The. Gender Bias: Fact or Fiction?

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2 The Odd Hidden tb Barrierrie Gender Bias: Fact or Fiction? ALL WOMEN S HEALTH, OBSTETRIC, AND NEONATAL CLIENTS AND THEIR FAMILIES have the right to quality care provided by a clinically competent, professional nurse. Many health care organizations support gender equity; AWHONN states that nurses, regardless of gender, should be employed in women s health, obstetric, and neonatal nursing based on their ability to provide quality care (Association of Women s Health, Obstetric, and Neonatal Nurses [AWHONN], 2005). The most recent National Sample Survey of Registered Nurses showed that although men represent only 5.4 percent of the registered nurse (RN) workforce, the number of male nurses has increased 226 percent since 1980 (AWHONN). But according to the Bernard Hodes Research Group s Men in Nursing Study (2005), the clinical specialty with the least male nurses is women s health, obstetric, and neonatal nursing. Gayle Cudé, PhD, RN Karen Winfrey, MS, RN

3 t The experiences of men in nursing show that the male nurse or nursing student often feels that he is viewed differently by his female counterparts regardless of the quality and sincerity of his work. Cudé (2004) interviewed male nursing students about their experiences during the maternity rotation. The students reported that despite the fact that they received the same training prior to the maternity rotation, they felt that they were often viewed with disdain by the nursing staff during the actual clinical experience. Male students held that they were often instructed to stand in the corner or stay out of the way while they were in labor and delivery. By contrast, female students were given the opportunity to assist with the birthing process. One male student was essentially well-received in the labor and delivery unit until he expressed that he wanted to be a labor and delivery based upon stereotypes. Cushner, McClelland, and Safford (2006) defined gender bias simply as behavior that results from the underlying belief in sex role stereotypes (p. 1). Gender bias is the propensity to consider a person on the basis of his or her gender and is reflected in attitudes and behaviors founded on stereotypical beliefs about the sexes rather than evaluating a person s individual abilities and experiences (National Center for State Courts, 2006). Hill and Hill (2005) approached gender bias from a legal standpoint, asserting that it is an unequal treatment in employment opportunity and expectations due to attitudes based on the sex of an employee or group of employees (p. 1). Under antidiscrimination laws, gender bias can be a legitimate reason for a lawsuit (Hill & Hill). Gender bias is often hidden so that even those who The experiences of men in nursing show that the male nurse or nursing student often feels that he is viewed differently by his female counterparts regardless of the quality and sincerity of his work. nurse. He reported a drastic change in behavior on the part of the nurses in that he felt no longer welcome (Cudé). Gender discrimination in employment is unlawful and is therefore not allowed to be used as a selection criterion by employers. In addition to legal requirements barring discrimination, there is no evidence indicating that female nurses provide superior care to male nurses in the areas of women s health, obstetric or neonatal nursing. Chung (2000) reported that male nurses state that it s more difficult for them to work in women s health areas, with at least one man stating that a physician told him that he did not want male nurses with his patients. Bias Defined Those who have studied gender bias state that it s Gayle Cudé, PhD, RN is an assistant professor and curriculum specialist at Tulsa Community College in Tulsa, OK, and she serves as the AWHONN Oklahoma secretary-treasurer. Karen Winfrey, MS, RN, is the AWHONN Oklahoma legislative chair in Tulsa, OK. DOI: /j X x support gender equity may be unaware of their own bias. O Lynn (2004) found that men experience gender bias and discrimination during nursing school and often overhear anti-male comments by nursing faculty. Male nurses have practiced in NICU and pediatric specialties alongside their female colleagues for years; yet, qualified men seeking to practice in labor and delivery/women s health care nursing are often effectively barred from that area. Very few male nurses work in labor and delivery or practice as nurse practitioners in women s health care. Further, it s uncommon to find a male lactation consultant or a male nurse midwife. There is very little research as to the reason for the lack of male nurses in these specialties. It may be due to anticipation of ridicule or rejection stemming from bad experiences during maternity rotations in nursing school, gender discrimination, poor networking and recruitment to connect available men to clinical vacancies or simply a lack of interest in this clinical area. These issues must be studied further in order to determine factors that influence and affect the lack of male nurses entering maternal child nursing , AWHONN

