Where are the Men in Nursing?

1. Where are the Men in Nursing? Peter Kellett BN RN Academic Assistant/Practice Course Coordinator NESA -University of Lethbridge Memorial University of NL – Graduate Student

2. Proportion of Men in Nursing in Canada (CNA, 2005)

3. (CNA, 2005)

4. The Alberta Picture Alberta 2006: RNs Employed in Registered Nursing 2003 2006 Alta. Canada 23,964 25,881 25,881 252,948 __________________________________ Sex 2003 2006 Male 820 (4.0%) 1,032 (5.6%) Female 23,144 (96%) 24,849 (94.4%)

5. Contributing Factors to Low Numbers

6. Historical Influences • Men were involved in the care of the sick throughout documented history • Male slaves in ancient Greece • Roman soldiers on the battlefield • Middle Ages: military nursing orders • Knights of St. Lazarus • Knights Templars • Teutonic Knights • Non-military monastic orders • 1095 Brothers of St. Antony • 1629 Jesuit missionaries were the first men to provide care to the French Colonists and Aboriginal Peoples in Canada -72 yrs • (Bartfay, 2007; Brown, Nolan, & Crawford, 2000; Evans, 2004)

7. 18th and early 19th century: men cared for male patients in English charity hospitals – particularly potentially violent patient populations such as those that may experience psychiatric disorders • Negative turn for men in mid- 19th century (Victorian Era) • Florence Nightingale – promoted nursing as a woman’s profession (felt men did not have the capacity to be nurses and promoted nursing as an extension of women’s domestic roles)  Reinforced the gender based power structure • Shift in perception of masculinity  emphasis on the avoidance of sensitivity, nurturing, and emotion. • Victorian society emphasized separation of gender and a clear division of labor between the sexes • Apprenticeship /residential model of nursing education presented a barrier for men This resulted in a significant decrease in men’s participation in nursing (Brown et al., 2000; Evans, 2004)

8. When self-regulation of British Nursing began in 1919  Men were restricted to a separate register (Evans, 2004). Persisted until mid- 1950s. • Men’s role in nursing was redirected from general nursing tasks to the care of the mentally ill (Evans) • Men frequently received less education and training  Society of Male registered Nurses formed in 1937 to address this (Evans)

9. Picture in Canada • In 1951 only 0.33% of all Canadian RNs were men and by 1966 this had only increased to 0.45% (Bartfay, 2007; Care, Gregory, English, & Venkatesh, 1996) • In 1961 only 25 of 170 Canadian nursing schools would accept men (Care et al.; Evans, 2004) • Canadian Military did not grant commissioned officer status to men until 1967 (Care et al.; Evans). • In 1969 the province of Quebec finally allowed men to be registered as nurses (Care et al.; Evans)

10. (Washington University School of Medicine, 2004)

11. Recruitment • Repeated calls to increase #s of Men in nursing since the early 20th century (Evans, 2004; Meadus & Twomey, 2007). • Attracting men to the profession has been suggested as one strategy to help address the global nursing shortage (Armstrong, 2002; Bartfay & Davis, 2001; Evans; Meadus, 2000; Meadus & Twomey, 2007; Sherrod, Sherrod, & Rasch, 2005; Tosh-Kennedy, 2007; Villeneuve, 1994) • Strong case to increase #s of men to reflect society’s cultural and gender diversity (Sullivan, 2000).

12. Factors Effecting Recruitment • Association of nursing as a female profession public perception • Men may not consider nursing a viable option because of perception that it will place their masculinity in question (Evans & Frank, 2003; Meadus, 2000) • Societal view that female professions are less important or a step down lack of support for the choice of nursing as a career (Evans & Frank; Williams, 2003). • Association with femininity  stereotype of homosexuality dissonance re choice (Bartfay, 2007; Evans, 2002, Meadus, Meadus & Twomey, 2007; Whittock & Leonard, 2003)

13. Supportive Factors to Recruitment • Opportunity to help people “a calling” • Salary • Job Security • Career Opportunities • Opportunity to travel • Presence of a nursing role model such as a family member (Bartfay, 2007; Kelly et al., 1996; Meadus, 2000; Meadus & Twomey, 2007, Villeneuve, 1994; Whittock & Leonard, 2003)

14. Place emphasis on supportive factors • Debunk stereotypes and myths about men in nursing • Increase the visibility of male nursing role models in the media (often popular media images are less than ideal) • Present nursing as a viable career option to young men in high school career counseling • Even popular nursing recruitment campaigns have some problems

