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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 3/25/2017.

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Presentation on theme: "The Male Experience in Nursing & Nursing Education (plus my masters thesis on male RN rates of discipline in Minnesota) Keith Rischer RN, MA, CEN 3/25/2017."— Presentation transcript:

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 3/25/2017

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 3/25/2017

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 3/25/2017

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 Women see their experience as applicable to all but unaware of the distinct and separate legacy that men have encountered as gender minority in matriarchal profession 3/25/2017

5 Timeline of Men’s Historical Contributions
400 BC Ancient Greece & Rome-Nosocomi 250 BC India First century AD Good Samaritan Bullet #1-Nosocomi-male caregivers in ancient Rome-’Nosocomial infection” #2 First recorded school of nursing in India-men were the only gender accepted #3 biblical account reflective of acceptance of men to serve in this context #4 nursing was a profession that was practiced primarily by men 3/25/2017

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 Bullet #1-Parabolani-group of men who started hospital and provided nursing care during black plague epidemic in Europe Bullet #2-monastic movement-men provided nursing care and protection to the sick wounded and dying as members of religious orders #4These included: Knights Hospitalers, Teutonic Knights, and the Knights of St. Lazurus The Badge of the Nightingale Training School. Introduced by Dame Alicia Lloyd Still in 1925, its design is taken from the eight-pointed cross of the Knights of the Hospital of St. John of Jerusalem. Its four arms symbolize the Cardinal Virtues -- Prudence, Temperance, Justice and Fortitude -- and the points represent the Eight Beatitudes which spring from the practice of those virtues. The center of the design portrays the head of Miss Nightingale in relief, with the words, "Schola Sancti Thomae." 3/25/2017

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 Note the symbol that was distinctive to this male nursing order 3/25/2017

8 3/25/2017

9 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.” Nightingale’s motivations: Early feminist-recognized oppression women experienced in context of Victorian England-saw nursing as a way for women to express and break out and perform other duties outside the home 3/25/2017

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 Bullet #2-nightingale’s vision believed that nursing was natural and uniquely suited to be performed by women 3/25/2017

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 Bullet #2-men who had equivalent training and performed same duties not even recognized as “nurses”-dneied official recognition from nursing profession 3/25/2017

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 Bullet #3-GNC-used its register to offer full membership only to women who were general trained in nightingales schools of nursing 3/25/2017

13 Institutionalized Bias: United States
American Nurses Association (ANA) Men not allowed to be members In 1901, the Army Nurse Corp was formed only women were allowed to serve as nurses This discriminatory policy continued until 1955 whose leadership was exclusively female used its matriarchal authority to deny male nurses to be admitted into this professional organization from its inception in 1898 until 1930 Bullet#1 ANA-no men allowed Bullet #2 MEN WHO WERE NURSES NOT ALLOWED TO SERVE IN THIS ROLE-ONLY COMBAT 3/25/2017

14 Application of Feminist Theory (feminism)
Attempts to understand the nature of gender bias Tenets: Gender discrimination and bias Oppression Stereotyping Patriarchy vs. Matriarchy 3/25/2017

15 Benefits to Men in Nursing
Token male Leadership/managerial positions Credibility with physicians 3/25/2017

16 Percentage Participation of Men in Nursing:US
1% of RN's from 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 American Bias American Nurses Association (ANA) In 1901, the Army Nurse Corp was formed only women were allowed to serve as nurses This discriminatory policy continued until 1955 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 Schools of medicine, engineering, and pharmacy expanding opportunities for women under affirmative action …schools of nursing not mandated to increase enrollment of men Note that medicine has achieved gender parity in their profession, but nursing remains so far behind Why is this important to know and understand? Why was Roots seen as such a powerful and important event that was more than just a miniseries? An awareness of the past gives a context to advocate for this who have historically been marginalized…men as well as minorities in nursing 3/25/2017

17 Educational Bias Late 1800's 1930 1960’s 1981
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 Mills School of Nursing for Men at New York’s Bellevue Hospital-psychiatric institution, and McLean Asylum Training School (Mackintosh, 1997) Bullet#1-Bellvue in NYC Bullet#2-men were considered more appropriate in stereotypical masculine roles that required physical strength Bullet #3-appealed to Supreme Court-lost battle for exclusion-attempted to claim that women were adversely affected by the presence of men in nursing program Bullet#5-why were schools of nursing not required to ince enrollment-WERE NOT A PROTECTED CLASS No comparable studies of this research topic were identified in the professional literature Was able to identify many related themes to men’s experiences in nursing that included: Men in nursing history Role strain Tokenism Stereotyping Recent examples of gender bias Educational bias was another significant theme and because of my audience today am going to present briefly this theme as well as the unique experience of men in nursing education 3/25/2017

18 Current Nursing Textbook Bias
Potter & Perry “Fundamentals in Nursing 6th ed Widely used textbook for first year nursing students Milestones in Nursing History” table begins with this entry: “300 AD Entry of women into nursing” Men were caregivers in ancient Greece and Rome almost 1000 years earlier The rest of the table emphasizes women’s contributions and includes only a brief reference to the various hospital Brothers orders of the middle ages 3/25/2017

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 Problem…men have higher attrition rates historically…some schools as high as 50% attrition Overall attrition rate on average is twice the rate as for women 3/25/2017

20 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 Survey of 113 men in nursing in Montana 3/25/2017

21 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 Qualitative study of 13 men in a BSN program 3/25/2017

22 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 Qualitative study of 4 men vs. 4 women w/interviews of 6 nsg faculty of same students COOLING BEHAVIORS…”you ask questions and they are harsh with you…there is a terseness in their response…sometimes in tone or body language. It is not what they say-it is how they say it MICROINEQUITIES-negative micro-messages freq. unconscious that can devalue-discourage students…such NV messages can include looks, gestures, ton, inflection PREJUDICE- “it seems that it is the males who are whispering or condescending…a lot of the males go into nursing for the wrong reasons…whatever they wanted to do didn’t work out and they have a chip on their shoulder Would you like to bring more men into the program…. “NO-I’d like to get rid of the men-they all want to be anesthetists…referring to the nurse in female pronoun SHE Women felt climate to be warmer from their perspective 3/25/2017

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 3/25/2017

24 Practical Strategies Curricular Incorporate male learning pedagogies
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 3/25/2017

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?” 3/25/2017

26 Less Severe (potentially more subjective):
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 #2 Nine men served on board over the past 15 years (12.6%) majority of these men were lay members vs. 62 women (87.4%) Bullet #4-identify any disproportionate trends of disciplinary action based on gender 3/25/2017

27 3/25/2017

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

29 3/25/2017

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) 3/25/2017

31 Research Results cont. Study Variables Gender of RN
Severity of Board discipline Time trend: 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) 3/25/2017

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? 3/25/2017

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 Nursing shortage will dramatically worsen in near future Nursing can no longer afford to be primarily one gendered profession To meet health care needs of future- 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 including possible on-going gender bias 3/25/2017

34 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? 3/25/2017

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