viewpoint how to avoid gender bias in nursing education€¦ · men are from mars: the chal-lenges...

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28 American Nurse Today Volume 14, Number 10 AmericanNurseToday.com AS A NURSE EDUCATOR who’s taught hundreds of stu- dents in classrooms, nursing skills labs, and clinical settings, I’m frequently reminded of my responsibility to help aspiring young professionals create healthy, resilient, well-balanced nursing identities. My own professional identity was framed largely by an exclu- sively female staff 20 years ago in a small hospital- based nursing program. Although I appreciated and respected their knowledge and clinical expertise, I recall many instances when a faculty member refer- enced my gender. Each of those interactions had a profound, additive effect on my budding nursing iden- tity. (See Watch what you say.) Of course, nurses of both genders can commiserate. After all, for many decades nursing was seen as one of a handful of occupations deemed socially—and per- haps biologically—appropriate for women, so many female colleagues can share gender-biased comments from high school advisors and teachers. But nursing can be a particularly challenging pro- fession for men. Questions from family and friends about the wisdom of nursing as a viable career choice may even include questioning their masculinity. I en- countered those questions from not only family and friends, but also instructors. Those questions and comments influenced my nursing identity and led me to more closely consider the roles we assign nurses based on gender. For example, obstetrics was by far the most difficult clinical rotation for me. I looked around the unit and noticed that other than physi- cians, I was the only man in sight. I questioned why it’s acceptable for men to act in the role of physician and not nurse in that clinical specialty. Was it rooted in a belief that men and women should serve within socially prescribed roles, with women as nurturers and men in more dominant leadership roles? Lessons learned Fast-forward 20 years into my role as a nurse educator. One of my primary objectives is to create learning ex- periences free from explicit—or implicit—gender bias that might discourage students from selecting any of nursing’s many disciplines. In other words, how can I do my part to create experiences where men don’t feel guided toward nursing’s technical, critical care, or cri- sis-oriented specialties, while only women pursue the “softer” disciplines like obstetrics and pediatrics? A teaching aid I frequently use to illustrate the com- plex concept of nursing identity is an old childhood game called KerPlunk. To set up the game, about 30 sticks are placed at various angles and depths through holes in a plastic cylinder and then marbles are dropped on top. The sticks form an intricate support network for the marbles. Players remove sticks one at a time until marbles come crashing down, resulting in the rest of the players calling “KerPlunk!” I’ve noticed that no two configurations of the sticks How to avoid gender bias in nursing education A simple game can teach valuable lessons. By David Foley, PhD, MSN, RN-BC, CNE, MPA HEALTHY NURSE VIEWPOINT

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Page 1: VIEWPOINT How to avoid gender bias in nursing education€¦ · Men are from Mars: The chal-lenges of communicating as a male nursing student. Nurse Educ Pract. 2018;33:102-6. O’Connor

28 American Nurse Today Volume 14, Number 10 AmericanNurseToday.com

AS A NURSE EDUCATOR who’s taught hundreds of stu-dents in classrooms, nursing skills labs, and clinical settings, I’m frequently reminded of my responsibility to help aspiring young professionals create healthy, resilient, well-balanced nursing identities. My own professional identity was framed largely by an exclu-sively female staff 20 years ago in a small hospital-based nursing program. Although I appreciated and

respected their knowledge and clinical expertise, I recall many instances when a faculty member refer-enced my gender. Each of those interactions had a profound, additive effect on my budding nursing iden-tity. (See Watch what you say.)

Of course, nurses of both genders can commiserate. After all, for many decades nursing was seen as one of

a handful of occupations deemed socially—and per-haps biologically—appropriate for women, so many female colleagues can share gender-biased comments from high school advisors and teachers.

But nursing can be a particularly challenging pro-fession for men. Questions from family and friends about the wisdom of nursing as a viable career choice may even include questioning their masculinity. I en-countered those questions from not only family and friends, but also instructors. Those questions and comments influenced my nursing identity and led me to more closely consider the roles we assign nurses based on gender. For example, obstetrics was by far the most difficult clinical rotation for me. I looked around the unit and noticed that other than physi-cians, I was the only man in sight. I questioned why it’s acceptable for men to act in the role of physician and not nurse in that clinical specialty. Was it rooted in a belief that men and women should serve within socially prescribed roles, with women as nurturers and men in more dominant leadership roles?

Lessons learned Fast-forward 20 years into my role as a nurse educator. One of my primary objectives is to create learning ex-periences free from explicit—or implicit—gender bias that might discourage students from selecting any of nursing’s many disciplines. In other words, how can I do my part to create experiences where men don’t feel guided toward nursing’s technical, critical care, or cri-sis-oriented specialties, while only women pursue the “softer” disciplines like obstetrics and pediatrics?

A teaching aid I frequently use to illustrate the com-plex concept of nursing identity is an old childhood game called KerPlunk. To set up the game, about 30 sticks are placed at various angles and depths through holes in a plastic cylinder and then marbles are dropped on top. The sticks form an intricate support network for the marbles. Players remove sticks one at a time until marbles come crashing down, resulting in the rest of the players calling “KerPlunk!”

I’ve noticed that no two configurations of the sticks

How to avoid gender bias in nursing education

A simple game can teach valuable lessons. By David Foley, PhD, MSN, RN-BC, CNE, MPA

HEALTHY NURSE VIEWPOINT

Page 2: VIEWPOINT How to avoid gender bias in nursing education€¦ · Men are from Mars: The chal-lenges of communicating as a male nursing student. Nurse Educ Pract. 2018;33:102-6. O’Connor

AmericanNurseToday.com October 2019 American Nurse Today 29

and marbles are ever quite the same, and as each stick is removed, the mass of marbles continually changes its configuration. Each stick represents a factor (gen-der, level of education, previous vocational experi-ences, religious background, social status, and individual formative experiences provided by nursing instructors, preceptors, and other authority figures) that makes up a nurse’s identity. Each comment made to a student may cause subtle—or significant—movement of the axes that comprise his or her budding nursing identity. In the case of many male students, the pressure to cre-ate a masculine identity within a historically female profession proves to be overwhelming, and they flee

for the operating room, emergency department, or in-tensive care unit.