4 O Historical Background To initiate change, it s necessary to view gender bias from a different perspective. The literature indicates that for nursing to self-actualize as a profession, internal injustice and lack of tolerance toward any member, regardless of gender, must be acknowledged and rectified (McMillan, Morgan, & Ament, 2006). Gender issues are nothing new in nursing. Many nurses mistakenly believe that nursing began with Nightingale and the presence of male nurses is a recent event. However, the earliest accounts of nurses were of men, with records existing from the Byzantine period, in Biblical accounts, and through the Middle Ages (Williams, 2006). The very first nursing school began in approximately 250 BC in India. Only men attended this school because they alone were considered pure enough to be nurses (Williams, 2006). Male nurses provided care during every plague that affected Europe. During the Middle Ages, men from military, religious and lay orders continued to provide nursing care. St. Camillus de Lellis, son of a military officer and a patron saint of nurses, created the sign of the Red Cross and formed the first ambulance service (Williams). Men often took caring roles especially for the wounded during times of war. Walt Whitman served as a nurse during the American Civil War and expressed his experience and ministry to the wounded in the form of poetry (Ahrens, 2002). Both the Union and the Confederacy had men in the military serving as nurses. Although male nurses took care of the public, Florence Nightingale, along with her followers, cared for those in the home. Nightingale brought dramatic reforms by overhauling nursing in the British army during peacetime. Additionally, she began nursing schools and wrote hundreds of documents that changed the face of nursing. As the role model of nursing, Nightingale dramatically shaped the future of nursing by declaring nursing as women s work (Cash, 1997), transforming nursing into a profession for single women of impeccable moral standards (Bostridge, 2002, p. 2), and opposed men s involvement, stating that their horny hands were detrimental to caring (Anthony, 2006, p. 45). Because Nightingale was educated, eloquent and prominent, she used her influence to make nursing a platform to liberate women from the Victorian restrictions of her time by proclaiming that nursing came naturally to women due to their inborn characteristics of mothering and caring for others. By contrast, men were excluded from nursing because, according to Nightingale, they lacked the capacity to provide mothering and caring (Anthony, 2006). With the advent of structured nursing schools, the stereotype of the female nurse was that of the nurturing, There is no evidence indicating that female nurses provide superior care to male nurses in the areas of women s health, obstetric or neonatal nursing. June July 2007 Nursing for Women s Health 257

5 Caring was the primary motivation for choosing a nursing major by both men and women enrolled in nursing school, providing evidence of a deep commitment to caring. domestic, subordinate and self-sacrificing nurse (Meadus, 2000). 00). Men who were strong and dominant nt no longer had a role in nursing, leaving men to be ostracized from nursing, their rich history and contributions forgotten as nursing continued to develop into a feminine role (Meadus). Separate nurse training programs just for men arose in the United States during the latter part of the 19th century at Bellevue Hospital in New York City. The curriculum was limited to those topics in which interventions by men were valued, such as cardiac, pulmonary, fracture management, ent, control of psychiatric patients and urology care. Men who expressed an interest in obstetrics, women s health, newborn or pediatrics were perceived as perverted and were at risk for expulsion from the nursing program. Yet, graduates from this program were held to the same standards for RN licensure as female graduates, requiring them to be tested on content they did not receive during their training (Sullivan, 2002; Villanueve, 1994). At the turn of the 20th century, men who were formerly serving in the military as nurses were suddenly excluded from continuing their practice as military nurses. U.S. military nurses changed from a predominately male group to a predominately female group. It was not until the Korean War that male nurses were again allowed to serve in the military. Since then, the number of male nurses in the military has been increasing. In all branches of the military, 30 percent or more of the nurses are men (Boivin, 2002). At present, male nurses are beginning to resume their historical role as nurturing, committed and caring nurses (Williams, 2006). Commitment to Caring Nursing is known as a caring profession. The public has selected nurses as the most trustworthy professionals (Jones, 2005). Caring was the primary motivation for choosing a nursing major by both men and women enrolled in nursing school, providing evidence of a deep commitment to caring (Boughn, 2001). Both genders stipulated that one of the fundamental reasons for entering the field of nursing was caring for others, and students, regardless of gender, referred to the need to make a difference through caring for others (Boughn). Although men cite caring as a motivation to enter nursing, they often describe the process of learning to care as awkward. Men are expected to limit expressions of emotions in Western society, whereas the opposite is true for women. Demonstrative caring behavior that seems natural and normal for female students seems unnatural for male students (Patterson et al., 1996). Men are surprised to learn that the beginning focal point is that of therapeutic communication. Additionally, they experience role strain because they may no longer be the primary breadwinner and experience isolation and loneliness 258 Nursing for Women s Health Volume 11 Issue 3

