Running head: IMPACT OF GENDER BIAS ON MALE NURSING STUDENTS 1

Impact of Gender Bias on Male Nursing Student’s Competence of Skills

Giovanni Bruno

Randall Gillum

Shereif Bynum

Youngstown State University

IMPACT OF GENDER BIAS ON MALE NURSING STUDENTS 2

Abstract

The purpose of this research paper is to share the effects of gender bias by a patient towards male

and female nursing students, and how it impacts the competency of skills learned in a women’s

health clinical rotation. This review examined several scholarly articles and cross-referenced

them to give an accurate depiction of the research to show the impact of gender bias on nursing

students. The research revealed that there is significant gender bias towards male nursing

students, when they have to provide intimate care to a female patient in a women’s health

clinical setting. There was a significant finding that showed that female patients seem to only

have this bias when it comes to certain aspects of intimate care and not technical care. There is a

need for more research on this topic and how it impacts patient care when a male nurse is

responsible for taking care of a female patient in the ‘real world’. Overall, when male and female

nursing students are in the same scenario in relation to giving a female patient intimate care,

most patients prefer a same-sex gender preference when it comes to the nurse that is providing

that care. However, this trend mostly pertains to the female patient population.
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Impact of Gender Bias on Male Nursing Students’ Competence of Skills

Gender bias is the unequal treatment in an employment opportunity due to attitudes based

on the sex of the employee. Male nursing students face this type of discrimination frequently

while trying to apply their hands on skills during a women’s health (OB, Maternity) clinical

rotation. When a female patient refuses care by a male nursing student based on gender alone,

the student does not have the same opportunity to learn and receive the hands on experience

compared to their female counterpart. Applying the skills and techniques learned in class to a

real world situation is how nursing students learn. When patients refuse care, male nursing

students do not develop their skills and cannot apply their knowledge in a real world scenario.

Therefore, the competency of skills related to a male nursing student are called in to question

while performing certain aspects of care. The research question proposed asked: Are male

nursing students who experience gender bias from patients during women’s health clinicals less

competent related to nursing skills than female nursing students?

Literature Review

Introduction

To have a better understanding of gender bias and its effects on male nursing students’

competence related to their skills in a women’s health clinical, information was retrieved from

ProQuest Nursing and MEDLINE databases. There was six reliable and significant sources to

pull information from to research this question. However, three studies were completed outside

of the United States and gender interactions among patients may be different amongst other

countries due to cultural norms. The following pages will contain various studies and

information regarding the impact of gender bias on male nursing students and their ability to

require the skills needed in a women’s health clinical rotation.

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Patient Preferences

Nursing is predominantly a female profession, which leaves males to be the minorities in

the field. However, over the past decade more males have been enrolling into schools of nursing.

Although more males are choosing nursing as a career, their clinical experience may be viewed

differently due to gender barriers in nursing practice. Because of social stereotypes in regards to

gender, male nursing students are often not given the same opportunities in their education

during clinical rotations as their female counterparts. Specifically in women’s health clinicals

(Maternity, OB), female patients often refuse care by male nursing students. Clinicals allow

students to apply their skills learned in theory and lab to ‘real world’ situations. When patients

refuse care by a nursing student, the student does not have the opportunity to practice. Therefore,

male nursing students become uncomfortable in performing those skills and it raises the question

if the nursing student is prepared to take care of a patient in a situation in which he was not

allowed to perform care. Most of the male nursing population works in a hospital (Black, 2017).

This causes great concern in regard to female patient care and patient outcomes, since most of

the inpatients in hospitals are of female gender, and the two most common diagnoses for

hospitalization in 2014 were pregnancy and neonatal (McDermott, Elixhauser, & Sun, 2017).

