but never a male nurse. In a survey of male nurses, 70 percent stated that gender stereotypes are the main barrier to entering the field of nursing.¹ Male nurse respondents indicated they were influenced by the misperception that the profession of nursing is not “appropriate” for men.

Challenging Masculinity

In an article in American Nurse Today, David Foley shares some of his experiences as a male nurse. “The pressure to create a masculine identity within a historically female profession proves overwhelming and they [male nurses] flee for the operating room, emergency department or intensive care unit.” Male nursing students may face questions from family and friends about choosing nursing and may face challenges to their masculinity because women are traditionally seen as nurturers, while men are in more dominant leadership roles. Foley shared a story about a student who was actively discouraged from going into a less technical discipline in nursing with comments like, “You’ll never be accepted,” “Why would you want to make your life so hard,” and “What’s wrong with critical care? You’ll make more money.”³

Edward Bennett, named 2018 Student Nurse of the Year by the National Black Nurses Association, said, “I’ve definitely gotten pushback for being a black male nurse. Other people look at me like, ‘why would you want to be a nurse when you can be doctor?” Bennett continues to advocate for changing misconceptions by reminding prospective male nurses that, “You work with your hands, you think critically and you advocate for your patients every day.”⁴

Male nurses face a particularly steep challenge in obstetrics and OB-GYN. Even if they overcome stereotypes about who should pursue this field of nursing, often they cannot obtain access to patients. As an instructor I have seen it happen many times – a woman giving birth or having a pelvic exam doesn’t want a male nursing student to observe or care for her.³

In a survey of 462 undergraduate nursing students in Canada, male students demonstrated significantly lower scores on the efficacy subscale, suggesting that some men experience feelings of marginalization and discrimination.⁵

Solutions

According to the IOM report, The Future of Nursing: Leading Health, Advancing Change, we must find a solution. Men provide unique perspectives and skills that are crucial to the profession and to society as a whole. We need to place a greater emphasis on recruiting men into the field. We know that patients are more receptive to healthcare providers of similar cultural and ethnic backgrounds.¹ Male patients may feel more comfortable discussing certain conditions, especially those related to sexual and reproductive health, with other men, than with women. The World Health Organization identifies the “men’s health gap” – men visit the doctor less frequently and are less likely to ask questions or bring up concerns during appointments. “Having a male nurse could help open them up” says Bryan Smith, president of the American Association for Men in Nursing.⁶

The nursing shortage is another reason to recruit men. The president of the American Assembly for Men in Nursing, William T. Lecher, states that “The shortage of the future will likely not be solved unless men are part of the equation.”¹

Elias Provencio-Vasquez, a Robert Wood Johnson Foundation Executive Nurse Fellow, shares that when he was met with resistance from some female patients in the maternity ward early in his career as a student at the University of Texas, in El Paso, “We overcame that by presenting ourselves as students, and our faculty members were very professional and very supportive."¹

Bennett recommends creating pipeline programs for male students at predominantly African American high schools to diversify the profession in multiple ways.⁴

The AAMN

To encourage more men to join the profession, the AAMN conducts outreach, challenging local chapters to reach as many male middle and high school students as possible through classroom visits, career fairs and more. The AAMN also offers an award to the best schools for men in nursing to recognize programs that have made efforts in recruiting and retaining male students. Award winners include Nebraska Methodist, Duke, Goldfarb, New York University, Rush, Rutgers, Vanderbilt and West Coast University. In addition, the AAMN enlists members to guest lecture at nursing schools. Only 6 percent of faculty are men. Having a lecture from a male nurse can have a powerful impact on male students who are feeling isolated and alone. “Just seeing a male being successful in nursing, even though it seems like something so small, can really trigger a sense of belonging.” says Smith.⁴

Nurse educators and preceptors must acknowledge that gender bias exists. We need to refrain from gender-biased language and teaching practices that may discourage male nurses from embracing a career in any of the specialties of nursing.

What do you think?

I’d love to hear from male nurses out there – what has your experience been? Did you find support when you needed it? Do you have ideas for how we can recruit more men into nursing and remove some of the misconceptions that are preventing a diverse workforce?

