More Than Just Male Nurses: Initiating Sustainable Processes and Structures to Promote and Protect Gender Diversity among Nevada's Male Nursing Workforce

With more than 3.1 million practicing members, nursing is recognized as the largest discipline in the U.S. health care system (Ahmed, Andrist, Davis, & Fuller, 2013; American Nurses Association, 2014a).  Nurses play a pivotal role in the consistent delivery of safe, high-quality, and cost effective, patient-centered health care, and have essential responsibilities in preventing medication errors, reducing rates of infection, and facilitating patients’ transition from hospital to home (Institute of Medicine, 2011; Wendel, O’Donohue, & Serratt, 2014).  For 13 consecutive years, 2002 to 2014, nurses have been recognized as the most honest and ethical profession in the U.S. outranking other highly respectable professions including physicians, police officers, clergy, and members of Congress (American Nurses Association, 2014b; Gallup Inc., 2014).  Despite tremendous public attention regarding the profession’s commitment and dedication to the advocacy, delivery, and promotion of societal health, safety, and well-being, there has been a documented shortage of the nursing workforce dating back to World War II (American Association of Colleges of Nursing, 2014c; American Nurses Association, 2014b; O’Lynn & Tranbarger, 2007).  According to the  U.S. Bureau of Labor Statistics (as cited by American Association of Colleges of Nursing, 2014C), the total number of vacant Registered Nurse (RN) positions is projected to total 1.05 million by the year 2022.  The hallmark 2011 Institute of Medicine (IOM) and Robert Wood Johnson Foundation (RWJF) report The Future of Nursing: Leading Change, Advancing Health called upon the nursing workforce to meet escalated demands of a reformed health care and public health system despite prominent shortages of nursing personnel (Institute of Medicine, 2011; Coleman, 2013).  The absence of a nursing shortage equates to fewer deaths, lower failure-to-rescue incidents, lower rates of infection, and shorter hospital stays (Blegen, Goode, Spetz, Vaughn, & Park, 2011).  The IOM and RWJF recognize today’s nursing shortage is unique suggesting it is equally important to increase the overall number of adequately trained and educated nursing personnel while supporting and promoting the general diversity of the overall workforce (American Association of Colleges of Nursing, 2014a; Institute of Medicine, 2011).  Diversifying the nation’s nursing workforce is imperative to meet the evolving dynamics of a substantially increasing diverse population (American Association of Colleges of Nursing, 2014a; Center to Champion Nursing in America, 2014b).  Increasing diversity among health care professionals improves access to care for minority patients, improves patient choice and satisfaction, and allows for better educational experiences for health professional students (Institute of Medicine, 2004).  Racial, ethnic, and gender minorities account for 30% of the U.S. population, but fewer than 15% of all RNs (Center to Champion Nursing in America, 2014a).  Among those minorities least represented in the U.S. nurse workforce are nurses identifying themselves as Asian, Native American, Pacific Islander, and male (Robert Wood Johnson Foundation, 2011a; 2011b). 

Men represent approximately 52.8% of the U.S. working-age population. However, women represent a higher proportion of workers and account for over 80% of the workforce in over half of all health care related occupations including nursing (United States Department of Health and Human Services, 2015).  Social, political, and economic values consistently perpetuate the feminine image of nursing (McMillian, Morgan, & Ament, 2006).  Very little has been written regarding the contribution, history, and role of men in nursing (Kenny, 2008).  As a result, nursing has been historically and predominately viewed as an exclusively female-dominated profession (Mackintosh, 1997; United States Census Bureau, 2011; 2013; Xu, 2008). Contrary to popular belief, virtually all the origins of the nursing profession lies completely in the hands of men called upon to care for the ill or injured in asylums, workhouse infirmaries, military services, and private associations (Mackintosh, 1997; Kenny, 2008; O’Lynn & Tranbarger, 2007; Roth & Coleman, 2008; Xu, 2008).  The first documented nursing school existed in India around 250 B.C. and only admitted male students because only men were considered “pure” enough to perform nursing duties (Kenny, 2008; Xu, 2008).  Nursing remained a predominately male dominated professional until the 19^th Century when Florence Nightingale, the founder of modern day nursing, dramatically transformed and feminized the science of nursing (Hsu, Chen, Yu, & Lou, 2010; McLaughlin, Muldoon, & Moutray, 2010; Xu, 2008).  Following her transformation of the profession, Nightingale firmly established nursing to solely be a woman’s profession proclaiming women who entered nurse training were only doing what came natural to them because of the innate feminine characteristics of the profession including cleanliness, compassion, and selflessness (Evans, 2004a; 2004b). Since the middle of the last century men have slowly reentered and regained their place in nursing following Nightingale’s radical feminization of the profession (Blackman, 2009).  However, there remains a noticeable shortage of males entering the nursing profession due in large part to gender-related stereotyping, misconceptions or misperceptions regarding the significance of work done in nursing, and a lack of available male role models for men entering or already involved in nursing. Approximately 56% of male nursing students report significant challenges faced during nursing education based on their sex including being a minority in a female-dominated field, being portrayed as “muscle strength” by female nurses, and being perceived as non-caring (Rajacich, Kane, Williston, & Cameron, 2013).  Furthermore, men leave nursing altogether 2.5 times more often than their female counterparts (Hayes et al., 2012; Rajacich et al., 2013).  Men contribute unique perspective and skills significant to the profession and society (Robert Wood Johnson Foundation, 2011a).  Evidence suggests doubling the number of men entering nursing would likely reduce if not completely eradicate the overall nursing workforce shortage (Bonair & Philipsen, 2009).

