Can a Community Mentorship Program Improve Male Student Nurses’ Satisfaction Through Understanding Gender Bias Issues: An Action Research Study

CHAPTER 1. INTRODUCTION

Introduction to the Problem

The profession of nursing is heavily influenced by cultural stereotypes, gender biases, and a predominance of female role models. Florence Nightingale founded the modern nursing profession at a time when Victorian notions of rigidly stratified gender roles were at their peak (Evan, 2004). Nightingale herself viewed nursing as an extension of the traditional feminine caring role. More than 150 years later, nursing is still perceived as a women’s profession. The association of nursing with traditionally feminine characteristics perpetuates outmoded, gender-stereotyped attitudes that marginalize men who choose nursing as a career (Meadus & Twomey, 2011; Roth & Coleman, 2008). Men account for only a small proportion of students entering nurse education programs, but have higher rates of attrition (Dyck, Oliffe, Phinney, & Garrett, 2009; Meadus & Twomey, 2011; Roth & Coleman, 2008). Less than 8% of registered nurses (RNs) in the United States are male (Roth & Coleman, 2008).

There is widespread recognition of a global nursing shortage, with calls for recruiting more men into nursing as a strategy for addressing this issue as well as developing a more diverse nursing force (Meadus & Twomey, 2011). At the same time there is scant attention given to the unique challenges confronting male students in nurse education programs. Male students enrolled in nursing programs face social isolation, gender stereotypes, unequal opportunities for clinical placements, textbooks biased in favor of females, and ineffective teaching strategies for their learning needs (Bell-Scriber, 2008; Dyck et al., 2009; Ierardi, Fitzgerald, & Holland, 2010). As long as these issues remain unresolved, it is probable that men will continue to drop out of nursing programs in high numbers, thereby sustaining the gender imbalance and perpetuating the societal stereotypes surrounding the nursing profession.

Background

Since its inception as a profession in the mid-19th century, nursing has retained its traditionally feminine image (Evans, 2004; Roth & Coleman, 2008). Male students who choose to enter nursing programs often have strong support from their families, but their perceived support diminishes in the classroom. Bell-Scriber (2008) illuminated the “cool” climate for men of a nursing education program. Other studies confirm that male nursing students face specific challengers in courses designed for female learners where they alternately stand out or are treated as if they were invisible (Dyck et al., 2009; Ierardi et et al., 2010; Meadus & Twomey, 2010). Mentorship is recommended as a promising strategy for reducing the sense of isolation of men who choose nursing and increasing their presence in the nursing force (Roth & Coleman, 2008).

Context

The site of this study is the Los Rios Community College District, which is dedicated to supporting the community through academic excellence and community involvement (www.losrios.edu). The mission of the nursing program is to graduate students equipped with the theoretical knowledge and clinical practice competencies required for safe and effective entry level nursing practice. American River College (ARC) is the largest of the Los Rios colleges. Yet despite the institution’s commitment to promoting the success of its nursing students, there had been virtually no attention to the challenges faced by male students. After being surveyed on the validity of this project and its potential benefits to the program, the nursing faculty strongly agreed that there is a need for intervention to ensure the success of male students.

Theoretical Framework

The theoretical framework guiding this study is Argyris and Schon’s (1996) model of single loop and double loop learning. Reactive and self-protective, Model I behavior is only capable of single loop learning. That is, Model I behavior inhibits self-reflection, analytical thinking and openness, and is not conducive to double loop learning. Model II principles are built on openness to new information, emotion, reflection, and uninhibited choice. Model II behavior promotes double loop learning, which is essential for organizational learning. To create a welcoming climate for male students, nursing faculty must be open to double loop learning.

Statement of the Problem

Research indicates that male nursing students have higher attrition rates than their female counterparts (Dyck et al., 2009; Meadus & Twomey, 2011; Roth & Coleman, 2008). According to the director of the nursing program, the majority of students who drop out within the first two weeks are male. This is a significant concern for several reasons. First, when male students drop out of the program their “slots” are given to female students on the rationale that they are more likely to succeed. Second, the loss of male students diminishes the male perspective and directly impacts specialties such as psychiatric nursing and critical care, which tend to be more attractive to men (Rothman & Coleman, 2008). Third, the attrition of male students can be demoralizing to the remaining male learners, who are made even more aware of their minority status (Bell-Scriber, 2008). Finally, the institution received a grant to grant to increase the number of military veterans in the nursing program. This population is predominantly male.