The following studies looked at multiple factors pertaining to gender bias and its impact

on nursing students like lack of competence, knowledge, being comfortable, feeling isolated,

stress and other negative characteristics in the clinical setting. According to these studies that

have been conducted, gender bias occurs more often with a male nursing student and a female

patient. The participants were to fill out questionnaires based on the gender preference they

would prefer for their nurse in several aspects of care in the likely scenario that they would need

said care. The subjects went through a series of interviews to reflect on their past experiences
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while providing care to patients at a women’s health clinical rotation. The overall results show

that male nursing students are more likely to be rejected by a female patient when in an OB or

Maternity clinical rotation compared to a female nursing student, and that the male nursing

students’ ability to learn is hindered. Both qualitative and quantitative studies suggested that the

level of intimacy needed in female patient care was the major determinant for whether a patient

preferred a male or female nursing student.

In a study done by Eswi and Sayed (2011), the learning experiences of male student

nurses who attended a maternity nursing clinical course were assessed by using a descriptive

design, so both quantitative and qualitative data could be collected; a semi-structured interview

scale was used. This study randomly assigned sixty students who finished the clinic maternity

course in a college of Nursing. Students in the maternity clinical preformed several procedures:

abdominal examination, breast examination and perineal care, newborn, attending cesarean

section and providing mother classes for mother in both antenatal clinic and postpartum (Eswi &

Sayed, 2011). Several male nursing students felt stress during these procedures, and it was found

that rejection by the female patient was the major cause of anxiety. From examining this study,

one third of the sample dealt with the refusal from female patients when receiving care by a male

student nurse, and a handful of male students reported the difficulty of acquiring the skills in the

maternity nursing clinical setting (Eswi & Sayed, 2011). If students cannot acquire their skills,

then how are they expected to take care of patients? The limitation pertaining to this study was

the cultural views towards gender because of where the study was conducted. There is still

gender bias when receiving intimate care by an opposite gender healthcare provider, especially if

the provider is a student nurse.

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In a similar study done by Chur-Hansen (2002), she replicated a quantitative study that

was produced in 1984 to see if gender preference by a care provider was still a trend in the year

2000. The study researched preferences for a male or female nurse in an imagined hospital

situation, depending on the level of personal intimacy involved in the clinical situation (Chur-

Hansen, 2002). In 2000, 210 participants of male and female gender participated in the study and

answered the same questionnaire given to the participants of the 1984 study. The questionnaires

asked for preferences for a male or female nurse in several scenarios like bathing, shaving,

inserting IVs, etc. if they would receive care in that aspect. Consistent with previous research,

the degree of intimacy in a clinical situation was found to be predictive of same-gender

preferences. In both the 1984 and 2000 studies, the results have shown that the degree of

intimacy in an interaction is a predictor of same-gender preference. In 2000, the p was < 0.001

when females declined male students to provide baths, shave them before surgery, and when

asked for a same-sex preference for a nursing student to provide intimate care (Chur-Hansen,

2002). The limitations in this study are related to the use of only four clinical situations to

prompt the study. Patients are less concerned about the gender of their nurse when technological

expertise is required, however in intimate situations more females prefer a female nursing

student compared to a male.

In a study conducted by Jose Mitra (2017), at East Tennessee State University,

participates preconceptions prior and post OB clinical rotations were recorded. A common

preconception before participants underwent their OB rotation were “[women] are more suited to

take care of pregnant women” (as cited in Mitra, 2017, 10). The idea that a female nursing

student could relate more or provide more cohesive care was widely recognized within the study.

Participants felt that the “intimate topics and procedures” would make patient feel uncomfortable
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and ultimately interfere with their educational process. Furthermore, participants expressed that

this ideology extended beyond the students and to any male nurses currently working in women

health settings. Access to procedures and routine check-ups would be denied solely because they

were males (Mitra, 2017).

Upon completion of OB rotation, the participants reported a mixed review of their

experiences. In comparison to their prior preconceptions a few participants experience very

welcoming patients and nurses. They reported “pretty good interaction” and feeling welcomed

with their nursing preceptors “very accepting, and eager to teach” (as cited in Mitra, 2017, 11).

