Men nurses in Atlantic Canada: career choice, barriers, and satisfaction.
Military, religious, and lay orders of men have a long history of caring for the sick and injured during the Crusades in the 11th century (MacPhail, 1996). Despite the fact that men historically have played important caregiver roles in organized nursing, today nursing is still perceived to be a sex-role occupation exclusive to females. This perception of nursing continues to be influenced by the attitudes and beliefs about occupations appropriate for men and women that are well documented in the literature and perpetuated by the media. Traditional images of the nurse were influenced by female attributes and values engrained by Nightingale, and reinforced by media perpetuate nursing as a "feminine" profession. This attitude creates a cycle of bias that limits the role of men in nursing (Meadus, 2000; Strong, 2004). A related perception affecting the numbers of men in the profession is the value of nursing in society. Historically, nursing is considered to be a natural extension of women's role in society, and as a result, nursing as a profession is considered to be of low economic status and devalued in comparison with male occupations (Meadus, 2000).
Men who choose nursing as a career choice challenge contemporary notions of gender and masculinity (Brown, 2009). In the nursing literature and media, sex stereotypes are seen as a major deterrent to men entering nursing (Twomey & Meadus, 2008; Weaver, Ferguson, Wilbourn, & Salamonson, 2013). A common stereotype concerning men who choose nursing as a career is the perception that they are gay (Jinks & Bradley, 2004). It can be argued that there has been little change in societal attitudes toward female nursing stereotypes. In a quantitative study undertaken by the authors of this study, sexual stereotypes and gender biases were reported as key barriers inhibiting men from choosing nursing as a career (Meadus & Twomey, 2007).
Related factors identified such as gender bias in the workplace and in nursing education impede retention and recruitment of men into the profession (Kouta & Kaite, 2011; Meadus & Twomey, 2011). Because of their gender, men may be asked to do such tasks that require "muscle" such as moving heavy patients or restraining clients (Meadus & Twomey, 2011; Rajacich, Kane, Williston, & Cameron, 2013). According to Burtt (1998), men in nursing are entering a profession dominated by women and may face constraints that women have historically faced in entering workplaces dominated by men. It is believed that because of professional prejudice, obstetrical nursing as a specialty has few male RNs choosing to work or being hired in that area. McRae (2003) reported that clinical nurse specialists and nurse educators in academia had more negative perceptions of men working in this field of nursing. Further research is needed to address the discrimination against men in nursing.
There has been limited discussion in the literature as to whether patients prefer female or male nurses. Chur-Hansen (2002) used a questionnaire to identify the preferences for women and men nurses by patients in four clinical situations. Her findings were consistent with her previous research (1984) that the degree of intimacy in a clinical situation was found to be predictive of same-gender preferences. Further research is recommended in this area to understand patients' preferences and attitudes regarding the gender of their nurse (Chur-Hansen).
Over the years, several authors have identified initiatives necessary to recruit men to the nursing profession. As nursing naturally maintains and reflects society's sex stereotypes, many researchers recommend that recruitment strategies attack both the myths and barriers (Meadus & Twomey, 2007, 2011; Rajacich et ah, 2013; Whittock & Leonard, 2003). Several examples of campaigns, particularly within the United States to attract men to nursing, have been reported in the literature. In the United States, a national "Discover Nursing" advertising campaign launched by Johnson and Johnson features male nurses in television commercials and on the Internet (Groeller, 2002). Another campaign that targeted nursing as a career choice for men, undertaken by the Oregon Center for Nursing (2003), used a poster titled "Are You Man Enough to Be a Nurse." In response to the difficulties that men have encountered, the American Assembly for Men in Nursing (AAMN) was founded in 1971. The organization's goals were to recruit more men to the profession, to provide support to those men who are RNs, and to increase the visibility of men in nursing (AAMN, 2015). In 2011, this organization launched a campaign titled "20 x 20" to encourage males to enter the profession and increase enrollment in nursing programs to 20% by the year 2020 (AAMN, 2011). In the United States, several Schools of Nursing have actively campaigned to recruit and retain men in nursing. However, in Canada, many schools of nursing have not made a formalized effort in recruitment of men within the profession.