Approximately 2.7% of U.S. RNs were men in 1970 compared to 9.1% in 2011 (United States Census Bureau, 2011; 2013; United States Department of Health and Human Services, 2013).  Globally men account for 5.8% of RNs in Canada, 10% of RNs in the United Kingdom, and 23% of RNs in the Netherlands (Blackman, 2009; Roth & Coleman, 2008).  The state of Nevada currently ranks 47^th among states in the number of RNs per 100,000 residents at 724.7, significantly lower than the national average of 920.9 (Nevada Legislative Counsel Bureau, 2008; United States Department of Health and Human Services, 2013).  Approximately 8.8% of Nevada’s RN workforce is male, slightly lower than the national average (Griswold, Etchegoyhen, & Packham, 2014). Currently there are no publically recognized formalized processes or structures in place to recruit, promote, and protect the gender diversity of Nevada’s male nursing workforce.  The American Assembly for Men in Nursing (AAMN) was founded in 1971 by Steve Miller and Luther Christman and is recognized as the only professional nursing organization dedicated to men (American Assembly for Men in Nursing, 2011; 2014d).  Collectively, AAMN exists and is organized to promote the recruitment and retention of men, and provides a framework for nurses to identify, explore, and discuss factors affecting men in nursing (American Assembly for Men in Nursing, 2014a; 2014d).  Strategic objectives of AAMN include; 1) encourage men of all ages to become nurses and join together with all nurses in strengthening and humanizing health care, 2) support men who are nurses to grow professionally and demonstrate to each other and to society the increasing contributions being made by men within the nursing profession, 3) advocate for continued research, education, and dissemination of information about men’s health issues, men in nursing, and nurse knowledge at the local and national levels, and 4) support members’ full participation in the nursing profession and it’s organizations and use of the Assembly for limited objectives stated above (American Assembly for Men in Nursing, 2014a, par. 2).  Despite great need, there is currently no local chapter of AAMN for Nevada’s male nurse workforce to actively participate in.

The Doctor of Nursing Practice (DNP) practices at the most advanced levels of nursing delivering evidence-based direct care, managing systems, and leading quality initiatives impacting organizations and policy at organizational, intraorganizational, and industry levels (Ahmed et al., 2013; Borkowski, 2009; Dahnke & Dreher, 2011; Institute of Medicine, 2011).  Doctors of Nursing Practice (DNPs) are recognized as leaders in health care who demonstrate commitment and dedication for innovative changes that maintains urgency, sets consistent direction, reinforces expectations, and provides resources and accountability for the nursing profession and U.S. health care system as recommended by the Patient Protection and Affordable Care Act (PPACA), IOM, and RWJF (Ahmed et al., 2013; American Association of Colleges of Nursing, 2014b; Borkowski, 2009; Institute of Medicine, 2011).  The purpose of this DNP-student led initiative is to charter Nevada’s first local chapter of AAMN likely improving the proportion of men who are nurses in Nevada ultimately reducing the state and overall national shortage of nursing personnel.