Gayle Cudé, PhD, RN DoMen Have a Role in Maternal Newborn Nursing? The Male Student Nurse Experience The number of male nurses in the U.S. is increasing, but are male nurses welcomed into maternal-newborn care units? Male nurses account for 5.4 percent of all registered nurses in the U.S., up from 2.4 percent in 1980 for an increase of 226 percent over the past 20 years (American Nurses Association, 2004). MacRae (2003) asserts that although professional organizations such as the American College of Nurse Midwives (ACNM) and the Association of Women s Health, Obstetrics and Neonatal Nurses (AWHONN) have position statements that support men s roles in their organizations, it s not always evident that nurses in the fields represented by those organizations agree. The well-discussed nursing phenomenon known as eating our young refers to the lack of support provided to new graduates by experienced nurses. Is there also a phenomenon of eating our young male students in the obstetrics rotation August September 2004 AWHONN Lifelines 343
before they graduate? Such gender issues became acute in one nursing research seminar in which half the enrolled students were male. Three of these men expressed interest in careers in maternal-newborn nursing. This article offers personal insight from these male students in addition to a summary of the literature. Literature Review Though not often acknowledged, nursing traces its modern roots as a tradition of men ministering to the needs of the sick in hospitals, including those established for the treatment of women, to the sixth century Roman Empire. In the late nineteenth century, Florence Nightingale deemed nursing as a suitable profession for women because they were nurturing and caring by nature. This opinion gave women the power to break through the dominance that male nurses possessed throughout the centuries and established nursing as a female profession (Whittock & Leonard, 2003). Although male nurses have made significant contributions to the profession, little research has been undertaken regarding the role of men in nursing (Streubert, 1994). While prejudicial treatment toward men seems to be lessening, male nurses and male student nurses continue to report incidents of discrimination (Hilton, 2001). Male nurses often suspect their employment is more for their muscle power than for their cognitive ability (Kelly, Shoemaker, & Steele, 1996). Numerous stereotypes exist among health care professionals and the general public that dissuade men from a nursing career. Hilton (2001) found that some male nurses reported recurrent hostility from their female colleagues. A substantial number of male nurses believe the public views them as gay or effeminate, and many report that they tire of explaining their professional role as a nurse (Streubert, 1994). Although most male nurses say they love the profession, they do not appreciate being treated like women (Hilton, 2001, p. 14). Nursing is gradually changing its image to that of a profession for both genders, although many male nurses believe that stereotyping continues within the profession as well as in the public (Armstrong, 2002). Oxtoby (2003) maintains that the stereotype is changing. Positive role modeling of male nurses and midwives depicted by popular television programming is one explanation for the image change, in addition to career opportunities previously not available such as independent practice (Oxtoby, 2003). Despite these advancements, men in nursing continue to report episodes of exclusion from gender-specific areas of care (Whittock & Leonard, 2003). These exclusions come primarily from female nursing colleagues rather than female patients. Gayle Cudé, PhD, RN, is associate professor and coordinator at Langston School of Nursing at Tulsa in Tulsa, OK. DOI:10.1177/1091592304269633 According to Patterson and Morin (2002), male students have expressed concerns about maternity nursing rotations. Most of the men in the study sought ways to avoid the postpartum setting by requesting additional time in newborn nursery or labor and delivery because of their heightened level of comfort in those units and a greater sense of personal acceptance by the nursing staff. Students claimed that the maternal-newborn clinical experience was rewarding because it provided them with the opportunity to teach and interact with patients, nevertheless male nursing students verbalized relief that the rotation had ended (Patterson & Morin, 2002). The discussion of the legal rights of men to work in maternalnewborn nursing is an ongoing one. In two cases, the courts have ruled that female gender is a legitimate qualification for labor and delivery nurses, while the Equal Employment Opportunity Commission (EEOC) has determined these qualifications to be discriminatory (Boughn, 1994). A number of experts in the field have published several arguments supporting the position that there is no reason why men could not or should not provide or be accepted for women s health nursing care. Brown (1986) argues that female nurses can be educated to act professionally when providing for the physical needs of male patients; therefore, the male nurse with the same education and dedication to the physical well-being of his patients can do likewise without violating the privacy and dignity of female patients. Brown further asserts that female patients