6 because they are in the minority (Anthony, 2006). Men experience a sense of alienation due in part to the loss of the rich history of male nurses, with the major focus on contributions of female nurses. The majority of faculty members in nursing schools are middle-aged, white women who have been socialized to value the feminine qualities of nursing. While they are not likely to consciously exhibit bias against men, they may subconsciously exhibit behaviors that affect bias, influencing the learning climate. These subtle occurrences of gender bias may appreciably affect student learning and success (Anthony, 2006). Male students, leery of being accused of sexual harassment, usually find methods other than touch to demonstrate caring and eventually develop techniques such as therapeutic communication and even humor when indicated. As they progress through nursing school, male students find ways to express caring on their own terms by becoming connected and attentive in their nurse-patient relationships. However, male students expressed concern that nursing faculty members are unable to see their caring behavior. O Lynn (2004) concurs that while male nursing students realize that they provide caring behaviors, their different approach makes them feel at risk for negative faculty feedback. The Maternal-Newborn Experience The literature indicates that men s experience as nursing students is different from that of their female peers (Anthony, 2006). According to Anthony, They enter nursing school with differing expectations, experience learning to care differently, perceive that they are treated differently during their learning experience, and are more apprehensive about genderrelated care issues during specific clinic experiences such as the MCH (maternal child health) rotation (Anthony, 2006, p. 226). Men are the minority in nursing school, causing them to feel uncertain about expectations from faculty and peers. They are often expected to help with heavy lifting in addition to their clin- The experience of many male nurses in obstetrics and women s health indicates gender bias in the workplace. Gender bias is harmful to the nursing profession and to patients and their families. O Assumptions should not be made by individuals or institutions about who should care for women during the perinatal period. ical assignment (Anthony, 2006). Male students are frequently expected to be assertive, assume leadership positions and report that they are more likely to be closely scrutinized by their female peers and often feel as if they re under a microscope (Anthony, 2006, p. 47). Men frequently feel uncomfortable in the maternal child setting, possibly because they are unlikely to have been assigned to a female patient in other clinical rotations. Without the chance to experience a wide variety of patients that include women, male students have not had the opportunity to interact with female patients, who, in turn, may make them feel uncomfortable and unprepared in any setting with female patients (Emmons, Sells, & Eiff, 2002). Patterson, Morin, and Colby (2003) found that newly delivered mothers consistently stated that their nursing students were caring, competent and acted in a method similar to that of a staff nurse. These positive responses were made about the nursing students regardless of gender; the majority of the mothers responded that they would accept care from a nursing student again regardless of gender. Despite this positive finding, few men choose maternal-newborn nursing. Patterson and Morin (2002) reported that from a sample of 599 male RNs, only 6.8 percent had ever been employed in any women s health specialty. McRae (2003) asserts that the reasons most often cited for the small number of male nurses working in maternity or women s health were lack of interest, the environment and gender issues. Informal Survey In order to obtain an approximate idea of how many male nurses are working in labor and delivery and in postpartum, an informal survey was conducted using selected major hospitals chosen from a Google search of Oklahoma and its surrounding states including Arkansas, Colorado, Missouri, New Mexico and Texas. All hospitals had equal opportunity, nondiscriminatory hiring policies. Charge nurses, staff nurses or clinical managers from labor and delivery and postpartum June July 2007 Nursing for Women s Health 259