Read Gender Bias in Health Care to learn more about gender bias in health care.

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REFERENCES

1. Male nurses break through barriers to diversity profession
2. Men in Nursing: History, Stereotypes, and the Gender Pay Gap
3. How to Avoid Gender Bias in Nursing Education
4. Bohanon M. (2019, January 8). Men in nursing: A crucial profession continues to lack gender diversity.
5. Sedgwick, M. G. & Kellett, P. (2015). Exploring masculinity and marginalization of male undergraduate nursing students’ experience of belonging during clinical experiences. Journal of Nursing Education, 54(3):121-129.
6. American Association for Men in Nursing.

[c0untzer0, ASN, BSN]

Hx: I am male, graduated from high school in 1962, my favorite aunt was an RN, and I wanted to go to nursing school. Unfortunately my guidance counselor convinced my parents that nursing was for females and I should go for medical school and be a physician. Instead I went into engineering.

Fast forward to 2006: I retired and decided to go to nursing school, trained and worked as a CNA, graduated with an ASN in 2011, passed the NCLEX, went to work in psych, entered an RN to BSN program, and graduated with a BSN in 2016.

I have experienced both sexism and ageism from the beginning of nursing school, but never on the floor as an RN! In school, during clinicals, all the MDs seemed fascinated and would ask "what's your story." They never asked that of any other student in my clinical group. During my Maternal/Child health semester I was fortunate to have a clinical instructor who was my age, and she saw to it that I got very chance the other students got; I never had a problem with patients in the L&D unit.

I have worked psych, home health, long-term care, and hospice without ever having a problem with floor staff or patients. When discrimination came it was from instructors, older charge nurses, MDs, and nurse managers. Yes it is there, you just have to work through it by showing your competence.

As for dealing with female patients: I questioned my clinical instructor in CNA training at a long-term care facility as to how to know if a female would accept care from a male CNA. She replied: "It's simple. Ask them, and they'll tell you." That's always worked for me.

[SafetyNurse1968, BSN, MSN, PhD]

8 hours ago, Quota said:

The ER nurse that comes to mind is Malik (spelling?). There are more from all shows as more background characters too. With Grey’s Anatomy the story line is very rarely about the nurses, plus the doctors are doing the jobs the nurses would be doing most of the time too. With how little most of the shows focus on nurses in general I don’t think the ratios are horrible.

Oh dear! how could I forget Malik? OP brain is turning to Jello....

[SafetyNurse1968, BSN, MSN, PhD]

23 hours ago, PeakRN said:

I doubt you would actually hold to that when you give birth.

What about if your baby has complications? No Male NNP, RT, or NICU nurse?

What if you have to go to the OR? No Male surgical techs or anesthesiologists?

What if you go into preterm labor and your OB isn't available? Will you say no if the deck doc is a Male you have never seen before?

If you are a code white should they keep the men on the code response team out of the room?

If you begin to deliver in the field will you say no to the Male EMTs, Paramedics, and firefighters?

If you have complications and have to be seen in the ED will you say no to the Male nurses, NPs, PAs, and Docs?

If you require specialty transport to a high risk center are you going to say no to a Male flight nurse, CNM, RT, or medic?

If you have a life threatening complication that requires intensive care will you say no to Male ICU nurses, RTs, and Docs?

I feel like DeeAngel is saying that if she has a choice and can plan ahead, she does not want a male nurse. I don't think it's fair to assume that this would also extend to physicians, since as a previous poster pointed out, the relationship with the physician is often very close and evolves over a long period of time, thus trust can be built.

[SafetyNurse1968, BSN, MSN, PhD]

On 11/1/2019 at 2:38 AM, jinct said:

Im curious because it would seem to me that a study of gender bias in nursing would, by definition, have to consider the objective truth of a person's gender in order to be taken seriously. What I mean by that is, if I am objectively a female, despite "identifying" as a male, than how can I be discriminated against for being a male, or vice versa? For example, I think that a female L&D nurse who identifies as a male would face much less bias from her patients than would an actual male L&D nurse. I understand and fully appreciate that you are trying to be sensitive to others, but the fact remains that objective truth still exists even if one "feels" otherwise.