In the classroom, I use an overhead camera focused inside the KerPlunk cylinder and projected on a screen for students to see. Then, to illustrate how gender bias can affect an individual nurse’s identity, I call out gen-der-biased comments as I manipulate the sticks so that a number of marbles come crashing down. “KerPlunk,” I tell the class. “Be careful what you say to peers, ori-entees, and the students you precept in the future. You can have a powerful influence over someone else’s nursing identity. Use it wisely.”

The game also illustrates the concept of in group/ out group, and how one group’s power can easily in-fluence another group’s (or individual’s) identity. In the case of nursing, because women are more than 90% of all practicing nurses—and an even higher percentage of nursing faculty—they’re in a position to create edu-cational practices that either maintain a self-perpetuat-ing paradigm or allow unfettered exploration into all aspects of nursing.

An enduring challenge A recent student told me that when he expressed a desire to pursue a career in one of nursing’s less tech-nical disciplines, he was actively discouraged with comments such as, “You’ll never be accepted,” “Why would you want to make your life so hard,” “What’s wrong with critical care? They will have openings and it pays more.” I was stunned to hear this story and re-alized that more work needs to be done. As the stu-dent shared his story, I could see the concern in his eyes. He was at a crossroads; he was wondering if he made the right decision to pursue a career in nurs-ing. Should he abandon his dream? The answer in his case was no. I networked with former graduates to find a man who had bravely pursued his nursing career in a less technical discipline and was thriving in his career.

Nursing students are taught by faculty who are most-ly white women, each of whom has her own views of gender diversity within the profession. They have pow-erful influence through verbal and nonverbal communi-cation. Assumptions about where male nurses should work (critical care, emergency services, operative servic-es, flight nursing, and administration) may be inadver-tently encouraged by instructors out of implicit bias. Each of these subspecialties offers men opportunities to work with technical equipment and to engage in res-cue, trauma, and leadership, traits in keeping with tradi-tional views of masculinity.

The perceptions about men who enter nursing seem to collide with social expectations that view women as subservient to men. The notion that traits like car-ing and nurturing are somehow innate to the female

Gender bias from nursing faculty can shape a student’s ca-reer. While in nursing school, I experienced many in-stances of gender bias.

• A seasoned faculty member pointed to me in front of the entire student body, asking me to offer an opinion on contraception, as if I was the sole representative of the world’s male population.

• Another instructor, acting as my advisor, asked me “Why are you here? You could be a fireman, policeman, doctor….”

• My nursing skills lab instructor once said, “Don’t worry, I know the classroom material is boring, but you’ll really love the lab…men are so good with equipment.”

• One day during my obstetrics clinicals, my instructor ac-tually told the entire clinical group, “Male students must be seated when holding a baby…that is, if we can find a patient who doesn’t mind you holding her baby. Until then, you [meaning me] just sit at the nurses’ station and look over these NCLEX questions.”

• My psych instructor said, “You’re a big guy, they’ll love you in the psych. You can be the bouncer. Go work there.”

Watch what you say

Page 3: VIEWPOINT How to avoid gender bias in nursing education€¦ · Men are from Mars: The chal-lenges of communicating as a male nursing student. Nurse Educ Pract. 2018;33:102-6. O’Connor

30 American Nurse Today Volume 14, Number 10 AmericanNurseToday.com

psyche perpetuates the tenacious, though fading myth that nursing is a career best suited for women. Re-cruiting additional men into the nursing profession through affirma-tive action may provide empower-ing role models who can encourage other male nursing students to ex-plore all the opportunities that nurs-ing has to offer.

However, so few male nursing faculty exist that ob-taining a sufficient critical mass to effect change seems currently out of reach. Analyzing the rigid social identi-ties within nursing schools and healthcare organizations provides opportunities for rich exploration, especially given the evolving fluidity of contemporary concepts of gender. Philosophical doors opened by dialogue about these concepts have provided new opportunities for men to enter the profession in increasing numbers, set-ting the stage for positive change.

Taking responsibility Nurse educators and preceptors must recognize the awesome responsibility they have in helping students and young professionals construct their nursing identi-ties. They must refrain from gender-biased language

and teaching practices that may discourage men—and women—from embracing a career within any of nursing’s specialties. Engag-ing in frequent, reflective practice and dialogue with students can help uncover gender-biased com-ments that may have negatively impacted them. Open, honest com-munication and thoughtful guid-

ance will avoid cries of “KerPlunk” as we strive for eq-uity within the profession. David Foley is the dean and associate professor of nursing at Notre Dame College in Cleveland, Ohio. Selected references American Association for Men in Nursing. aamn.org

Bohanon M. Men in nursing: A crucial profession continues to lack gender diversity. Insight into Diversity. January 8, 2019. insightintodi-versity.com/men-in-nursing-a-crucial-profession-continues-to-lack-gen-der-diversity

Christensen M, Welch A, Barr J. (2018). Men are from Mars: The chal-lenges of communicating as a male nursing student. Nurse Educ Pract. 2018;33:102-6.

O’Connor T. (2015). Men choosing nursing: Negotiating a masculine identity in a feminine world. J Mens Stud. 2015;23(2):194-211.

Assumptions about where male nurses

should work may be inadvertently

encouraged by instructors out of

implicit bias.