Aim. The aim of this study was to determine what female and male undergraduate nursing students think of males in nursing.Method and material. Senior nursing students (n=90) at an undergraduate program in School of Health located in the Northwestern Region of Turkey were included in the study. A questionnaire was used for data collection which received a response rate of 97 %.Results. Close to half of the female nursing students (45.3 %) want to see males as staff nurses while most of the male nursing students wanted to occupy administrative or administrative/instructor positions after graduation. Female and male students’ perceptions about effects of males on image and status of nursing (p
Career, gender, nursing
The nursing community aims to increase the number of male nursing students and practicing male nurses lately. Current research has examined perceptions of male students about their nursing program experiences (Okrainec, 1994), the personality characteristics of male students (Baker, 2001), where should males be working after graduation (Karadakovan, 1993; Yavuz & Dramali, 1997; Senses et al. 2001).While there is a growing body of literature on men in nursing, research has failed to question gender differences between opinions of female and male nursing students on where men should be in nursing career and what they will add to nursing profession.
Many female dominant positions, including nursing, have failed to attract male recruits. This can be attributed to in part of issues such as status and pay, but it is also result of the gender role stereotyping of the profession. Thus; it has become identified as a profession deeply embedded in the gender based power relations of society (Cash 1997, Meadus 2000). Although number of males in nursing is increasing recently, feminization of nursing is still an important issue (Davies 1998, Harloyd et al. 2002). Men’s position in taking care of patients and being in health care industry all around the world is not new and goes far back to medieval times and there is recorded evidence of males’ skill and care (Girard, 1997).
Florence Nightingale considered nursing as a suitable job for women because it was an extension of their domestic roles. Nightingale’s image of nurse as a subordinate, nurturing, domestic, humble, self sacrificing as well as not too educated became prevalent in society. The social construction of what it means to be a nurse has typically meant a caring, hard working woman. Roles like nurturing, caring, dependency, submission given to her are opposite from the ones that are attributed to men in society (Evans 1997). Over all, men who enter nursing typically face questions about their masculinity or sexuality (Streubert 1994). Sociologists describe the sex role socialization as “instrumental” for men and “expressive” for women. The characteristics of instrumental socialization include the ability to compete, aggressiveness and ability to lead and to wield a power to accomplish tasks. Expressive socialization includes learning to nurture, to be affiliative and to be sensitive to needs of others (Strasen 1992).
In patriarchical cultures the value given to women and her place in society is naturally reflected to the nursing profession.This also presents particular problems to the image of nursing as a career (Girard 2003, Muldoon& Reilly 2003, Yagmur & Ozerdogan 2001). Although, negative image is not anything new to nurses and they have battled a negative image since the profession began, several writers believe that women came a long way by themselves in the last century without any help from men (Evans 1997).
It is widely accepted that Modern Turkish Nursing had started with the practice of Florence Nightingale during Crimean War (1854-1856) between Ottoman and Russian armies. Therefore, Turkish nursing education was greatly influenced by Florence Nightingale’s practice and ideas. Nightingale established schools that did not mix male and female students. This tradition in many countries persisted into the 20th century (Donahue, 1996), as well as in Turkey. Most of the nurses who work in health care settings in Turkey are female today. The first nursing education in Turkey started in 1911. Volunteer Muslim Turkish women got certified after 6 month courses in patient care. During Balkan War (1912) and Dardanelle War (1915-1916) these certified women took care of ill and wounded soldiers. Since the establishment of the first nursing school in Turkey in 1920, the development of professional education of nurses has been greatly influenced by the political situation in the country. In 1925, a diploma program in nursing was established and at the beginning the length of these diploma programs was 2 years. In 1936 these diploma programs were converted to schools that offered nursing education after 8 years of primary school education. Nursing education was given for years at high schools and graduates of these schools used to receive diplomas as nurses and practice nursing in health care settings. During 1955s university based first nursing program was introduced in Turkey. In 1985 associate degree nursing programs were introduced. Schools that had been providing nursing education in high schools and associate degree programs were abolished and length of nursing education was increased to four years at college level in 1996. Currently, there are 13 Nursing Colleges and 72 Schools of Health providing the same nursing programs and graduates of these schools receive BS degrees in nursing.
Turkish word for nurse is “hemsire” in Turkish language, which has two meanings such as “sister” and “woman who gives care to sick people” (TDK, 2001). This word evokes both a female gender and a profession. The Turkish Nursing Law which was issued back in 1954’s describes nursing as a profession which only can be performed by Turkish women (www. türk hemsireler dernegi.org.tr). However, 100 male students have graduated from nursing programs in Turkey who received official titles as nurses (Erdil, 2001).