who choose male physicians should be equally open to receiving care from a male nurse. Subsequent authors have pointed out that there is no logic in the fact that obstetricians are traditionally male and yet a strong bias often exists against male obstetric nurses (MacRae, 2003). While both male and female nurses are equally competent to care for female patients, it s noteworthy to examine the female patient s perspective in regard to her caregiver. Lodge, Mallett, Blake, and Fryatt (1997) conducted a study to determine gynecological patients perceived levels of embarrassment when provided care given by female and male nurses. Although significant statistical findings indicated a preference for female nurses by female patients, one-third of the patients stated they had no preference for the gender of the nurse (Lodge et al., 1997). Patient comments from the study include, If we saw more male nurses on the wards we would become less embarrassed (p. 899) and Male nurses are often more gentle and kinder (p. 900). MacRae (2003) compared perceptions of men in obstetric nursing among AWHONN members, male registered nurses (RN), and pregnant women. The majority of respondents belonging to AWHONN and nurses who had worked with male nurses in maternity care had supportive attitudes toward male nurses. The majority of the respondents surveyed reported that men belong in obstetrics, and they claim that professional nursing competence is more important than gender 344 AWHONN Lifelines Volume 8 Issue 4
(MacRae, 2003, p. 170). Likewise, pregnant women were supportive of men in obstetric nursing. Clinical nurse educators were found to be less likely to perceive men in obstetric nursing in a positive light. According to MacRae (2003), male nurses reject obstetrics as a career option due to lack of interest, lack of comfort level, and societal bias (p. 171). Morin, Patterson, Kurtz, and Brzowski (1999) specifically studied women s responses to care provided by male nursing students. Patients expressed a preference for female nurses mainly because of the private nature of the care given. Some patients indicated that their partners viewpoint was a major factor in whether or not to accept a male nursing student. Characteristics of the male student were important; women expressed acceptance when the student exhibited professional behavior. While most of the women preferred female nurses, they expressed a need for male nurses in general. Some even viewed depriving the male student of the opportunity to care for them as discriminatory yet it did not affect their decision about male students in the maternity setting (Morin et al., 1999). While supporting a patient s right to decline care provided by a male nurse, O Lynn (2003) contends that discrimination based on gender should be considered an ethical issue similar to ethnic discrimination. Kelly et al. (1996) assert that faculty and administration specifically identify male student nurses as different merely by referring to them as males, leaving the students with a tendency to have perceptions of isolation, exclusion, and receiving different treatment from that of their female counterparts. Both men and women are held accountable for the same objectives in nursing school, but society has different expectations for men and women. During the obstetrics rotation, male students often find themselves in awkward circumstances, sometimes facing rejection from both patients and nurses, thereby making it difficult to meet the course objectives. Male Student Nursing Experiences The class from which the following stories were gathered was more than half male, including three who were interested in careers in maternal-newborn nursing. During their senior research seminar, the impact of gender roles in nursing education and practice were discussed frequently. The following accounts are from several men from the seminar describing their obstetric nursing rotation. I want to be seen not as a male nurse but just as a nurse. My father was a nurse, so I am comfortable with the idea of being a man in that position, stated one young man. We never saw ourselves as different. During our maternal-newborn rotation, our clinical instructors prepared us to provide the same care as our female classmates and never once implied there was any difference, declared another male student. He encountered differing attitudes when he began hospital rotations. He stated, It appeared to us that staff perceived us as assets as long as we were willing to help turn, lift, move, bathe, or walk patients. It seemed as though we had to prove our motivations for working in nursing, especially when giving care to female clients. Another male student was initially anxious that maternity patients might have concerns about receiving personal care from a male nursing student; however, he found the hospital nursing staff expressed more concern about it than the patients. Sean s Perspective My experience as a male nursing student in obstetrics was a bit different from that of my male peers. Previous students told me that I would be treated differently as a male in a profession dominated by women. They warned me that female nurses would run me out. I had few interactions with nursing staff during my first semester of nursing school. As I began the second semester obstetrical rotation, the frequency of interactions with the staff increased as well as my awareness of gender differences. Laboring patients seemed to object to care provided by a male student nurse prior to receiving an epidural. After the epidural, it was my observation that most women I encountered no longer objected. The treatment I received from the hospital staff varied widely; male physicians seemed to enjoy having the opportunity to work with me, whereas some female nurses seemed to conveniently forget explanations pertaining to procedures. Additionally, I felt as though I was playing a game of tag with the obstetric nurses to whom I was assigned; I felt as though I was getting in the way when I was instructed by a staff nurse to stand in the corner and observe. When I took the initiative August September 2004 AWHONN Lifelines 345
