Leading an Initiative to Addressing Gender Associated Incivility in Nursing Education

Saturday, 23 February 2019: 1:20 PM

Brett T. Morgan, DNP, CRNA
Nurse Anesthesia Program, Duke University School of Nursing, Durham, NC, NC, USA
Benjamin A. Smallheer, PhD, RN, ACNP-BC, FNP-BC, CCRN, CNE
School of Nursing, Duke University, Durham, NC, USA
Margory A. Molloy, DNP, RN, CNE, CHSE
Center for Nursing Discovery, Duke University Medical Center, Durham, NC, USA
Helen Gordon, DNP, CNM, CNE, CHSE
Accelerated Bachelor of Science in Nursing Program, Duke University School of Nursing, Durham, NC, NC, USA

Background/ Significance:

In December of 2017, a focus group was conducted among male nursing students in an Accelerated Bachelor of Science in Nursing program to identify barriers within the educational environment. In addition, potential strategies for overcoming those barriers were discussed. One unanticipated finding was the presence of significant female to male incivility between students. Related, student participants felt that faculty either failed to recognize the behavior or did not have the skills to intervene. The male students also suggested that simple tactics might be effective in preventing this type of student misconduct, and those could have a significant impact on the learning environment.

Uncivil behavior is not a new phenomenon in nursing education. In fact, it is well understood that nursing students often experience behaviors such as bullying and isolating comments from other students. In addition, students who are receivers of these behaviors often report a much different educational experience compared to those who do not. The behaviors most commonly identified in the literature include: name calling; refusing to include others in activities or study groups; making racial, sexual, or gender specific insults; speaking negatively about a student to others; or making belittling comments about other students in-front of the class. These behaviors extend outside of the traditional classroom and have also been well documented in the online learning environment.

Bullying behavior on university medical campus' is not limited to students in the classroom. Several studies have demonstrated that faculty to faculty bullying has a significant effect on work performance, satisfaction, and academic progression in healthcare professional programs. Workplace violence and behaviors of bullying and incivility are common between faculty and clinicians as well. Healthcare professionals experience significant workplace incivility. Nurses have long reported that workplace violence between healthcare providers has a significant impact on their ability to care for patients.

Until recently, the topic of gender driven incivility in higher education has not received much attention. Several studies have now shown that gender dynamics play a significant role in negative behaviors within groups. This is especially true when there is a disproportionate number of one gender type. In undergraduate nursing education, men account for approximately 10% of the student population. This is unique in healthcare provider training programs. It is therefore, not entirely surprising that male nursing students have had negative behaviors directed towards them by their female colleagues.

Initiative to Address Gender Associated Incivility:

Information gathered during the focus group was used to construct an action plan, designed to address gender associated barriers for male nursing students. In particular, it was decided to focus on addressing the uncivil behaviors that were reported between male and female nursing students. A stepwise approach was used to engage in targeted conversations and activities, designed to inform educators and students about issues surrounding gender and incivility, as well as equip them with skills to manage behaviors that occur. The year-long plan includes:

· Gathering key stakeholders: The team collectively identified potential avenues for discussion and impactful implementation of interventions. This initially involved targeted discussions with key academic leaders such as the Dean of the School of Nursing and Associate Dean for Diversity and Inclusion. In addition, the team met with faculty from the school's pre-licensure nursing program to make them aware of issues identified by the focus group, and to illicit suggestions for interventions to be implemented.

· Additional Focus Groups: An additional focus group was conducted using a similar group of participants. The goal was to gain additional insight into gender associated barriers and conflicts in nursing education. Additional schools of nursing were recruited to participate in a study that will replicate these focus groups at multiple sites.

· School-wide discussion: Findings from the focus groups have been shared with school of nursing leadership, and a school-wide discussion on gender-related issues in nursing education has begun. This has included conversations at the faculty governance meetings, one-on-one meetings with key leadership, and a planned presentation at a school-wide "Diversity Conversation" in the Fall of 2018.

· Engaging and empowering student groups: Faculty mentors for the school's chapter of the American Association of Men in Nursing (AAMN) have charged chapter leaders to reach out to other student nursing organizations for collaboration to include the Emergency Nursing Students Association and Neonatal and Pediatric Students. These collaborations focus on team building activities and service projects, including a blood drive and an open-house for area male high school students considering a career in a healthcare profession. The AAMN chapter also planned a "Nursing Specialty Speed-dating" event open to all nursing students. This activity allowed for men within various professions of nursing to serve as role models, professional mentors, and expert resources within their area of specialty. These types of events are intended to foster better understanding of differences between groups of students and lead to a stronger appreciation for the strengths all students bring to the profession.

· Faculty development workshop: Funding has been secured to build and implement a faculty workshop that will focus on developing skills to both prevent and manage uncivil behaviors in the classroom, with an emphasis on gender driven issues. According to research, if actions are taken against uncivil behavior, an enhanced learning environment can be created for all students. Potential strategies found in the literature include both proactive and reactive measures. Proactive measures include actions such as: incorporating strategies and expectations on incivility into course objectives, class assignments, and grading policies. In addition, faculty can model appropriate behavior, as well as facilitate deliberate discussion on issues around incivility in the learning environment. It is equally important for faculty to have reactive skills in the event that they witness negative behaviors between students. These skills should include taking immediate and appropriate action in a manner that is supportive, composed, and unemotional.

Evaluation Plan:

· Faculty confidence: To measure the impact of the faculty development workshop, it will be important to evaluate faculty's confidence toward recognizing and addressing gender-associated incivility in the educational environment. Longitudinal measurements will determine the initiative's success along with identifying proper time intervals for skill refreshers and re-education. These measures will occur both before and after the faculty development workshop, and in intervals throughout the year-long initiative.

· Continued focus groups: The project team will continue to hold focus groups with students from the pre-licensure program to further explore gender-related issues in nursing education. Additional focus groups involving faculty will also be held to explore the impact of discussion and training around issues of gender-associated incivility.

Further Implications and Conclusion:

Attention towards diversity and inclusivity, both in the nursing workforce and the educational environment are being recognized for their importance. However, a great deal of work still needs to be done in order to achieve impactful changes. The challenging experiences of male nursing students have been studied and described for many years. Minimal strategies, however, have been employed to address these challenges. As equality for all students begins to take priority in the educational landscape, leading successful initiatives such as these described will be vital. These initiatives will bridge the gap between the current environment of nursing education and the potential for an equitable environment free of gender associated biases and barriers.

See more of: I 05
See more of: Oral Paper & Posters