Collaboration and teamwork, both inter and intra-professionally, are essential skills for the nursing profession (American Nurses Association, 2015; International Council of Nurses, 2012; QSEN, n.d.) and deemed a necessary component for positive patient outcomes, nurse satisfaction, and nurse retention (Suter et al., 2012). One factor to consider when examining ability to collaborate and work together is attitudes of acceptance between different work groups. In the case of nursing, male and females constitute two distinct work groups. Since males are typically a minority in the nursing workforce, it is important to determine if there are issues with attitudes of acceptance that may interfere with teamwork and collaboration.
Males are generally underrepresented in the nursing workforce worldwide. Males comprise 6.4% of the RNs in Canada (Canadian Nurses Association, 2012), 9.5 % in South Africa (South African Nursing Council, 2017), 9.6% in the U.S. (United States Census Bureau [USCB], 2013), and 11.5% in Australia (Nursing & Midwifery Board of Australia, 2016). Efforts to increase the number of men in nursing are important to improve inclusivity of male patients and decrease health disparities (Robert Wood Johnson Foundation, 2011) in addition to enhancing the nursing profession (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011). Despite the recognition given to the importance of improving the ratio of males in nursing, the number of men in nursing has only grown approximately 7% over the past 40 years in the United States (USCB, 2013). This raises the question, why gender diversity in nursing has not been more rapid? This question could be explored from both recruitment and retention perspectives. The latter was the approach chosen for this study.
The purpose of this non-experimental, correlational, descriptive study was to investigate if the attitudes of acceptance of male nurses are different between male and female nurses, by comparing male and female nurses’ scores on the Sexist Attitude Inventory, and to explore correlations between female nurses’ levels of acceptance and certain demographic variables.
Methods:
A convenience sample of all male and female nurses employed at three health care facilities within the same health system in the Midwest was utilized. Data was collected from May 9th - May 31st, 2017 via an online anonymous survey. The Sexist Attitude Inventory (SAI) was used to measure attitudes of acceptance of male nurses. Bentivegna (1974) originally developed this tool to measure the attitudes of acceptance of female home economics professionals of males in the same profession, but envisioned it to be used by other professions that are dominated by one sex. The higher participant’s score on the SAI, the greater the attitude of acceptance of males in that profession. The tool was successfully adapted and utilized in a nursing study by McMillian, Morgan, and Ament (2006) which included changing the title of the tool to “Attitude Inventory” along with replacing all of the terms “home economics” with “nursing” within the tool itself. These same adaptations were also employed in this study.
The SAI was developed via the solicitation of statements of attitudes regarding males entering this female dominated profession by sending 200 open-ended questionnaires to male and female faculty and graduate students in the profession or related professional disciplines at a large, eastern U.S. university. The 127 responses received were refined into 46 item survey and piloted with 175 male and female graduate students in home economics and related fields at this same university. The Kuder-Richardson formula 20 (KR20) for the 46 items in the survey is .996 (Bentivegna, 1974) and .826 (Bentivegna & Weis, 1977). Cronbach’s alpha for the tool in its original form is .87 (Bentivegna, 1974) and .832 (Bentivegna & Weis, 1977) and .87 in its altered form (McMillian et al., 2006). In this study, the Cronbach’s alpha was .83.
A total of 435 nurses submitted surveys. Participants who did not identify gender or answer all of the SAI items were eliminated from the analysis. This resulted in a final sample of 311 nurses (251 females and 60 males; 72% of the original participants). Per McMillian et al. (2006), a response rate of 144 completed surveys was necessary to reach power and statistical significance.
Results:
Total SAI scores ranged from 118-154 for males and 108-160 for females. The mean score for males was 137.42 (SD= 9.06, SE=1.17) and 130.52 (SD =9.45, SE=0.59) for females. The difference between the males and females total SAI scores, 6.90, Ca 95% CI [4.25, 9.55], was significant t(309) = 5.12, p < 0.001.
There was a significant, positive correlation between the female’s highest-held nursing degree and attitudes of acceptance (n = 251), rho = .21, p = 0.001. There was not a significant correlation between the female’s age (n = 251), r = -.08, p = 0.19, years of nursing experience (n = 244), r = -.09, p = 0.17, number of male pre-licensure program classmates (n = 221), r =.07, p = 0.32, and number of male pre-licensure program faculty (n = 240), r = .10, p = 0.11 and attitudes of acceptance.
A t-test for independent groups was conducted to compare the scores of the male and female nurses on each item of the SAI. Significant differences (p < 0.05) were noted on 24 of the 46 items. Insights into the relationship between male and female nurses were also gleaned from the items for which both genders agreed upon.
Conclusion:
Although it appears when comparing the female nurses’ SAI scores to McMillian et al.’s (2006) results that attitudes of acceptance of male nurses have improved, their level of acceptance was still significantly less than male nurses’ attitudes of acceptance of male nurses. The only variable found to be correlated to the female nurses’ attitudes of acceptance was education. This positive correlation provides some additional support for nursing employers to encourage and assist their nursing staff’s degree advancement.