to try and be actively involved, I was told to wait. My experience in labor and delivery was different from my peers, both of whom had wonderful experiences in obstetrics. My perception of this rotation was that the nursing staff was negative and nonsupportive. Alan s Perspective My experience working in obstetrics was incredible with a pace that was fast and challenging. I was assigned to a nurse who was experienced and demonstrated an ability to teach. When we entered a patient s room, she introduced the two of us, explaining that we were working together. Not once did she apologetically introduce me as a male student. She never said Alan is a student nurse working with me today; will that be okay? My patient assignment was diverse; not one female patient objected to me providing care. The nurse I worked with served as a mentor and made the experience wonderful. She told me that if I could keep up with her, she would be happy to answer any questions I might have, and I had plenty of them. She explained everything we were doing and why we were doing it. While she was teaching me, she was teaching the patient. The patients in this hospital delivered in birthing rooms. The fathers seemed to gravitate toward me, giving me a unique opportunity to visit and answer their questions. Holding the newborns and seeing the joy they brought to their parents was an awesome experience. Maternal-newborn nursing facilitated the nurturing side of my personality. I decided that obstetrics nursing was for me, but then I began to encounter the negative aspects of being a male nurse. When I was just another student doing a clinical rotation, nobody seemed to mind. However, once I began to state that I wanted to work in obstetrics, I perceived a different attitude from the maternal-newborn nurses. The more I studied the literature pertaining to males in obstetrical nursing, the more I felt that the possibility of working there was unrealistic. Although I wanted what I saw as a challenging career in maternal-newborn nursing, it was an unrealistic dream. Following my maternal-newborn clinical experience, I felt discouraged and began to feel that despite my hard work and good instruction from faculty, I could never enter maternalnewborn nursing. For the first time I saw myself limited by my gender. My experience in obstetrics opened my eyes, and I cannot help but wonder if this is how women feel in a maledominated work area. Regardless, in the future I will be more sensitive to gender issues in the workplace. Richard s Perspective My desire to work in labor and delivery was tempered by the assumption that it was not a realistic goal. Moreover, I was unsure whether I could endure additional stress after having recently completed nursing school. When I expressed a desire to work in obstetrics, the maternal-newborn faculty encouraged me to pursue a career in this area of nursing. This desire stems directly from my positive experience as a student in this area. I spoke with the obstetric nurse manager about applying for a position in labor and delivery, and she assured me that she would check into hospital policy regarding the gender issue. A week later, I received a call from her and scheduled an interview. The manager told me that she asked the staff to share their thoughts about hiring a male nurse for the obstetrics unit. At first, the women responded with, We can t have a male nurse in obstetrics. However, as the discussion proceeded, several nurses asked, why not? By the end of the discussion, the staff was in favor of the idea. According to the manager, most physicians expressed their support as well. Because of the nurse manager s objective and thorough approach, I was able to overcome stereotypes. I accepted a position that afternoon. Implications for Practice and Education Because both men and women must fulfill the same requirements to obtain RN licensure, men should not be denied the option to obtain employment in maternal-newborn nursing solely based upon gender. Discrimination against male nurses must come to an end, beginning with nursing school, according to Burtt (1998). Nursing faculty has an obligation to elim- 346 AWHONN Lifelines Volume 8 Issue 4