Thank you for reading and commenting. The answer lies in what you can objectively determine. It's not always possible to determine that a person who identifies as male, was born with female genitalia. You often can't tell by looking at a person with their clothes on that they are transgendered, and you can't ask (at least in polite society) for them to undress. All we can go on is how the person has decided to present to the world. My understanding of working with transgendered folk is that if they present as a certain gender, then that is how they would like to be perceived. What is more confusing for us cis-gendered folks is when we see someone and we can't tell immediately what gender they are. It's tricky because it's not polite to ask, so we have to do our best to be respectful and open minded. I think these folks might experience the most bias of all...but that's another article!

[SafetyNurse1968, BSN, MSN, PhD]

On 10/31/2019 at 7:44 AM, OUxPhys said:

First, either you are a male or you aren't. I don't understand the "identify as a male nurse".

I disagree – we now know that gender is nonbinary, meaning it falls on a spectrum. The chance of being born in the US with external genitalia that doesn’t match the textbook definition of “male” vs. “female” is the same as being born a red head (about 1 in 1000). A person born with anatomy that isn’t immediately identifiable is at risk for being placed into a gender category that doesn’t match how they feel. Young people who don't fit our outdated ideas of binary gender are at much greater risk for sexual violence and self-harm (just to name a few challenges they face). As nurses, our code of ethics demands that we respect the inherent worth and dignity of all our patients regardless of personal feelings so that we can provide the best possible care for everyone. In this article, I have attempted to do that, though I realize as a cis-gendered person (I identify as the gender I was born with), I come with my own inherent bias, despite my best efforts.

[jinct]

1 hour ago, SafetyNurse1968 said:

I feel like DeeAngel is saying that if she has a choice and can plan ahead, she does not want a male nurse. I don't think it's fair to assume that this would also extend to physicians, since as a previous poster pointed out, the relationship with the physician is often very close and evolves over a long period of time, thus trust can be built.

That's certainly a fair perspective, but then I'd have to assume that she would be ok with a male doula.

[SummitRN, BSN, RN]

I remember in OB clinical the clinical scholar would phrase the student question to the patient very differently.

For female nursing students she would say " this is a teaching hospital so you're going to have a student nurse with you today unless you have an objection."

For male nursing students she said, "there's a male nursing student interested in helping with your care Today and I just wanted to make sure is that okay with you?"

Note a statement of implied duty to accept the female nursing student in the name of learning based in greater good. That is vs an implication that there was something unusual, and based on personal motivation, in the case of the male student. The consent question for a female nursing student requires an active opt-out while male nursing student needs an active opt-in from the patient.

When you see treatment like that and you look around and see that there are absolutely zero male nurses, it's very clear who is welcome and who is really being tolerated until they leave. That perception is only reinforced by looking around and seeing both gender balance and acceptance of men as OB Physicians.

Imagine if someone asks the patient about an OB provider sex preference using the same biased speech patterns in question structures.

[SummitRN, BSN, RN]

There's quite a bit of talk about gender identity. For the sake of semantics :

Sex vs gender

Sex is a wholy biologically determined characteristic. It is mostly binary but not purely binary, and this is nothing new to the medical world. Sex is an immutable characteristic. Primary determinants are genetic. Secondary determinants being Environmental meaning of hormonal/chemical/nutrition.

Gender is often confused with sex.

Gender is traditionally binary, men and women, almost exclusively determined by sex (male female). However gender determinants are biological, developmental/environmental, and cultural. This means that new cultural understandings are creating space for additional gender identities and the gender is not treated as a determinatistic characteristic, or even an immutable characteristic. Sadly I think our society has become stuck on the term identity with gender when it may be better to use a word that has a meaning closer to personality, and individuals in a culture confused about their identity hyper focus on the traditional sexual determinants set as something that must be changed to match personality. How many genders are there, is it on a Spectrum, if it's a spectrum then how many axes are there on the Spectrum... these are difficult questions because the answers are found at the collision point between science, culture/tradition, opinion/emotion.

I think it's a topic worthy of its own thread and shouldn't distract from this thread.

