Increasing Inclusion: Assessing Gender Diversity in Nursing

UNLV nursing students assess a patient's needs at the Clinical Simulation Center of Las Vegas

UNLV nursing students assess a patient's needs at the Clinical Simulation Center of Las Vegas

UNLV School of Nursing Associate Dean of Academic Affairs Steven J. Palazzo

UNLV School of Nursing Associate Dean of Academic Affairs Steven J. Palazzo

Sep. 10, 2020

By Dean Angela Amar (PhD, RN, FAAN, Professor and Dean, School of Nursing), Steven J. Palazzo (PhD, RN, CNE, Associate Dean for Academic Affairs, School of Nursing), Andrew Thomas Reyes (PhD, MSN, RN, Assistant Professor, School of Nursing), and Joseph Gaccione (Communications & Outreach Specialist, School of Nursing)

 

What started as an observation for Jayison McCorkle turned into an opportunity to help correct a widespread concern. 

The first-year nursing student entered his Bachelor of Science in Nursing orientation with UNLV School of Nursing back in Spring 2020 and noticed something that stood out: Him.  He realized he was the only Black male student in the group. “I just thought it was interesting”, he explains.  “Nursing is such an important, essential job.  Obviously, women have predominantly been in the field, all the way from Florence Nightingale.  It makes sense how she influenced the gender specificity of nursing.”  McCorkle says this sparked a conversation about how to better advertise nursing programs.  “Diversity will always be the goal of any job because it offers more opportunities to more people”, he says.

This is a scenario other nursing schools across the U.S. experience, whether they recognize it or not. The health disparities of COVID has brought diversity discussions to the forefront. Nurses, as a group, are overwhelmingly white, older (over 50), and female. The need for nurses that better represent the communities they serve is readily apparent and on most schools’ agenda for change. However, the need to increase gender representation is not discussed as often. The patients we serve, the students we educate, and the institutions where we work are all enriched by having multiple perspectives.

Slow Growth

Men in nursing have traditionally been outnumbered compared to women in the field, based on statistics over the past several decades.  Though numbers are steadily rising, the growth is far from swift.  Here are some examples.

  • In the 1970s, the U.S. Census Bureau recorded the percentage of male nurses at 2.7%. 
  • A 2017 study from the NCSBN and National Forum of State Nursing Workforce Centers reported male registered nurses at 9%.
  • A 2019 report from the U.S. Labor Bureau of Statistics found 12% of registered nurses were male.

UNLV School of Nursing’s current enrollment includes nearly 21% self-identified male students, more than the national figure. But while progress is encouraging, there is room for improvement, especially with men comprising about 50% of society.

Identifiable Causes

To better balance the male to female nurse ratio, it’s critical to assess the obstacles stopping men from entering the profession. One cause is lack of visibility. There are less men in nursing because nursing is not an identifiable career option in high school when male students are considering for a college degree (LaRocco, 2007).  That unidentifiability translates to home life as well. McCorkle says he watched his father go through nursing school and become a Nurse Practitioner, motivating him to become a nurse, but this is far from normal. Research shows a lack of men in nursing family role models, and usually this is a result of higher rates of men leaving the nursing profession than women (Ellis et al., 2006; LaRocco, 2007). Additionally, there is also a shortage of representation of men in nursing in promotional materials for nursing degrees as well as in textbooks (Bell-Scriber, 2008).

It is difficult to promote men in nursing if there are so few. What may heavily perpetuate the lack of representation and discourage young men in high school from this kind of career is typecasting.  From media to marketing, the nurse position is typically not portrayed as a symbol of masculinity. The stereotypical images of a nurse that generally spring to mind can range from the more historical (Florence Nightingale, women in white hats with red crosses) to more exaggerated labelling (the “sexy” nurse or the “old battleax”). Because of role incongruity, men will be negatively assessed by others when their characteristics are recognized as not affiliated with men’s usual social role. In other words, men and nursing are not seen as congruent because of historical role association of female subordination. 