One participant went as far as to admit that they were wrong and “patients are more open to

having males in the OB field” (as cited in Mitra, 2017, 11). Regrettably not all the participants

had such a positive experience. A few subjects expressed a “feeling of rejection from patients”

(as cited in Mitra, 2017, 12). Their feelings of rejection were confirmed with “glares and

suspiciously watching [movement]” to almost say that “they did not belong there” (as cited in

Mitra, 2017, 12). Other participants reported verbal rejection that resulted in them being removed

from the examination room or denied complete entry into procedures upon request of patients

(Mitra, 2017).

Male nursing students face an occupational stigma because the field is dominated by their

female counterparts. As a result, they encounter challenges unique to their gender, especially in

women focused health settings. Male students have reported not only verbal rejection but

psychological rejection evident by patient body language and communication patterns. This

creates an unsuitable learning environment for males pursuing their nursing degree. Rejection

effects students’ self-esteem in providing competent patient care and also limits the amount of

opportunities to practice skills essential for being a productive and effective nurse. In a study
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conducted by Buthelezi, Fakude, Martin, and Daniels (2015) they propose strategies to help

overcome challenges male students face. Identifying potential situations where gender bias is

most common is important, so strategies can be implemented in case of patient-nurse

discrepancies (Buthelezi et al. 2015). In conjunction to proper planning the relationship between

faculty and student needs to be strong. Encouragement during times of rejection can have a

positive impact on the self; “professional nurses should take the lead to motivate younger nurses”

(as cited in Buthelezi et al. 2015, 4). Additionally, learning objectives and nursing activities

should not be allocated according to gender. Male and female students need to acquire the same

knowledge. A division of labor bars one group from fully honing skills necessary to grow in the

nursing profession (Buthelezi et al 2015).

After reviewing these studies, it was apparent that male nurses are negatively impacted

more than female nursing students in relation to gender bias within a women’s health clinical

setting. These studies show a trend in which gender bias towards male nursing students is still

occurring in clinical rotations. Both studies address that the level of intimacy in certain aspects of

patient care is the major theme for having a same sex healthcare provider. Male nursing students

who do not have the opportunity to apply theirs skills in the clinical setting have increased stress,

become more uncomfortable and question their abilities to practice. Even though one of these

previous studies was conducted outside of the United States, it shows gender bias is a global

situation in nursing practice.

Limitations in Clinical Practice

The clinical element is a crucial part of nursing education that provides upcoming nurses

with the hands-on skills and knowledge to develop their professional dexterities. If gender bias,

discrimination, or inequalities are present in the world of nursing how does one develop such
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skills? This in not only an epidemic in the United States but around the world as well. A study

from New Zealand collected data through an in-depth semi structured interview process to gather

information of the male perspective (Christensen & Knight, 2014). The study stated that while

male students provided intimate or even basic care to female patients, it became evident that

there were certain rules and guidelines put in place for the care that they were and were not

allowed to give, which became a great challenge for these male students (Christensen & Knight,

2014). On the other hand, female nurses were able to give male patients the optimal care they

needed without their integrity being called into question (Christensen & Knight, 2014). These

unwritten rules and boundaries can cause a great challenge to the male nurse not only to

complete the required education curriculum, but also when it comes to developing the confidence

and skills needed to provide care to these patients.

Furthermore, another act of discrimination towards male students is when they are placed

in the maternity setting. Students have noted obtrusive behaviors from professional colleagues

only allowing them to provide care to newborn male babies and not allowing them to care for or

support mothers during times of breastfeeding (Christensen & Knight, 2014). How will students

learn to develop competent skills to treat female patients if one has never had the hands-on

experience? Nursing students can learn a lot from literature and text books, but half of the battle

in nursing is physical touch. If males are kept from that, they will not develop the skills needed

to care for patients of the opposite sex.

Outside of the discrimination, labelling is an area that poses a challenge for male nurses

causing them to be discriminated against. Crossing over into the female dominated field, often

times, males are looked at as ‘gay’ or as a ‘predator’ and this is not easy to ignore. According to

this study, female students tried to encourage male students to be proud of who they are and
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ignore comments from patients viewing them as dirty old men (Christensen & Knight, 2014).