Purpose of the Study

The long-range goal of this study is to increase the retention of male students in the Associate Degree in Nursing (ADN) program by providing them with a gender-specific support system in the form of a mentorship program. The immediate goal of this project is to determine the effectiveness of the mentorship program in decreasing the male students’ perceptions of gender bias and enhancing their self-esteem, self-image, and perceived support.

Research Questions

This study is driven by two interrelated research questions. The first research question asks in what ways can a male support system increase the ability to male nursing students to reflect on issues related to gender role conflict, social support, gender-related work barriers, and work and life satisfaction to promote the retention of men in the ADN program. The second research question asks what specific program components are needed to increase the ability to male nursing students to reflect on these issues to promote their retention in the ADN program.

Rationale, Relevance, and Significance

The persistently high rates of attrition among male students enrolled in the ADN program offer a clear rationale for a program designed to provide male students with gender-specific support to help them succeed in the program. The mentorship program will be designed with input from the male students so it can best serve their needs. The high male attrition rates are not limited to this institution, and there is a shortage of qualified nurses in the U.S. and worldwide. These issues extend the relevance of this study beyond a single educational institution.

The findings of this study are expected to have a significant impact on the nursing students, nursing faculty, and the organization as a whole. This study will provide insights into the needs of male learners and the effectiveness of a mentorship program designed to address those needs. The program can be improved on the basis of ongoing evaluation. Presentation and discussion of these findings is expected to promote organizational learning and change. The institution and the community will benefit from having a more gender-balanced nursing pool.

Nature of the Study

This project involves a pretest-posttest design. The intervention chosen for this study is the development of a mentorship program matching male nursing students with male nurses practicing in the local community. The key requirement is that the mentor and mentee will be in contact at least twice within one month (they are free to choose the mode of communication). Participation is open to all male students enrolled in the ADN program. Prior to the mentorship program the students will be surveyed on issues related to gender bias and asked for ideas on how this can be decreased. Those who choose to participate in the program will be surveyed again using the same instrument (see Appendix A) after a designated time period. The survey as adapted from the existing literature and will be field tested with three practicing male RNs.

The survey is qualitative by design and the data will be analyzed and coded according to common themes (Gillham, 2005). The results of this project will be presented at a faculty meeting and shared with the leadership of the educational institution.

Definition of Terms

The following terms are defined for the purpose of this research study:

Mentorship: a formal relationship in which a more experienced professional is matched with a student or novice to provide him or her with psychosocial and instrumental (career and/or academic) support.

Mentor: for this study, a mentor refers to a male RN with five years of less of professional nursing experience who agrees to work with and support a male nursing student.

Mentee/Protégé: for this study, the term mentee or protégé refers to a male nursing student who is paired with a practicing male RN.

Gender bias: attitudes, beliefs, and conditions that promote societal stereotypes based on biological sex.

Assumptions, Limitations, and Delimitations

The main assumptions are that the nursing program has a problem retaining male students and that a mentorship program will positively impact the retention of male students. One potential limitation for this study is a possible lack of interest in the mentorship program by male nursing students. An additional limitation is the reliance on a self-report measure. Although the male students will be assured of complete confidentiality, it is possible they may be inhibited about honestly answering questions and/or will provide responses they perceive as socially desirable. The delimitations of this study are the choice of a single ADN program within a community college system, restricting the participant sample to male students enrolled in the program, and limiting potential mentors to male RNs with no more than five years of experience.

Organization of the Remainder of the Study

Chapter 2 will present a review of the relevant theoretical and empirical literature and conclude with a brief summary. Chapter 3 will describe the research methodology in detail. Chapter 4 will present the data analysis and results, and Chapter 5 will present a discussion of findings, conclusions, implications for practice, and recommendations for future research.

CHAPTER 2. LITERATURE REVIEW

Introduction

A review of the scholarly literature revealed a dearth of research on the topic of men in the nursing profession and in nurse education programs. Keywords used for this study include: male nurses, male nursing students, nurse education, gender, gender bias, gender stereotypes, social support, and mentorship.