It has been reported that men who enter nursing tend not to stay in the profession. Factors such as work setting, job stress, pay, promotional opportunities, and involvement in patient care had been identified as key determinants in job and career satisfaction for nurses (Andrews, Stewart, Morgan, & D'Arcy, 2012; Coomber & Barriball, 2007; Toh, Ang, & Devi, 2012). In an integrative review of the literature, Flinkman, Leino-Kilpi, and Salantera (2010) found that male nurses tend to leave the profession in comparison with female nurses. A similar finding is that male nurses within the first 4 years following graduation are leaving the profession approximately 4 times more frequently than female nurses. Men in comparison with women reported less satisfaction with nursing regardless of their clinical setting or position (Sochalski, 2002). Rajapaksa and Rothstein (2009) in a national sample survey of RNs found that men nurses left the profession due to their perceptions of the low financial rewards aligned with nursing. In a Canadian cross-sectional correlational study of male RNs, Rajacich et al. (2014) examined work-related factors and their influence on job satisfaction and intention to stay in the profession. Nurses who were most satisfied were influenced by career extrinsic factors (pay, vacation, and benefits), control and responsibility, and professional development opportunities. Nurses who were least satisfied and intended to leave experienced gender mistreatment worked part-time and were dissatisfied with extrinsic rewards. The study of satisfaction with a nursing career has had less attention than work satisfaction. However, most of the research has not investigated specific factors related to career satisfaction and reasons for recommending nursing for men nurses to others as a career option. Using a survey design, Twomey and Meadus (2008) found that 93% of men in Newfoundland and Labrador were satisfied with nursing career choice and would recommend nursing to others.
In summary, despite an abundance of literature related to the topic of men in nursing, little addresses knowledge about reasons why men choose nursing, the barriers experienced in practice, and information about factors that affect career path and satisfaction within the Canadian context specifically. In the absence of this knowledge, recruitment and retention barriers to men's full participation in the profession remain invisible and unaddressed in policy. With men being a minority and many leaving the profession, it is imperative that greater efforts are undertaken to understand this phenomenon, and strategies are needed for recruitment and retention of men. A body of literature has been developed on factors related to reasons for choosing nursing as a career option. The authors who have specifically investigated men nurses have found that salary, security, career opportunities, and the opportunity to work with people attract them to the profession (Boughn, 2001; Meadus & Twomey, 2007).
The present study was conducted to examine the following research objectives: (a) to examine why men chose nursing as an occupation, (b) to assess barriers men experienced when they selected nursing as a career choice, (c) to identify strategies to improve recruitment of men into nursing, and (d) to assess career satisfaction and reasons for recommending nursing to others as a career option.
During this research study, the necessary steps were taken to ensure that the rights of all subjects were recognized and protected. Ethical approval was granted by the Human Investigation Committee, Memorial University of Newfoundland. The package sent to nurses included an informed consent letter, the questionnaire, and a postage-paid return envelope. Completing the survey was taken as anonymous consent to participate in the study. Data were kept in a locked cabinet and accessible only to the researchers.
Design and Sample
Using a descriptive design, this research investigated why (n = 240) men choose nursing as an occupation, assessed barriers they experienced in practice, their career satisfaction and career path. All men nurses in the provinces of Newfoundland and Labrador, Nova Scotia, New Brunswick, and Prince Edward Island were eligible to participate in the study. A convenience and snowball sampling was utilized. Addresses of nurses were obtained from their professional association.
Data were collected using a questionnaire developed by the researchers. Questions related to career choices and barriers were partially based on findings from a qualitative research report prepared by the Canadian Nurses Association (CNA; 2003) on men in nursing. In reference to this report and the existing literature, a draft questionnaire was developed. In 2004, the questionnaire was pilot tested for face and content validity. Two nurses and two nursing students completed the survey, and some adjustments were made to increase item clarity and readability. The final questionnaire contains both open- and closed-ended questions to measure the importance men in nursing place on factors contributing to their choice of nursing as a career, the barriers they experience in practice, suggestions for recruitment, and satisfaction with career choice. At the end of each section, a space was left blank for anonymous respondents to add comments related to their practice. The survey included four sections: (a) demographic data, (b) reasons for entering the nursing profession, (c) perceived barriers experienced by men in nursing, and (d) open-ended questions related to recruitment strategies, satisfaction with career choice, and career recommendations. Reliability testing of the instrument indicated Cronbach's alpha of .73 for the Total scale, .63 for the subscale measuring the reasons for career choices, and .81 for the Barriers subscale. With this population, internal consistency levels suggest that the scale and subscales adequately measure the constructs.
Data were analyzed using the Statistical Package for Social Sciences (SPSS) software program. Indices of central tendency were calculated, and where appropriate, depending on the level of data, tests of difference were computed. Alpha was set at p < .05.