[FullGlass, BSN, MSN, NP]

6 hours ago, SummitRN said:

I remember in OB clinical the clinical scholar would phrase the student question to the patient very differently.

For female nursing students she would say " this is a teaching hospital so you're going to have a student nurse with you today unless you have an objection."

For male nursing students she said, "there's a male nursing student interested in helping with your care Today and I just wanted to make sure is that okay with you?"

Note a statement of implied duty to accept the female nursing student in the name of learning based in greater good. That is vs an implication that there was something unusual, and based on personal motivation, in the case of the male student. The consent question for a female nursing student requires an active opt-out while male nursing student needs an active opt-in from the patient.

When you see treatment like that and you look around and see that there are absolutely zero male nurses, it's very clear who is welcome and who is really being tolerated until they leave. That perception is only reinforced by looking around and seeing both gender balance and acceptance of men as OB Physicians.

Imagine if someone asks the patient about an OB provider sex preference using the same biased speech patterns in question structures.

In Ob/Gyn, many patients prefer female providers and nurses. That is their right. It may be personal preference or due to cultural or religious reasons. Traditionally, L&D was a "women's" function and laboring women would be attended to only by women. There are mid-wife run birthing centers that only employ female providers and nurses, for this reason. We need to be sensitive to this. Many women have been subject to sexual assault and molestation by men, as well, so they only want women to care for them with regard to Ob/Gyn.

I am an NP, and for awhile I was the only female provider in my clinic. Many female patients of the male providers would make their annual Women's Wellness appointments with me, or come to me for "female" issues. They would see their male provider for everything else. No one's feelings got hurt.

Conversely, there are male patients that will only allow care by male nurses and doctors for cultural, religious, or personal reasons. I've had my own male patients see a male provider for certain "male" issues and it didn't hurt my feelings. I'm glad they got the care they needed. Many men have complained that they prefer male providers and chaperones for urogenital issues and urology is male-dominated.

We can't force or pressure patients with regard to providers in "intimate" care areas. This isn't something that we can shove down patients' throats. We can't compare this to racial prejudices, either, or try to give it the same level of significance.

One of my BSN classmates, a male, went on to become an L&D nurse and is doing very well. My nursing school is one of the leaders in admitting male students and none of my male peers ever complained about trouble completing clinicals because they were male.

[SummitRN, BSN, RN]

3 hours ago, FullGlass said:

In Ob/Gyn, many patients prefer female providers and nurses.

Not to be pointed, but was your takeaway from my post really that I was oblivious to this extremely well known reality and all of the other very common sense realities from your post? Does anyone enter, much less leave nursing school without knowing those things?

[FullGlass, BSN, MSN, NP]

1 minute ago, SummitRN said:

Not to be pointed, but was your takeaway from my post really that I was oblivious to this extremely well known reality and all of the other very common sense realities from your post?

Yes, here is what you said:

"For male nursing students she said, "there's a male nursing student interested in helping with your care Today and I just wanted to make sure is that okay with you?"

In Ob/Gyn it is absolutely appropriate to ask that. We don't know if the female patient in question may have an issue with a male nurse. Perhaps she was sexually assaulted in the past. I've had female patients start bawling with me because they have to have a pelvic exam because they have been sexually assaulted. After a lot of reassurance, I have been able to examine them and have been told multiple times they would never let a male examine them. If I have to refer them to an actual Ob/Gyn they are adamant it must be a female. Some have even insisted it has to be a female-only Ob/Gyn practice, and these do exist, for precisely this reason. There are also female-only birthing centers.

As for how student Ob/Gyn providers are introduced and so forth, it doesn't matter. We are nurses and we control nursing students. We absolutely should be sensitive to the preferences of female patients in the Ob/Gyn setting. If doctors and medical students don't care to be so accommodating, well, perhaps they should rethink that. Any patient has the right to refuse having a nursing or medical student present. In addition, a female patient absolutely can demand only a female provider.

I've also been in a large hospital in an area with a large number of Jewish Orthodox patients. Such male patients will only be seen by a male provider and demand male nurses, due to their religion. That is their right.

[Rionoir, ADN, RN]

The only issue I’ve experienced is that our scrub choices are solid color, camo, or marvel.