Notably, media portrayal of nurses does a disservice to the profession more than impacting gender diversity.  It can muddle the truth of a nurse’s role beyond a caregiver, which in turn, could dissuade men from enrolling in nursing schools. Steven J. Palazzo, associate dean for academic affairs at SON, says while the caring responsibility is vital, it’s not unique to just nurses. “The historical and contemporary emphasis on caring is important and should be valued by the profession and community”, he says. “But, at its core, contemporary nursing is a science. It takes a scientific mind, a critical thinker. A person who possess the skill of metacognition. A person who embodies the spirit of discernment and critical self-reflection. These inherent and acquired characteristics personify the professional nurse."

Before nursing students start their core nursing courses, they first must master the sciences of chemistry, biology, anatomy and physiology, microbiology, nutrition, pathophysiology, psychology, and pharmacology. Palazzo says, "The foundation these sciences provide are instrumental in formatting the competent nurse ready to provide complex, patient-centered (family-centered, community-centered, population-centered) care in an evolving, complex, multidimensional health care system that is facing significant financial challenges and barriers to equity in care delivery.”   

Angela Amar, Dean of SON, echoed these sentiments about the core of what nurses do. “At the heart of our educational program is preparing students to be able to assess patient’s needs and use clinical reasoning to respond. The critical thinking and scientific nature of the profession is not readily seen, until you are a patient in a hospital. The caring for people’s basic needs through illness and health predominates public perception. While this is not strictly a bad thing, most nurses are attracted to a job that enables them to think and respond using science, reasoning and creativity.”

Eliminating Exclusion and Increasing Inclusion

How do we encourage more gender diversity in nursing?  It starts with more inclusion and less exclusion on both academic and professional levels. Because men in nursing are in the minority, it is important that schools of nursing make them feel welcomed. There are examples of faculty who subscribe to the belief that men are not as caring as women, as well as patients who don’t feel comfortable with male nurses, according to Dean Amar. “I have known of situations in labor and delivery where male students are not welcomed into the clinical environment,” she explains. “At one institution in Georgia, when the clinical instructor would call the night before clinical to get a sense of the unit and make assignments, this faculty would also ask about male students. Often, they would not want to assign the male students to patients and make the clinical observational. This faculty person would try to avoid the question so that her students weren’t penalized. This is extreme, but stereotypes exist that affect men.” Palazzo added these microaggressions are prevalent.

McCorkle advocates for bring more diverse groups of nurses into high schools as an educational tool. “Having people like me speak to high school kids who are in the process of choosing their major might not know about nursing or maybe turned off from it because they would be a minority.  Know it’s ok to be a minority in this field and it’s accepted – I haven’t been treated differently from my other classmates and staff.” He added, “When I was a pre-nursing student, I would have loved to speak to actual nursing students.”

Palazzo agrees, signaling for more conversations in junior high school and high school on career pathways in nursing, encouraging those interested in science. In terms of communication, he also stresses the importance of how nurses talk about their profession, specifically the explicitness of their responsibilities. “You say, ‘Yes, I care for patients’, but explain, ‘I took my patient’s blood pressure.  I used equipment and technology to monitor my patients in order to anticipate or recognize changes in their healthcare status so I could react in such a way to deliver care. I use my critical thinking skills in the sciences to provide interventions.’” He contends these kinds of interactions can help promote the position and attract more nurses, including more men.

There are also larger efforts across the country to advocate for more gender diversity.  The Men in Nursing of Southern Nevada (MNSN) helps promote more gender diversity in nursing through continuing education offerings, BSN orientation, social media, and radio appearances. The MNSN also promotes role modeling of men in the nursing profession by supporting the academic success of our student members and facilitates the leadership skills of our RN members in mentoring male nursing students and novice nurses. The purpose of the MNSN is to provide a framework for nurses as a group to meet, discuss, and influence factors which affect men as nurses.

References:

For more "Rebel Nursing Notes", click here: https://www.unlv.edu/nursing/notes