7 t The reasons most often cited for the small number of men nurses working in maternity or women s health were lack of interest, the environment and gender issues. Box 1 Survey of Male Nurses: Demographics Survey ed 51 Responses received 12 (24%) Age Range 31 to 60 years Ethnicity European American (11), Native American (1) Education Master s degree (75%), bachelor s degree (25%) Description of current position ER, NICU, L&D, CNM, IBCLC, WHNP, administration, academia were asked if they had a male nurse working on the unit. Of 30 hospitals surveyed, only 3 had male nurses employed in labor and delivery. The unit nurses working with each of these men spoke highly of their qualifications and performance. Two of the nurses interviewed stated that they had employed a male nurse in the past, who was skilled and competent. In each case, not only were the male nurses qualified and competent but were also respected and wellliked by staff and patients. However, gender bias was evident in some of the survey responses. One of the nurses interviewed actually laughed at the question, Do you have any male nurses working on your labor and delivery or postpartum units? The nurse replied that male nurses were inappropriate in maternity, stating that it would be a staffing nightmare. She further stated that she would have to increase her female staff in order to have male nurses because most of the patients would reject male nurses. Findings of AWHONN Male Members Survey Of the approximately 22,000 AWHONN members, 54 are men (0.25 percent). However, it should be noted that AWHONN has only recently begun to track the gender of its members. Since the specification of gender is optional, it is unknown how many men are actually members of AWHONN. To further examine the question of bias, a survey was constructed to determine the experiences of male AWHONN members. Face and content validity were established by a panel of experts. For this type of research (qualitative), no other type of reliability and validity is consistently used (Polit & Beck, 2004). The survey was sent to the 51 available addresses of male members through the courtesy of the AWHONN administration, which ed the surveys. The survey used open-ended questions asking the men to share their stories and experiences. They were asked to share their stories about (a) professional satisfaction, (b) experiences with obstetrics and women s health both in nursing school and as professionals, and (c) if they had ever experienced a sense of discrimination based on gender. There was also space for comments. Although the response rate was relatively low (24 percent; n = 12) and since the respondents were ethnically and educationally homogeneous (see Box 1), the responses cannot be assumed to be representative of all AWHONN men. Nevertheless, their stories serve to provoke professional self-reflection and are thus important. The majority of the respondents (58 percent) stated that they had not experienced gender bias during nursing school. Those who did experience gender bias (42 percent) reported that it came from nursing faculty and nursing staff but not from patients. However, as professional nurses, the majority of the respondents experienced gender bias, with 75 percent reporting bias from nursing staff and 8 percent from female physicians. No one reported experience with gender bias on the part of male physicians (see Box 2). In the commentary, most of the respondents expressed gratitude for having the chance to share their experiences. The frustrations revealed through their stories appeared to be deep and most relayed 260 Nursing for Women s Health Volume 11 Issue 3

8 appreciation that someone wanted to listen to them. One man stated, I hated my labor and delivery clinical rotation in nursing school. While the professors thought they were being helpful and protective of the patients, what they were really doing was insinuating there was something wrong with having a male nurse in their labor. One respondent said, I completed a CNM degree and was met with a certain amount of prejudice because of my gender. I was even told I would not be hired as a CNM because of my gender. Another man wrote, In newborn nursery, a clinical manager wondered what my motivation was for working with babies. A military nurse who practices as a certified nurse midwife (CNM) and lactation consultant stated that he rarely encounters gender bias because prejudice of any kind is not tolerated in the armed forces. He reported knowing other male CNMs who practiced while in the military only to learn that they could not find employment as a CNM following discharge. He added, that s why I m staying in the service. One respondent in particular had a poignant story to tell, beginning with nursing school and continuing through his professional role: In nursing school, I was applying for a nursing scholarship and had to go before a review board. One of the older gentlemen in the group commented I should leave nursing to the women. As a Newborn Nursery/NICU Director, I once hired a male newborn nursery nurse who was a certified lactation consultant. My female peers questioned the appropriateness of a male nurse O counseling and assisting women with breastfeeding and my decision to hire him. My labor and delivery and postpartum counterparts in a community hospital were very outspoken about their view that male RNs should not work in labor and delivery and postpartum and stated flatly they would not hire males. I have had nurses say I was promoted because I was male. I have been referred to as the token male. I have had RNs who did not work in obstetrics express curiosity as to why I chose obstetrics and ask how patients accepted me, clearly with the idea it was inappropriate. I try to offer some education. I let them know I feel their questioning of my professional motives based on my gender is as inappropriate as would be their questioning my motives based on race or religion. These experiences bring to mind several questions. If examining one s motives for working with newborns is justified for male applicants, it seems that all female applicants should have their motives queried just as extensively. If the appropriateness of a male nurse counseling a lactating woman is questioned, then should the appropriateness of a female nurse counseling a male patient facing or recovering from an orchiectomy be questioned as well? If nursing is a quality, independently governed profession, with evidenced-based standards of care, then the focus in hiring should direct one to qualifications, experience and professional goals regardless of gender. Discussion Men as nurses can present advantages, not just for the new mother and baby but also for the new father as role models. In this way, support can be provided Box 2 Survey of Male Nurses: Reports of Gender Bias During Nursing School (%) As Professionals (%) No bias Bias from faculty and staff 42 na Bias from nursing staff na 75 Bias from female physicians* na 8 Bias from female patients 0 0 * Respondents did not list male physicians as having bias. June July 2007 Nursing for Women s Health 261

