Chris Edwards BS, BSN, RN University of Texas Medical Branch at Galveston

A Critical Ethnographic Study of the Perceptions of Men in Nursing about Gender Influences on Their Career Paths: Preliminary Findings Chris Edwards BS, BSN, RN University of Texas Medical Branch at Galveston Graduate School of Biomedical Sciences credward@utmb.edu

Problem • Nursing shortage affecting patient care (Beurhaus, 2008; IOM, 2004) • Increase number of men in nursing (Eveloff, 2003) • Men in nursing represent <6% of the 2.9 million nurses (NINR, 2007) • Males more likely to leave nursing (Sochalski, 2002) • Gender specific challenges (Bernard Hodes Group, 2005; Evans, 2004; O’Lynn, 2004, 2007)

Purpose • Explore and describe the perceptions of men in nursing about gender influences on their career paths

Research Questions • What influenced the decision of men in nursing to pursue nursing as a career? • What are the perceptions of men in nursing regarding the effects of their gender on their nursing educational experience? • What are the perceptions of men in nursing regarding the effects of their gender on their professional experiences? • What do men in nursing believe would increase male participation in nursing?

Literature Review • Themes • Historical changes affecting the experiences of men in nursing • Recruitment and retention of men in nursing • Challenges after deciding to pursue nursing as a career • Role strain • Gaps • Rationale for career paths of men in nursing • Gender specific challenges affects on men in nursing • Subjective understanding of the role strain men in nursing experience

Sensitizing Orientation • Male Sex Role Identity (MSRI) and Sex Role Strain (SRS) paradigms (Pleck, 1981) • Gender roles defined by gender role norms and gender role stereotypes. • Simple or unitary bipolar vs. androgynous or dual-polar characteristics (opposite vs. separate) • Gender roles are contradictory and inconsistent causing violations and gender role strain. • Role strain experienced as shame, anxiety, depression, or experience of social condemnation. • Overcompensate by overexaggerating gender characteristics in order to adjust

Methods • Design: Critical Ethnography (Thomas, 1993) • Explores non-quantifiable features of social life and social inequalities in order to influence positive social change (Thomas, 1993; Carspecken, 1996) • Asks what could be for a group (Thomas, 1993) • Opens people’s minds by challenging perceptions and offering different viewpoints (Carspecken, 1996) • Studies exploring cultural schema in various situations can focus on interviews. (Carspecken, 1996)

Methods Cont. • Sampling Procedures • Inclusion criteria • Convenience, snowball, & purposive sampling • Allows for maximum variability in age, ethnicity, education, years in practice, and practice settings • Setting • Medical centers in the Southern Texas • Interviews at setting outside the hospital

Methods Cont. • Data collection • Demographic questionnaire • Semi-structured, face-to-face interviews • “Tell me about how people responded when you told them you wanted to be a nurse” and “Tell me what it has been like being a man in nursing” • Follow-up interviews • Journals – primary record and field journal • Data saturation or informational redundancy (Burns & Grove, 2005; Spradley, 1979)

Methods Cont. • Data analysis • Thematic analysis using Carpsecken’s 6 steps for critical ethnography (1996) • Read transcripts • Develop preliminary codes • Develop subcodes for similar phenomena • Review data for recurring codes and subcodes • Move from low-level, concrete codes to higher-level, abstract codes • Provide instances to support codes

Methods Cont. • Trustworthiness • Credibility - data saturation, member checks, & peer debriefers • Fittingness - sampling methods to ensure maximum variability of respondents and experiences; follow-up interviews • Auditability - decision or audit trail through preliminary and field journals (Lincoln & Guba, 1985; Beck, 1993; Denzin, 1978;Janesick, 2003; Thomas, 1993; Carspecken, 1996)

Results • Sample • N = 9 male nurses • Age: 25-52 • Experience: 3-29 years • Ethnicity: Caucasian (6), Hispanic, African American, Asian • Education: Assoc. (3), Baccalaureate (6) • Nursing as first career: yes (4), no (5) • Employment areas: ER, ICU, Intermediate Care, Med-Surg, & dialysis • Role: staff RN (4); charge RN (5)

RQ 1: What influenced the decision of men in nursing to pursue nursing as a career? 1. Pros of pursuing a nursing career • Nursing as a calling • “I don’t know of any particular person or event or anything, that I can recall that was actually something that led to this other than I always felt like this was a calling, that this was something I was supposed to do.” (P5) • Being of Service • “I liked the idea that I might be able to help out. And the fact that, you’re in a hospital and it might be my third day there and my fifth year as a nurse but, it might be your first day, your first time in a hospital or, you know, the first time that you’ve ever been this sick. And you’re tired and you wanna go home. They’re still stuck there, so I try and give ‘em a little sense of, I don’t know, a little piece of home, a little normal sense, a little sense of humor, a little something to brighten up their day….” (P7)