Two hundred thirty-nine questionnaires were returned to the researchers from an accessible population of 648. Problems were encountered accessing the nurses' information in the provinces of Nova Scotia and Prince Edward Island (see Table 1). The mean age of the sample was 42.9 years, with a range of 23 to 70. Respondents had been practicing as a nurse for 1 to 51 years with a mean of 16 years. Nurses had been in the same position for an average of 7.2 years. Eighty-five percent were employed full-time, 7.6% were employed part-time, 4.6% worked in casual positions, and only 0.4% were unemployed. The majority of the sample, 29%, were diploma-prepared RNs, 28.6% had a bachelor's degree, 19.4% had a post-RN diploma, 35.5% had a bachelor of nursing (BN), 12% had completed a post-RN specialty course, and 3.4% had graduate degrees. The majority of nurses worked in a medical/surgical practice setting, with 20% identifying other as their area of practice. The remaining categories were a fairly even distribution with administration leading the group with 5%. Sixty-six percent worked in the Eastern Health Authority, which is the largest health care region and the most populated geographical area in Newfoundland and Labrador.
The most common reasons for entering the nursing profession were helping people, job security, challenging profession, career opportunities, caring personality, and making a contribution to society in descending order (see Table 2).
Other reasons that were reported as important were the opportunity to travel and having a family member in the profession. Reasons not included in the questionnaire and identified by the nurses were to be involved in a caring profession, wanting a professional career, and feeling it was a calling.
Table 3 depicts the nurses' level of satisfaction with their career choice. Eighty-eight percent were satisfied or very satisfied. Degree of satisfaction is also reflected in the qualitative comments added by individual participants.
* "I get a satisfaction with the rapport I have with the patients and families that I can make a difference in their lives."
* "The idea that maybe what I'm doing matters, perhaps I am helping and making a difference. Aspect of caring; knowing you are helping others."
* "Hearing a thank you and seeing your clients more comfortable as a result of my caring."
* "Sense of pride and satisfaction knowing you are helping people on a day-to-day basis."
* "Nursing has been a fulfilling career for me; salary has improved greatly; greater job security; greater mobility."
* "Satisfying, intellectually and spirituality, challenging and rewarding; work with intelligent co-workers with high degree of ethics."
* "It's a challenging but rewarding profession. You will be both physically and mentally pushed to your limits. You will smile every day at work."
The most commonly perceived barriers to being a male in a female-concentrated profession in descending order are being seen as muscle, a female-oriented profession, inadequate recruitment, sexual stereotypes, few male nurses portrayed in the media, and lack of recruitment strategies (see Table 4).
Further analysis was completed on the results. The respondents were grouped by age, levels of education, and practice roles. At alpha p < .05, there were no significant differences between age groups, levels of education, or practice roles in terms of reasons for career choices or barriers experienced.
Findings from this study are important at this stage in the development of nursing as a profession. Despite the repeated call for greater diversity in nursing, the untapped resource, men, has and continues to be overlooked during recruitment. Some major points to consider when planning recruitment of students in the future and assessing barriers that men may face in nursing are highlighted in this article. Each conclusion is followed by a recommendation from the researchers:
1. Regardless of age, educational background, and practice role, men in nursing concurred the main reasons they chose nursing as a career were helping people, job security, career opportunities, salary, and the opportunity to travel. These findings have been reported by other researchers (Boughn, 2001 ; Meadus & Twomey, 2007; Rajacich et ah, 2014). To recruit more men into the profession, it is recommended that these results be incorporated into recruiting advertisements, career fairs, and promotional material designed to influence men's choice to enter nursing.
2. Other reasons for choosing nursing as a career identified by this sample were attraction to the social image of the profession, belief that the job would be rewarding, and congruence of a caring personality with their perceptions of being a nurse. As indicated above, these concepts need to be addressed during recruitment activities. It is recommended that future research include further investigation of these constructs.
3. The top barrier was being seen as muscle, and men felt that they were always asked to do the heavy work. Strength was the reason men felt that they were being used in the clinical setting. This particular finding has been stated as a challenge for men working in a female-concentrated profession (Meadus & Twomey, 2011; Rajacich et ah, 2014; Twomey & Meadus, 2008). There is a need within nursing practice and education to bring greater awareness regarding this barrier and the gender discrimination as reported by above-cited authors.
4. Despite the fact that men have been working in the profession for a number of years, sexual stereotypes continue to be a barrier in the clinical setting. Therefore, we have not been effective in dispelling the myth that nursing is not an appropriate career choice for men. The challenge for nursing organizations and nursing programs is to aid recruitment efforts by challenging the societal stereotypes of femininity and masculinity. As a result of a lack of recruitment efforts directed at the male population, it is recommended that specific initiatives be developed. For example, advertisements/promotional materials that portray nurses in ways that demonstrate competency, knowledge, and technical expertise without regard to gender should be developed to counter any stigma held by society (Sayman, 2010). Schools of Nursing should increase the visibility of men in nursing by seeking their participation in school career days and public health fairs. Such opportunities provide exposure to elementary to high school students and the general public, highlighting the diversity of a nursing career.
5. Another barrier to entering the nursing profession identified was the lack of male nurses portrayed in the media. We need to increase the visibility of men in the profession and promote nursing as a genderless career option. Strategies may include the representation of men in promotional materials, career fairs, and all forms of media. Another strategy would be the assignment of nursing students to men nurses in the clinical setting.