inate gender-specific references to nurses from the curricula. Faculty should present maternal newborn nursing as a choice for all their students, both male and female. Clearly men and women can function equally well in maternal-newborn nursing. Female patients are cared for by both male and female physicians; therefore, it seems just as logical to be cared for by both male and female nurses. The AWHONN position statement maintains that nurses, regardless of gender, have the right to employment in women s health, obstetric and neonatal nursing based on their ability and qualifications. Furthermore, AWHONN states, Gender is not a qualification requirement to practice as a nurse and gender discrimination in employment is unlawful (Association of Women s Health, Obstetric and Neonatal Nurses, 2001). A review of the literature indicates that AWHONN members, nurses who have worked with male obstetric nurses, and pregnant women displayed positive attitudes toward men in obstetric nursing. While this is encouraging, the remainder of the literature indicates that despite the increase in their numbers, many male nurses continue to encounter discrimination, stereotyping and misunderstandings despite their qualifications. Research has indicated that female patients prefer to be cared for by female nurses, but at the same time, these patients admit that there is a need for more exposure to male nurses. The literature reflects little input from male maternalnewborn nurses about their experience in that particular specialty. Is this because male nurses do not share their observations or because there are a limited number of maternal-newborn male nurses? The literature has shown that female nurses sometimes demonstrate hostility toward male nurses. In contrast, MacRae (2003) found that female nurses who have worked with men in obstetric nursing are supportive of their male colleagues, yet nursing educators held negative attitudes toward men in obstetric nursing. Female patients reveal a preference toward female nurses while at the same time indicate an awareness of bias on their part against male nurses. Nursing faculty must be sensitive to potential gender problems, especially when patients may feel uncomfortable with a male nursing student based on personal or cultural issues (Hilton, 2001; MacRae, 2003). However, male students can function on the obstetrics unit as well as female students if given support and encouragement from the faculty and staff with whom they are working. Therefore, it s important for faculty to examine their attitudes, overt or covert, about male students in obstetrics and recognize the potential negative consequence of attitudes imposed on men in the academic setting. Both nurse educators and nursing staff have the responsibility to ensure that male students are properly received and encouraged in order to gain the experience they need. It s essential for prenatal educators to inform childbirth couples that nurses on the units are of both genders. With the growing emphasis on family-centered maternity care, it s more important than ever that male students receive an adequate experience in the maternal newborn area. Men may not only be beneficial to maternal newborn nursing by caring for the mother and baby, but they may also bring gender balance to the childbirth event by providing support and role modeling for new fathers, thereby making the experience more family based in the process. References American Nurses Association. (2004). Nursing facts: Today s registered nurse Numbers and demographics. Retrieved April 24, 2004, from http://www. nursingworld.org/readroom/fsdemogrpt.htm Armstrong, F. (2002). Not just women s business: Men in nursing. Australian Nursing Journal, 9, 24-26. Association of Women s Health, Obstetric and Neonatal Nurses. (2001). Gender as a qualification requirement for nursing positions in women s health, obstetrics, and newborn nursing. Position statement available at www.awhonn.org. Retrieved July 16, 2004, from http://www. awhonn. org/awhonn/?pg=873-6230-7000-4810-7300. Boughn, S. (1994). Why do men choose nursing? Nursing and Health Care, 15(8), 40-41. Brown, M. D. (1986). Why won t they let us deliver babies? RN, 7, 69-71. Burtt, K. (1998). Male nurses still face bias. American Journal of Nursing, 98(9), 64-65. Hilton, L. (2001). A few good men. Nurse Week.Retrieved August 25, 2001, from http://www.nurseweek.com/ news/features/01-05/men.html Kelly, N. R., Shoemaker, M., & Steele, T. (1996). The experience of being a male student nurse. Journal of Nursing Education, 35(4), 170-174. Lodge, N., Mallett, J, Blake, P., & Fryatt, I. (1997). A study to ascertain gynaecological patients perceived levels of embarrassment with physical and psychological care given by female and male nurses. Journal of Advanced Nursing, 25, 893-907. MacRae, M. J. (2003). Men in obstetrical nursing: Perceptions of the role. MCN, 28(3), 167-173. Morin, K. H., Patterson, B. J., Kurtz, B., & Brzowski, B. (1999). Mothers response to care given by male nursing students during and after birth. Image: Journal of Nursing Scholarship, 31, 83-87. O Lynn, C. (2003). Men in nursing. American Journal of Maternal Child Nursing, 28(6), 399. Oxtoby (2003). Men in Nursing. Nursing Times, 99(32), 20-23 Patterson, B. J., & Morin, K. H. (2002). Perceptions of the maternal-child clinical rotation: The male student nurse experience. Journal of Nursing Education, 41(6), 272. Streubert, H. J. (1994). Male nursing students perceptions of clinical experience. Nurse Educator, 19(5), 28-32. Whittock, M., & Leonard, L. (2003). Stepping outside the stereotype. A pilot study of the motivations and experiences of males in the nursing profession. Journal of Nursing Management, 11, 242-249. August September 2004 AWHONN Lifelines 347