RQ 1 Cont. 1. Pros of pursuing a nursing career cont. • Exposure to healthcare providers or illness • “Actually [wanting to be a nurse] started when I was about eleven years old. I had a uh uncle that was sick, uh he had diabetes real bad and um, he had just become debilitated, and so, we didn’t want to put him in any nursing home or something like that, so we just took him home and we took care of him. And uh, both of my parents were older, so basically, they showed me how to do it.”(p7) • Job opportunities • “the job market looked really good and it, it always has for nurses.” (P8) • “the money part of it was good”(p2) • “a good platform to go anywhere” (P1)

RQ 1 Cont. 2. Cons of pursuing nursing • Negative responses from people • “[friends] call you a murse or uh, you know, make several jokes” (P1) • Encountering stereotypes • “wearing the little white hats, and the dress and whatever.” (P2) • “you’re going to be doing a lot of wiping butt” (P2) • “you wanted to go to med school one day” (P4) • “if you was a guy going into nursing you was gay” (P3) • “I’m already gay and they will find out I’m gay.” (P9) • Lack of exposure to male nurses • “when I was growing up, I never heard of males being nurses.” (P4) • Media influences • “Of course we got a lot [of jokes] about the uh, you know about the Meet the Fockers kind of thing” (P3)

RQ 2: What are the perceptions of men in nursing regarding the effects of their gender on their nursing educational experience? 1. Pros of nursing school • Nursing as a calling • “[My rotations in a nursing home] really nailed down that I picked the right field because I was just as upset on my last that I was on my first day…. These people go back to the same position I just got ‘em in, you know a few weeks before hand, so it almost crushed me as much as the first day as it was the last day because then I realized, you know, it’s still affecting me.” (P4) • Positive responses from people • I could remember faculty sayin’ something to the effect that, you know, that, you’re gonna do good, you’re gonna go up. The guys, there’s such a need for guys in nursing.” (P7) • The challenge • “[In nursing school] there’s so much information to learn, to know, and so challenging.” (P9)

RQ 2 Cont. 2.Cons of nursing school • Negative responses from people • “I think uh, that there were some instructors who felt like, males coming into nursing was a threat to them, and so they treated us a little bit, uh, harsher, especially in clinical.”(p4) • “[Instructors] would ignore all the guys in the class and just say well you women know about this.” (P6) • “I was [in L&D] for like two days and nobody said a word to me the whole time” (P7) • Encountering stereotypes • “I think [instructors] were trying to tell me something… this is a female dominated business. Just wanted to make sure I understood that…. I know that's what I got out of the situation.” (P8)

RQ 2 Cont. 3. Feelings from cons of nursing school • “I’ve experienced more, discrimination in nursing school, than I did when I became a nurse. ” (p4) • “Don’t emascualte me” (P6) • “No men [allowed] here” (P7) • “Disappointed” (P5) • “I was in uh, some trouble as far as the male female thing” (P8)

RQ 3: What are the perceptions of men in nursing regarding the effects of their gender on their professional experiences? 1. Pros of being a nurse • Being of service • “It’s very rewarding, um, just to know, that you’re taking care of people and um, enhancing their life in some way and actually making a difference.” (P7) • The challenge • “there’s a lot of toys and things and um, you know, devices, that require a lot more skill to operate. I think that’s why men area attracted to critical care.” (P4) • “Respect” • “I feel nurse is good because people trust you more that you’re not going to abuse or take, take uh, you’re going to give the best, compassionate care.” (P9) • “people have said that the males nurses was the best nurses they ever had.” (P5) • “I think [men in nursing] get a little more respect from, the doctors.” (p1)

RQ 3 Cont. 2. Cons of being a nurse • Different expectations • “Viewed as muscles” (P3) • “Expected to go into leadership positions” (P2) • “[taking care of both gendered patients] is okay for girls, female nurses and men, but the reverse of that, it's not always etched in stone so to speak.” (P9) • Stereotypes • “You can sometimes see it in [a young female patient’s] face, that they uh, they feel like maybe you’re, you know, looking at them sexually ” (P1) • “given heavier patient or the more agitated patient” (p4) • Patients “refuse to have a male nurse” (P1)

RQ 3 Cont. 3. Feelings from cons of being a nurse • “sometimes I feel a little abused” (P1) • “Frustrated” (P2) • “Less of a man” (P3) • “Singled out” (P4) • “You’re just that guy” (P4) • “Stigma of being a male” (P6, 7, & 9) • “Guard your emotions” (P8)

RQ 4: What do male nurses believe would increase male participation in nursing? • Change social image of men in nursing • Positive portrayal in the media • Advertisements focusing on pros of nursing for men • “I would tell them my experience.” (P7)

Summary • “there are pros and cons to being a man in nursing.” (P1) • “You’ve got to get comfortable with [being a man in nursing], cause this is what you’re gonna be doing, and you focus on that.” (P4) • Personal and social changes needed to increase the number of men in nursing

Limitations • Participants all presently working in critical or acute care areas • Participants have chosen to stay in nursing • Nine participants • Metropolitan area

Implications to Nursing • Better understanding of the experiences of men in nursing • Lead to research exploring the attrition of men in nursing and nursing schools • Modifying recruitment of men into nursing

Questions or comments?credward@utmb.edu

Chris Edwards BS, BSN, RN University of Texas Medical Branch at Galveston