9 t To begin the process of eliminating gender bias, there must be acknowledgment and recognition of bias before any measurable change can be expected. to mother, father and baby, making the experience more family-focused in the process. Even male students have noticed that new fathers gravitate toward them to ask questions (Cudé, 2004). Because men have different learning styles than women, and with the increased efforts to involve fathers, the nursing profession has an obligation to assure every opportunity of support and education for new fathers as well as for new mothers. The literature indicates that men are just as capable of demonstrating caring as women; yet, the motives of a male nurse working in maternal-newborn nursing are frequently questioned (Cudé; Patterson et al., 2003). It s critical for the nursing profession and especially for the maternal-newborn specialty to recognize and address gender bias. Such bias is not always conscious. All nurses must evaluate their own feelings and prejudices about male nurses and begin to recognize their own biases; acknowledgment is the first step in overcoming bias. Male nurses bring a variety of unique contributions to maternal nursing, which should be recognized. The diversity of perspectives, perceptions, communication skills, caring styles, leadership abilities and mentoring capacities all bring enrichment to nursing. O Lynn (2004) contends that while patients have a right to decline care provided by a male nurse, discrimination based on gender should be considered an ethical issue similar to ethnic discrimination. This statement presents the patient or the recipient of the nursing services as the one to determine if gender of the nurse is of concern. Men are often not given the opportunity to ask the patient her preference, and when they are given that opportunity, patients are generally open and nondiscriminatory (Poliafico, 1998). The literature supports the fact that men may be actively discouraged from pursuing a career in obstetrics, neonatal and women s health while they are in school so that they do not have the opportunity to form an interest in that specialty (Callister, Hobbins- Garbett, & Coverston, 2000; Chur-Hansen, 2002; Cudé, 2004; Emmons et al., 2002; McKenna, 1997; Patterson & Morin, 2002; Poliafico; Whittock & Leonard, 2003). Men frequently become interested in obstetrics and women s health during medical school and finish a residency in obstetrics and gynecology without any discouragement or question about motivation. If this is a common phenomenon in medical school, why would it not be similar in nursing school? In a presentation at the 2006 AWHONN National Convention in Baltimore, MD, the contents of this article were presented, including the result of the AWHONN Male Members Survey. Participants of the session included nursing faculty, two male nurses who work in the maternal-newborn area and one nurse who volunteered that she attended to explore whether she held biases toward male nurses. The biases reported in this article were substantiated by the participants of the AWHONN session. Nursing faculty related stories about difficulties in finding beneficial maternity experiences for their male students and apparent bias on the part of many staff nurses. They reported that the male students were often not allowed the same experiences in maternity as their female students. The male nurses told of multiple situations in which they were denied positions in maternity for which they were well-qualified. One of the men stated, Just please, give me a chance. Toward the end of the presentation, a participant asked for methods in which she could help her unit eliminate bias. In 1994, a California hospital banned male nurses from working in labor and delivery, asserting that vaginal examinations by male nurses increased patient stress (Poliafico, 1998); yet, male physicians were not banned or limited in their performance of vaginal examinations or their presence in delivery rooms. The issue of chaperones during intimate examinations is widely researched predominantly within the context of the physician-patient relationship. Studies conducted among practicing physicians as well as among residents report considerable 262 Nursing for Women s Health Volume 11 Issue 3

10 Men have been practicing as obstetricians and gynecologists for years; yet something about nursing suprisingly creates barriers for men in obstetrics and gynecology. variations in policies and practices of chaperone use during intimate exams (Ehrenthal, Farber, Collier, & Aboff, 2000; Rockwell, Steyer, & Ruffin, 2003). Whether the physician is male and the patient female or the physician is female and the patient is male or the physician and patient are of the same gender, the planned use of chaperones is identified to be most common when the physician is male, the patient is female and the procedure is a Pap smear or pelvic examination (Rockwell et al., 2003). Age of the physician, frequency of examinations and geographical region appear to influence the consistency in use of chaperones. Young physicians who perform fewer examinations and live in the South seem to use routine chaperones more than any other group studied (Rockwell et al.). Interestingly, patients attitudes regarding the use of chaperones during intimate examinations also vary, with the majority of patients indicating no preference regardless of patient age or the gender of the physician (Fawcett, 2003; Fiddes, Scott, Fletcher, & Glasier, 2003). Numerous questions must be considered if the desire is gender neutrality. Is a chaperone only necessary to consider for physician examination? Is a chaperone only necessary if patient and clinician are of the opposite sex? There may be risk of sexual harassment or impropriety or even just sexual tension/discomfort between patients and clinicians of the same sex. Men have been practicing as obstetricians and gynecologists for O years; yet, something about nursing surprisingly creates barriers for men in obstetrics and gynecology. The same interventions or procedures performed by a sensitive and skilled clinician should not be viewed differently because the clinician is a female nurse or a male nurse or a physician. It causes one to wonder if the issue is actually about the patient s privacy or if some nurses are afraid to admit that they truly believe men are not as compassionate, not as caring and not as capable of sensing women s needs. Anthony (2004a, 2004b) states that gender bias is harmful to the nursing profession and asserts that current educational practices result in different learning experiences for male and female nursing students. These differences hinder the recruitment and retention of men into nursing and perpetuate traditional male and female stereotypes. She further contends that bias based on gender not only harms the profession as a whole, but also contributes to maintaining limits in the role of male nurses. Implications for Nursing In order to eliminate gender bias, nursing must change. Change is never easy; but in order for nursing to continue evolving and progressing, all nurses must be willing to commit to eliminating prejudice due to gender. To begin the process of eliminating gender bias, there must be acknowledgment and recognition of bias before any measurable change can be June July 2007 Nursing for Women s Health 263