Theoretical Framework

The theoretical framework guiding this study is Argyris and Schon’s (1996) model of single loop and double loop learning. Nurse education programs have historically clung to the reactive and self-protective mode of Model I behavior on issues related to gender stereotypes and gender biases in the nursing profession. Mistrust and rigidity are consequences of Model I thinking (Argyris & Schon, 1996). Many nurse educators display Model I behavior in their attitudes and actions toward male students (Bell-Scriber, 2008). This predilection perpetuates a reliance on single loop learning.

To promote organizational learning and change what is needed is Model II behavior, which welcomes novel ideas, emotion, reflection, and expands possibilities (Argyris & Schon, 1996). This model is necessary to promote double loop learning for the male and female students as well as nursing faculty. Many male students are uncomfortable with emotions and reflection, which they feel are overemphasized in the nursing curriculum (Dyck et al., 2009). Challenging the status quo to promote double loop thinking, which in turn is requisite for organizational learning, requires critical analysis and reflection of the gendered nature of nurse education and exploration of new ways of thinking, practice, and a revision of core competencies that support the success of all learners.

According to Smith (2001), the closer alignment between theory and practice, the more effective is a leader or institution. In this instance, the espoused theory of being a fair and non-gender biased nursing program may conflict with the present theory, which does not consider the needs of male students when planning and implementing nursing curriculum. A major goal of this action research project is promoting organizational learning and change.

Review of Research on Men in the Nursing Profession

Evans (2004) examined the history of men in nursing in Canada, Britain and the U.S. from antiquity to the present. She provided good insights into the ways that gender relations and the idea of nursing as women’s work have excluded and limited, and ironically also advanced the careers of men in nursing. Male nurses tend to advance more rapidly into management positions rather than stay at the bedside. At the same time, their opportunities for choosing clinical specialties are limited by gender stereotypes. Men have traditionally performed as psychiatric and critical care nurses but have been restricted in pursuing obstetrical nursing. This bias remains pervasive today (Roth & Coleman, 2008; Twomey & Meadus, 2010). Evans (2004) concluded that “Understanding the centrality of gender in relation to the history of nursing” is requisite for addressing “longstanding gender inequities that impact on men and women nurses” (p. 327).

Roth and Coleman (2008) conducted an extensive review of the literature on the presence of men in nursing with emphasis on the distinctive qualities of men in nursing as well as their unique struggles. A major conclusion was that public perceptions of nursing as a women’s profession are so deeply entrenched in our culture that changing them is extremely difficult. The researchers implicate the challenges faced by male nurses and nursing students as a key contributor to their scarcity. They strongly advocate creating male peer-support programs and mentorship programs as important mechanisms for decreasing the sense of isolation experienced by men and increasing their numbers in the nursing workforce.

Rochlen, Good, and Carver (2009) examined the experiences of 174 male nurses in the U.S. The participants were surveyed on measures of gender role conflict, social support, gender-related work barriers, and work and life satisfaction. The findings revealed that men who experienced more conflict in their work and family lives, had lower self-appraised job competencies, and had less support from their families had stronger perceptions of gender-related barriers at work. Nonetheless, most of the men appeared to be satisfied with their personal and professional roles and lives.

Male nursing students. Meadus and Twomey (2011) conducted a phenomenological exploration of the experience of 27 male students in a baccalaureate degree nursing students. Ranging in age from 20 to 38, the sample included students who entered the program from high school and students who had prior degrees and/or careers. Five key themes arose from the analysis: choosing nursing, becoming a nurse, caring within the nursing role, gender-based stereotypes, and visible/invisible. The men were motivated to choose nursing by both extrinsic and intrinsic rewards. Several participants had relatives in the nursing profession who were sources of social support. In the nursing program, however, they encountered gender biases.

Bell-Scriber (2008) and Dyck et al. (2009) both combined classroom observations with individual interviews to examine the experiences of male students in baccalaureate degree nursing programs in the U.S. and Canada, respectively. Bell-Scriber’s (2008) focus was on the climate for men in the nursing program. The most inhospitable factor for men was discriminatory (cooling) behavior by female educators. Male and female students alike stated that men were not treated equitably. The students noted that both genders were praised equally for posing excellent questions and contributing to classroom discussions. However, educators would sometimes use female pronouns to describe nurses and generally provided the female students with more learning and social support. The literature suggests that societal stereotypes are so deeply entrenched in nursing programs that male learners require formal,