On other hand, males have received nursing education for years in Turkey under different titles as well. They were named differently because in Turkey’s traditional structure it was hard to find a name for males who actually receive nursing education. The aim of this practice was to provide primary health services (actually provide nursing care) to individuals by males all over the Turkey. Since infrastructure was not adequate right after declaration of Republic of Turkey, it was thought that females would not be able carry health services to peripheral settlements. While nursing education has gone through tremendous changes over the years, some of the schools in Turkey (Schools of Health) started to offer nursing education to male students at the universities in separate departments and these programs were named as health officer programs. Recently there is a regulation issued in May 2007 in Turkey, all of the nursing and health officer programs named under “nursing program”. However especially male nurses who entered health officer programs continue their education under same program and titles they will receive is going to be as “health officer”.
Although numbers of males in nursing are increasing significantly, having different names for the same position is a source of confusion among students and the society (Bayik et al., 2002). This practice endangers nursing as a profession and causes role tension among male students who actually receive nursing education.
This study aimed to determine the following issues:
1. To determine if male and female nursing students have different opinions of what professional roles male versus female nurses should occupy.
2. To determine whether gender effects the career aspirations of the nursing students.
Design and Sample
This study was designed as a pilot study to identify gender differences perceived by female and male nursing students about “men in nursing”. Senior undergraduate students from nursing and health officer departments (n=90) at the Uludag University School of Health were included. Data were collected during May 2004. Since two questionnaires were not completed properly 88 questionnaires were analyzed. Response rate of this study was 97 %.
Instrument and Data Collection
For data collection a questionnaire was developed by authors which was contained three sections. The first part of the questionnaire included socio demographic data, second part of the questionnaire included questions about perceptions of both female and male students about position of males in nursing career while questions regarding effects of recruiting males to nursing career were included in the third part. The questionnaire was prepared in light of the relevant literature.
Data were analyzed by using statistical software (SPSS for Windows version 11.0). Frequency distributions and percentages were used for quantitative analysis of the demographic data. Chi-square test was used to determine differences between variables. Findings were accepted as statistically significant at a P value < 0.05.
The authors obtained permission from School of Health Directorate for this study. All the students received an explanation about the study before introduction of the questionnaire and only those who agreed to participate included. Students’ names were not sought in the questionnaires and their confidentiality was respected.
Demographic variables of the 4th year students were as fallows: 60.2 % of the students were females (n=53) while the rest of them were males (n=35). More than half of the (56.8 %) students’ ages ranged between 20–22 years (mean=21).
Students’ perceptions about effects of males in nursing
Female nursing students agreed on that, by recruiting males in to nursing profession; the quality of patient care will increase (31%) and negative perceptions of health care team about nursing will decrease (7 %). On the other hand, male students think that men will improve quality of patient care because of their physical power (47.8 %) and men will also improve negative perceptions of health care teams about nursing (30.4%) (Only 52 students answered this question).
Work places and positions seen fit for males after graduation by both genders
More than half of the female students and close to half of the male students prefer working as instructors in nursing schools after graduation. Hospital wards were secondly preferred places to work by both genders in this study. Statistically no differences were found in working place preferences of students after graduation according to their genders (p>0.05).
Both female and male students consider intensive care units (ICU), operating rooms and emergency departments as proper places for men to work. There were significant differences between both genders’ perceptions about males positions in work places after graduation (p<0.001).While 45.3 % (n=24) of the female students consider males as staff nurses, most of the male students wanted to occupy administrative (34.3%, n=12) or administrative/instructor positions (28.6%, n=10) after graduation. Both female and male students’ expectations about where males should be in nursing were given in Table 1.
Students’ perceptions about effects of males on image and status of nursing
Both genders consider nursing as a profession which has negative image in the public (80%).
Statistically significant differences were found between perceptions of female and male students about effects of males on image (X2 =11.26, p<0.01) and status (X2 =14.35, p<0.01) of nursing. Less than half of the male students 48.6 %( n=17) reported that nursing should be only a female profession, where majority of female students disagree. There were statistically significant results between the opinions of two genders (X2 =22.10, p<0.001). Distribution of the student opinions about effects of males on the image and status of nursing were given in Table 2.