11 t Nurses should ask themselves how they feel about male nurses working in labor and delivery, newborn nursery or postpartum and whether it bothers them to consider working alongside a male nurse. expected. Self-examination is critical. Nurses should ask themselves how they feel about male nurses working in labor and delivery, newborn nursery or postpartum and whether it bothers them to consider working alongside a male nurse. The answers to these questions on an individual basis must then be examined at a unit level. It s not good enough to simply say, I have no problems working with a male nurse. If the majority of female nurses truly accept male nurses, why did the majority of the men questioned in the AWHONN survey report having difficulty finding employment in these clinical specialties? The Hodes Study (2005) offered opportunity for open-ended responses in certain sections. When sharing their own experiences in nursing, some comments appeared repeatedly, including men in nursing being disrespected, being discriminated against, being outsiders, having too many roadblocks, the feminine focus of the profession the vocabulary, the administration, the rewards (flowers, facials, pink things) and the hostile nature in which the women treat each other. Clearly, the permeation of femininity in nursing must be recognized as a deterrent in recruiting men. Terminology in nursing publications and textbooks must be examined and edited to be gender neutral. Professional publications and Web sites must lead by example through their own gender-neutral language and include photographs of male nurses caring for women in labor and delivery and women s health settings. Nursing organizations must strive for more gender neutrality in their presentations at national conventions and local conferences, as well as among their leadership positions. Men currently in nursing must be used in strategic planning. Consultation groups could be formed and sensitivity training developed to assist units in identifying gender bias and strategies for alleviating it. Awards could be created for a unit, facility or clinic that is exemplary in their gender-neutral practice that reflects cultural, ethnic and religious diversity in the community. Efforts to break the cycle of bias can begin in nursing school by making all students aware of the historical contributions of male nurses. Nursing schools must prioritize the need for more men among the faculty, especially in the clinical specialties of women s health, obstetrics and neonatal nursing. During the maternal-newborn rotation, faculty and nursing staff have the obligation to ensure that both men and women students have equal opportunities. Students who are truly interested in women s health, obstetrics and neonatal nursing must be encouraged to pursue these areas regardless of gender without questions about motivation. Conclusions Removing bias of any kind is difficult because it often exists at a subconscious level. Many nurses remain in denial as to the existence of gender bias or question the need to change. The focus must remain on the benefits that men bring to the specialty of women s health, obstetrics and neonatal nursing. Change is never easy; but nursing must accept the challenge of change for the sake of all the children, families, elders, the wide diversity represented in the world s population and for the rich heritage that supports nursing s ability to adapt and improve the quality of the nursing profession itself. NWH References Ahrens, W. D. (2002). Walt Whitman: Poet and nurse. Nursing, 32(5), 43. Anthony, A. S. (2004b). Gender bias and discrimination in nursing education: Can we change it? Nurse Educator, 29(3), Anthony, A. S. (2004a). Tear down the barriers of gender bias. Men in Nursing, 1(4), Anthony, A. G. S. (2006). Retaining men in nursing Our role as nursing educators. In M. Oermann, & K. Heinrich (Eds.), Annual review of nursing education (4th ed.) (pp ). New York: Springer. Association of Women s Health, Obstetric, and Neonatal Nurses. (2005). Gender as a qualification requirement for nursing positions in women s health, obstetric, and neonatal health. Retrieved April 25, 2006, from awhonn.org 264 Nursing for Women s Health Volume 11 Issue 3

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