The study by Dyck et al. (2009) illuminated the powerful influence of cultural gender roles and stereotypes. The theme labeled nursing like a real man related to the assertiveness and willingness to assume a challenging or confrontational role by the male students. Despite their minority status, the men were more vocal in class than their female peers. One impression is that the men felt compelled to display traditionally masculine behavior in order to compensate for being in a “feminine” environment. Nurse educators in Bell-Scriber’s (2008) study viewed this negatively as a feeling on the part of male students “Like we have to prove ourselves as something” (p. 147). A related theme was masculinities in a feminine place. Many of the men felt compelled to assert a heterosexual identity to counter cultural stereotypes of male nurses as gay. The female educators viewed the gay stereotype as detrimental to both gay and heterosexual male students. In addition, the male students were often asked for the “male perspective” or “male input” (p. 652) as if they were a monolithic entity with no individual opinions.

The final them was diversity between masculine and feminine (Dyck et al., 2009). Some men perceived class as “overfeeling and underdoing” (p. 652). Their discomfort with emotion, self-reflection, and introspection had a potentially negative impact on their performance in a program in which these qualities were admired if not requisite. Most were still satisfied with the program; they “did not attest to being treated unjustly, but rather ineffectively” (p. 652).

Review of Methodological Issues

The most striking revelation was the dearth of quantitative studies examining the experiences and perceptions of men in nursing. Only Rochlen et al. (2009) used quantitative instruments and a fairly large sample. Evans (2004) and Roth and Coleman (2008) both built their studies on research reviews, although Roth and Coleman (2008) were mainly concerned with the present and Evans (2004) the past. Bell-Scriber (2008), Dyck et al. (2009), and Meadus and Twomey (2010) all utilized qualitative methodologies. These studies provide good insight into the lived experiences of men in nursing and would be an excellent precursor for future quantitative surveys.

Synthesis of Research Findings

All of the studies examined confirmed the pervasiveness of deeply ingrained societal gender biases and stereotypes in the nursing profession. Evidence of gender bias is rampant in nursing programs (Bell-Scriber, 2008; Dyck et al., 2009; Meadus & Twomey, 2010). Traditional gender roles shape the behavior of male students, female students, and nursing faculty alike. There is strong consensus that men in nursing face unique challenges, but those that persist through them express satisfaction with their chosen careers (Rochlen et al., 2009).

Critique of Previous Research

The main problem with the existing research on male nursing students is that there is so little of it. Furthermore, the preponderance of qualitative research limits the findings to small samples of students who are willing to share their experiences and are committed to continuing despite obstacles. There is a need for large-scale studies of male students and practicing nurses. It would also be useful to examine the experiences of men who dropped out of nursing programs or left professional nursing and gain their insights on how things could be improved. In addition, despite recommendations for peer support and mentoring programs for men pursuing nursing careers there seem to be no studies investigating their effectiveness.

Chapter 2 Summary

A review of the literature on men in nursing programs and in the profession in general confirmed the ubiquity of gender stereotypes and gender biases, which are thought to contribute to the acute shortage of male nurses (Roth & Coleman, 2009). Nursing curricula are designed for female students and consciously or unconsciously, educators often perpetuate the idea of nursing as a female profession (Bell-Scriber, 2008). The overarching conclusion is that there need to be important changes made to the nature of nurse education programs to encourage a more gender-balanced nursing workforce.

References

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Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi:10.1191/1478088706qp063oa

Dyck, J. M., Oliffe, J., Phinney, A., & Garrett, B. (2009). Nursing instructors’ and male nursing students’ perceptions of an undergraduate, classroom nursing education. Nurse Education Today, 29, 649-653. doi:10.1016/j.nedt.2009.02.003

Evans, J. (2004). Men nurses: A historical and feminist perspective. Journal of Advanced Nursing, 47, 321-328. doi:10.1111/j.1365-2648.2004.03096.x

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Rochlen, A. B., Good, G. E., & Carver, T. A. (2009). Predictors of gender-related barriers, work, and life satisfaction among men in nursing. Psychology of Men & Masculinities, 10, 41-56. doi:10.1037/a0013291

Roth, J. E., & Coleman, C. (2008). Perceived and real barriers for men entering nursing: implications for gender diversity. Journal of Cultural Diversity, 15(3), 148-152.

Smith, M. K. (2001). Chris Argyris: Theories of action, double-loop learning and organizational learning. Retrieved from http://www.infed.org/thinkers/argyris.htm