This study indicated that ICU, operating room and emergency departments were seen as proper places for males to work after graduation by both genders. On the other hand maternity and pediatric clinics were not seen as fit places for males to work. It is hard for the male nurse to be in a role that was traditionally perceived as a female role which brings up a role tension. Therefore, male nurses prefer to work in places like emergency departments, intensive care units and psychiatry where they can feel more accepted by other health care workers (Yavuz & Dramali 1997). These findings are supported by Chung 2000, Evans 1997, Karadakovan 1993, Savaser et al. 1999, Senses et al. 2001, Squires 1995, Yavuz & Dramali 1997). The places males choose to work in hospitals are psychiatry which is identified with physical power, ICU and ER which are identified with technical skills and autonomy (Evans 1997).
In our study some of the male students (47.8 %) see physical power as solution for better patient care and 30.4% of the male students also reported that men will also improve negative perceptions of health care teams about nursing. Men are typically seen as better leaders than women (Ryan& Porter 1993, Williams 1995). Characteristics like dependency, nurturing always thought to be perfectly fit roles for women on the other hand characteristics like aggressiveness, dominant and ambitious look like a fit for men (Evans 1997, Evans 2002). In study of Harloyd et al. (2002), nursing students in China expressed that an ideal nurse posed moderately high levels of extraversion and assertiveness, traits which are stereotypic of males in China. Whilst there are difficulties for men working in female dominated professions, men who enter the nursing profession tend to have a faster and more straightforward career progression than is the case for women (Boyd & Hewlett 2001). Since the men are always in different and special groups in a patriarchical society, they are likely to enter in nursing profession to benefit from their minority but powerful position. However, it has always been thought that, males in nursing profession will gather a power and they will improve the status of nursing professions. It is always thought that men entering in nursing profession will make a difference and nursing profession will be improved (Eksen 1997, Karadakovan 1993, Oktay& Gurel 1986, Savaser 1993).
The results of our study show that male students mainly wanted to occupy administrative and administrative/ instructor positions after graduation. In contrast to this finding female students wanted to see males in staff nurse positions. According to these results, female students actually did not want males to occupy administrative positions. We were not able to find any studies that compare both genders perceptions about males in nursing. In the future wide spread of this practice risks of males being mostly in administrative and educative positions and females being employed mostly as staff nurses (Ryan & Porter,1993). In a study done by Karadakovan (1993) with Nursing College students, 3.25 % of the nursing students reported that men will work in areas that need physical power and they will help females earn the rights they deserve. In the same study 64.63 % of the students reported that men would help to improve the status of nursing, while some of the students (19.9 %) thought men would have no effect on status of nursing.
Turkey has a male dominant culture and nursing is primarily a female dominant profession which practiced by women and males who are practicing nursing are very few. Especially in Turkey, having two different names for the same position cause some problems both in public and among students in terms of professional identity. This may be the reason for male students to see nursing as a female profession and try to discriminate themselves from female nurses. In our study, male students have a role tension regarding nursing, because almost half of them (48.6%) saw nursing as a female profession. Cakmakci (2003) reported that 82 % of the male high school students did not prefer nursing as a career and they believed that nursing should only be a female profession. Hansen (2002) reported that females tended to disagree that males are better suited to nursing than women.
We also found statistically significant results between female and male students’ perceptions about effects of males on image and status of nursing. Although majority of the students had expectations that males will increase image and status of nursing, some of the students had the opinion that males either will not change anything in nursing image and status or they will affect negatively. The reason for this could be even men who choose nursing as a career have some questions about gender. Cultural values, lack of understanding what nurses really do at work and the way the nurses portrayed in media highly affect nursing image in the public. In a study done in Turkey, Emiroglu (2000) found that both doctors and public have negative image for nursing as a profession. Doctors see nurses as their handmaiden and therefore, negative image of nursing continues to be a problem.
Also it is apparent that fictional portrayals of nurses as being doctors’ handmaidens are reinforcing the traditional images of nurses (Greenwood, 1999).
The results of this study indicate that nursing continues to be seen as a female dominant position especially by male students despite the increasing numbers of men in nursing. Having physical power was seen as a reason for male students to occupy administrative positions. Masculinity and dominant characteristics of the male students’ possibly affect their desire to occupy administrative positions after graduation; further studies need to describe the reasons for males to choose nursing as a career and their positions in their work places after graduation.
Nursing profession should be provided the best candidates without any gender segregation for better nursing care. Nursing schools, media and professional journals should emphasize nursing roles and portray positive image of nursing profession as well as males in nursing. A community education campaign to improve the image of nursing profession should be initiated. School educators should encourage students to manage gender related problems by emphasizing nurse’s role identity without any gender segregation. There is also an urgent need in regulations on rights of nursing professionals and males in nursing. Clarifying the role identity of the graduates under different titles but same job content in Turkey will help both public and students to accept nursing as a career.
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