16. Original Media Campaign by Oregon

17. Used by Georgia Nursing Consortium as a recruitment poster –”Are you Man Enough to be a Nurse?”

18. Australian Campaign promoting men in nursing

20. Retention • There is some anecdotal evidence to suggest that attrition among male nursing students is higher than that seen in women (Bartfay, 2007; Brady & Sherrod, 2003; Tosh-Kennedy, 2007; Villeneuve, 1994) • Not tracked by CNA or most nursing schools • Retention is significantly influenced by men’s experiences during their nursing education and practice

21. Experiences in Education and Practice Environments

22. Acceptance of Men in the Nursing Profession • Inconsistency regarding the acceptance of men in the profession • Range from outright support – to caution and criticism of men’s participation in the profession • Men may experience opposition or ridicule regarding their career choice from family or social network • Ontario study by Bartfay and Bartfay (2007) identified that men students felt there were perceived low levels of acceptance in their program, while female colleagues felt acceptance was high.

23. Gender-biased Practices in Nursing Education • Overt support for men on a policy level • Nursing textbooks frequently fail to acknowledge the role of men in the profession and use female identifiers e.g. “she” (Anthony, 2004; Brown et al., 2000; Evans, 2004; Keogh & O’Lynn, 2007; O’Lynn, 2004, 2007a) • One size fits all approach  promotes the idea of equality by fails to acknowledge potentially different learning and communication skills that diversity brings

24. Different Expectations • Men students frequently feel that there are different expectations on them and that they are under greater scrutiny due to minority status (Anthony, 2004; Evans, 1997; Kelly et al., 1996; Paterson et al.,1996) • Some report that peers expected them to be more assertive or display leadership qualities (Kelly et al., 1996) • Men are often expected to take on physical roles (e.g. heavy lifting, security or enforcer) – ambivalence (Evans; Kelly et al.) • Potentially undermines the perception of men as acceptable caregivers (Evans).

25. Gender-based Restrictions on Practice • Obstetrics & Gynecology is traditionally the most restricted practice area (Anthony, 2004; Morin et al., 1999; Okrainec, 1994) • Refusal by female clients to have men care for them – often precipitated by female instructors or colleagues (Paterson et al., 1996) Why? • Men viewed as a potential threat • Men’s touch is often sexualized (Evans, 2002) • Men may be considered less acceptable in OB/GYN because relationship with nurses is more intimate than with physicians (Morin et al.) • Greater comfort with older students, married, parents, those displaying professionalism, friendliness, and confidence (Morin et al.)

26. Cautious Caregiving & the Sexualization of Men Nurses’ Touch • In nursing, perception that effective caring requires demonstration of compassion and caring through touch – problematic for men • Danger that men’s touch will be misinterpreted as sexual misconduct (Anthony, 2004; Evans 2002; Keogh & Gleeson, 2006; Keogh & O’Lynn, 2007; O’Lynn, 2004, 2007a, 2007b; Paterson et al., 1996, Tillman, 2008) • Men nurses fear sexual allegations (Keogh & O’Lynn; O’Lynn, 2004). 45% of men nursing graduates between 1992 and 2002 report this fear (O’Lynn, 2007b) • Not limited to the care of women. Because of the stereotype that men nurses are homosexual there are also challenges caring for men and children (false association of homosexuality with sexual predation and pedophilia (Evans, 2002) • Implication that men’s touch is allways potentially sexual in nature (Evans, 2002)

27. Cautious Caregiving & the Sexualization of Men Nurses’ Touch • Little if any instruction regarding the appropriate use of touch in nursing education. O’Lynn (2007b) in a survey of 111 men nurses noted that 69% of graduates between 1992 and 2002 had received no instruction on the appropriate use of touch. • Men nursing students often report that female instructors do not always understand the challenges that they are having with touch (Paterson et al., 1996)

28. Influence on Men’s Practice Area • Men often select certain practice specialties including: • Psychiatry • Anesthesiology • Critical/Intensive care • Emergency care (Evans, 1997) • Frequently cited as an example of men’s relative advantage, but may be a result of challenges with touch and intimate care. These specialties often associated with high tech, low touch (Evan, 1997)

29. Social Isolation • Men nurses and students sometimes express feelings of loneliness and social isolation (Kelly et al., 1996) • Social exclusion such as not being invited to some student social events (O’Lynn, 2007) • Few male colleagues and teaching faculty in many cases (O’Lynn, 2007)

30. Questions ?