6. The final recommendations from this study relate to future research on men in nursing. The questionnaire used in this study should be refined and retested using a larger sample.
As with every research design, there are inherent limitations. The most obvious in a cross-sectional/survey design are types of biases and the sampling technique. Bias can result in an overestimation or underestimation of the construct of interest; in this study, there is no means to determine which effect has occurred. Volunteer or self-selection bias is a naturally occurring confounder that occurs when those who volunteer to participate in a study systematically differ from those who did not volunteer. Respondents have been practicing nursing for a mean of 13 years; this may lead to recall bias, where subjects do not remember the reason why they chose nursing as their career. In terms of the approach to sampling, self-report data may also lead to responding in a socially desired manner. This is also a limitation of using a convenience sample.
Despite the inherent and perceived barriers for males entering the nursing profession, study participants were satisfied with their career choice. Seventy-one percent would choose to become an RN again, and 81% reported that they would recommend the career option to a male friend. The RNs in this study choose nursing for altruistic reasons, job security, and career opportunities. Men also identified that they were drawn to the profession because of the challenges and responsibilities and the opportunity to care for others, and knowing that they were contributing to society. This study adds to our understanding that nursing still continues to be viewed as a gendered profession. Men who choose nursing are satisfied and have no hesitation in recommending nursing to others. Many countries are experiencing problems with critical shortage of nurses, and it is urgent that nursing organizations and Schools of Nursing take action on the gendered perceptions of nursing. To address the nursing shortages, strategies must be developed to recruit and retain men in nursing and provide opportunities to make the RN workforce more diverse. Such a change will benefit not only nursing but also the population at large. If nursing is serious in its desire to become more diverse its efforts to recruit men within the profession more dialogue and action are needed.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author(s) received financial support from the Memorial University Vice President's Research Grant--Social Sciences and Humanities Research Council/ Vice President's Research Grant Research Grant and the Atlantic Region--Canadian Association of Schools of Nursing Research Grant.
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June Creina Twomey is a graduate of the General Hospital School of Nursing, 1988, Memorial University of Newfoundland (Bachelor of Nursing, 1993, Master's of Nursing, 1996, PhD in Clinical Epidemiology, 2012). She has been employed by Memorial University for the past twelve ears and teaches in both the undergraduate and graduate programs. Dr. Twomey's research interests are in: Psychosocial Adaptation to Chronic Illness; Quality of Life; Psychometrics; Men in Nursing; Clinical Epidemiology and Community Health Assessment.
Robert Meadus is a faculty member and researcher who has been at Memorial University since 2000, teaching in both the undergraduate and graduate programs. He has experience in qualitative research methodologies and his area of research foci are families experiencing mental illness, adolescents coping with psychiatric illness and men in nursing. He has presented at provincial, national and international conferences.
June Creina Twomey (1) and Robert Meadus (1)
(1) Memorial University, St. John's, Newfoundland and Labrador, Canada
June Creina Twomey, School of Nursing, Memorial University, Prince Phillip Parkway, St. John's, NI, St. John's, Newfoundland and Labrador AIC 3V6, Canada.
Table 1. Province (n = 239). Province Frequency % Newfoundland and Labrador 69 28.9 Nova Scotia 58 24.3 New Brunswick 106 44.4 Prince Edward Island 6 2.5 Table 2. Reasons for Choosing Nursing (n = 239). Reason for choosing nursing (a) M SD Helping people 2.7 0.64 Job security 2.66 0.74 Challenging and responsible profession 2.51 0.80 Variety of career opportunities 2.49 0.83 Caring 2.39 0.84 Contribution to society 2.38 0.85 Note. Scale: 0 = not at all to 3 = very Important. (a) The scale was numbered from 0 to 3 indicating the level of importance to the subject. Table 3. Career Satisfaction Mean = 1.76 (Scale 1-5). % Very satisfied 46.0 Satisfied 41.8 Neutral 5.1 Dissatisfied 4.6 Very dissatisfied 2.5 Note. Scale: 1 = very satisfied to 5 = very dissatisfied. Table 4. Barriers to Men in Nursing Practice (n = 239). Barriers M SD Being seen as muscle 1.74 l.l Female-oriented profession 1.67 1.2 Inadequate recruitment 1.64 1.2 Sexual stereotypes 1.63 l.l Lack of exposure to male role models in the media 1.44 1.2 Female profession 1.42 1.2 Note. Scale: 0 = not at all to 3 = very important.
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|Author:||Twomey, June Creina; Meadus, Robert|
|Publication:||The Journal of Men's Studies|
|Date:||Mar 1, 2016|
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