Though they see themselves as motivating their fellow peers, living day to day with the narrow-

minded view of the small population makes it difficult for the male students to address and

discuss these issues (Christensen & Knight, 2014). Misrepresentation from patients and

coworkers makes the nursing student experience segregated, causing male nursing students to

develop strategies and coping mechanisms to reform their male identity (Liu & Li, 2017). Men

often times have to mitigate their gender differences when working with the female patients to

provide the care needed. Being classified as females or male, doctors often times ignore or

disregard the issue if that helps ease over the medical treatment needed (Liu & Li, 2017).

Most often there is the comparison of ‘women’s work vs men’s work’. For a male

profession, society argues that is has to be tough, strong, firm or work in some sort of business

and/or leadership position. Most people say or think that nursing is a woman’s profession.

Therefore, male nurses have had to reconstruct their identity ever since working in a female

profession. Males typically set their goals to hold some sort of leadership position within the

nursing field such as nurse practitioner, head charge nurse, or nurse manager. The opinions of

being ‘the higher up the ladder, the better’ makes the temporary feminization acceptable in the

profession. By holding a higher position in the hospital, masculinity is reserved (Liu & Li, 2017).

It is evident that gender discrimination towards males in the nursing world continues to be a

problem worldwide and makes for a difficult learning environment. This is an issue that needs to

be addressed in order for male students to learn at their optimal capacity.

Conclusion

Healthcare is always changing, however, the imbalance of gender in the field of nursing

remains constant due to social stereotypes and historical rationales. More efforts have to me
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made so male nursing students can have the same opportunities in clinical practice. These studies

show that gender bias negatively impacts the clinical learning experience of male students.

Female patients often refuse the care of male nursing students, especially if intimate care needs

to be provided. Therefore, the ability to apply theory into practice doesn’t occur for some.

Clinicals are an important aspect of nursing education.

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References

Black, B.P. (2017). Professional Nursing: Concepts and Challenges. Maryland Heights, MO:

Elsevier.

Buthelezi, S. F., Fakude, L. P., Martin, P. D., & Daniels, F. M. (2015). Clinical learning

experiences of male nursing students in a bachelor of nursing programme: Strategies to

overcome challenges. Curationis, 38(2), 1517. doi:10.4102/curationis.v38i2.1517

Christensen, M., & Knight, J. (2014). Nursing is no place for men: A thematic analysis of male

nursing students experiences of undergraduate nursing education. Journal of Nursing

Education and Practice, 4(12). doi.org/10.5430/jnep.v4n12p95

Chur-Hansen A. (2002). Preferences for female and male nurses: The role of age, gender and

previous experience -- year

2000 compared with 1984. Journal of Advanced Nursing (Wiley-Blackwell), 37(2), 192–

198. doi.org/10.1046/j.1365-2648.2002.02079.x

Eswi, A., & El Sayed, Y. (2011). The experience of egyptian male student nurses during

attending maternity nursing clinical course. Nurse Education in Practice, 11(2), 93-98.

doi:10.1016/J.NEPR.2010.11.012

Hsing-Yuan L., & Yun Ling L. (2017). Crossing the gender boundaries: The gender experiences

of male nursing students in initial nursing clinical practice in Taiwan. Nurse Education in

Practice, 58(1), 72-77. dx.doi.org/10.1016/j.nedt.2017.08.006

McDermott, K., Elixhauser, A., & Sun, R. (2017). Trends in hospital inpatient stays in the United

States, 2005–2014. Retrieved from https://www.hcup-

us.ahrq.gov/reports/statbriefs/sb225-Inpatient-US-Stays-Trends
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Mitra, J. (2017). Perceptions of Male Nursing Students About Working in Women’s Health.

(Undergraduate Honors Theses Paper). http://www.dc.etsu.edu/honors/389