Category Archives: Men and boys
Male Entry into a Discipline Not Designed to Accommodate Gender: Making Space for Diversity in Nursing
Michael R. Bleich, PhD, RN, FAAN, is Maxine Clark and Bob Fox dean and professor at the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Mo. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2000-2002).
With help from co-authors Brent MacWilliams, PhD, ANP, and Bonnie Schmidt, PhD(c), RN, in our recent American Journal of Nursing article summarizing research on men in nursing—and further inspired by a manuscript by Dena Hassouneh, PhD, ANP, entitled Anti-Racist Pedagogy: Challenges Faced by Faculty of Color in Predominantly White Schools of Nursing in the July 2006 issue of the Journal of Nursing Education—I am in a reflective place. After a nearly 40-year journey as a male in nursing, I now realize the discipline was never designed for me.
"Why did the faculty not do more to buffer me from faculty who were overtly gender-disparaging? Why were the gloves in procedural kits always sized for smaller hands?"
That is not to say that I have not had a fabulous career, worked with the finest colleagues one could imagine, or had opportunities that provided continuous challenge and opportunity. But as a discipline, nursing has had its broad shifts. Florence Nightingale was a master of evidence-based practice and spent a lifetime elevating nursing to a discipline in a world that was political, gender-biased against women, scientifically evolving, caste-oriented, and more. The gift of structure, process, and outcomes she gave nursing are irreplaceable.
Though it remains a predominantly female profession, a new study from the U.S. Census Bureau finds that the percentage of nurses who are male more than tripled from 1970 to 2011, from 2.7 percent to 9.6 percent.
The Census Bureau’s Men in Nursing Occupations also finds the proportion of male licensed practical and licensed vocational nurses increased, from 3.9 percent to 8.1 percent. Men's representation was highest among nurse anesthetists (41%).
“The aging of our population has fueled an increasing demand for long-term care and end-of-life services," said the report's author, Liana Christin Landivar, a sociologist in the Census Bureau's Industry and Occupation Statistics Branch, said in a news release about the study. “A predicted shortage has led to recruiting and retraining efforts to increase the pool of nurses. These efforts have included recruiting men into nursing.”
The study also found that men typically earn more in nursing fields than women, but not by as much as they do across all occupations. Male nurses earned an average of $60,700 in 2011—16 percent more than the average earnings for female nurses, which was $51,100. The difference in earnings is due partly to the concentration of men in higher-paid nursing occupations, like nurse anesthetics. “Men have typically enjoyed higher wages and faster promotions in female-dominated occupations,” the study says, a phenomenon known as the “glass escalator” effect.
By Brent MacWilliams, PhD, ANP, Assistant Professor, University of Wisconsin-Oshkosh, Member of the Board of Directors, American Assembly for Men in Nursing
The Robert Wood Johnson Foundation (RWJF) values diversity and inclusion, which includes historically underrepresented populations like men. The population of the United States is becoming more diverse, and the best way to increase cultural competence in the health care system is to increase the diversity of health care providers.
Medicine, pharmacy and other allied professions have increased gender diversity to near equitable levels. Nearly half—or 48 percent—of 2010 medical school graduates were women, according to the Association of American Medical Colleges. Yet men account for less than 10 percent of the nursing profession.
It is time for nursing to recalibrate to meet the needs of a 21st century health care workforce through sustainable metrics. RWJF and the American Assembly for Men in Nursing (AAMN) share a vision for measurable change to take place in the nursing workforce through cultural change, greater diversity in health care leadership and evidence-based change.
By Craig Pollack, MD, MS, MHS, a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar alumnus (2006-2009), assistant professor of medicine and associate director of the General Internal Medicine Fellowship program at Johns Hopkins University
The United States Preventive Services Task Force, a group never to shy away from controversy, recently released its final recommendations on prostate cancer screening. The Task Force gave prostate-specific antigen (PSA) testing a grade D, indicating that it should be discouraged as part of routine testing. They noted that there were substantial harms associated with testing and subsequent diagnosis and treatment: worry and anxiety; infections from biopsies; incontinence and erectile dysfunction. And the benefits were likely to be small—on the order of 1 life saved for every 1,000 men screened.
However, the recommendations have caused tremendous controversy. Critics question whether the Task Force has appropriately weighed the risks and benefits and balanced the existing evidence. Our research suggests that even those who agree with the recommendations will find it hard to stop screening. We are now working on a set of decision-making tools for primary care providers (PCPs) and patients to minimize unnecessary screening.
Donna Shalala stated at the IOM Future of Nursing: Leading Change, Advancing Health hearings that accelerated nursing programs could be a strategy to increase the number of men in nursing.
At the University of Wisconsin-Oshkosh, we’ve implemented an accelerated degree nursing program, and it is drawing in male students at a rate that is double the national average.
The program is called the Accelerated Online Bachelors to BSN (ACCEL). It is currently being evaluated as a potential exemplar for nursing education by the Robert Wood Johnson Foundation (RWJF) Evaluating Innovations in Nursing Education (EIN) program. Since 2003, the ACCEL option has offered students a technology-rich, immersive online learning environment coupled with a unique precepted clinical experience.
The ACCEL October 2011 cohort is 20 percent male—a typical percentage for the ACCEL option and for accelerated programs across the country. A 20 percent male student population is double the average number of men typically enrolled in more traditional nursing programs. Men currently comprise 10 percent of the national population of registered nurses, surveys show.
William T. Lecher, RN, MS, MBA, NE-BC, is president of the American Assembly for Men in Nursing.
The American Assembly for Men in Nursing (AAMN) is taking a lead role nationally to increase the number and percent of men in the nursing workforce. The Institute of Medicine (IOM) nursing report clearly articulates that to improve the quality of patient care, a greater emphasis must be placed on making the nursing workforce more diverse, particularly in the areas of gender and race/ethnicity. But over the last 100 to 150 years, nursing has been almost exclusively female, even though men have had a long history in nursing. In the private sector, the percentage of men who are nurses continues to range between 5 and 10 percent. By contrast the armed forces enjoy a culture in which the balance between men and women nurses is nearly equal.
Creating greater diversity was also named or implied in several of the eight IOM recommendations.
Recommendation 4 identified the need to increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. To meet this goal, it was identified that leaders should work together to increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan. IOM Chair Donna Shalala specifically cited that accelerated BSN and second degree programs have regularly demonstrated better gender diversity in student enrollment and completion. There is a need to show similar gains in traditional pre-licensure nursing programs regarding men in nursing recruitment and retention.
And recommendation 5 identified the need for schools of nursing to double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to increasing diversity. Doubling the number of men in nursing with a doctorate will add value to nursing science, and add men in nursing faculty as teachers and role models for male nursing students.
Brandon Echtenkamp is a New Careers in Nursing scholar, a program of the Robert Wood Johnson Foundation and the American Association of Colleges of Nursing.
I would wager that any male who has contemplated a career in nursing has considered the stigma of it being a woman’s career. I certainly did before I began my nursing program. However, those thoughts were exceedingly transient in nature. After being exposed to the nursing world and being able to observe men first-hand in the nursing role, I could see that gender made no difference. Based on my experiences, female nurses have been incredibly open to sharing their nursing role with men. Men have become integrated into the field in such a way that it is becoming typical to see male nurses on most hospital units. Of course, as males, we are still the minority, but great strides are being made.
The patients I have had the pleasure of caring for throughout my clinical experiences as a nursing student have been generally accepting of a male nurse caring for them. The one exception to this would be during my mother/baby rotation where I was welcomed by patients as a nursing student, but subsequently turned down as a student caregiver upon the discovery of my male status. This was very frustrating to me as a nursing student eager to learn. However, these were only my experiences, and it seemed as though patients readily accepted other males in my nursing cohort, which gives me hope that this sort of discrimination is not a common occurrence and was more coincidental in my case.
Despite my setbacks in my mother/baby rotation, this has certainly not been the case in other areas of nursing. My presence has been well received by patients I have cared for. This is not to say that my being a male nursing student goes without scrutiny. Although welcomed by patients, they are often somewhat confused at seeing a male nurse.