While nursing still has many more women working in it than men, more and more men are entering the profession each year. Minority Nurse spoke with some men working in the field to find out what they believe could be done to help recruit more men to work in this great career.
Overall, one of the first things that those in the profession need to do, some say, is eliminate the misconceptions about the field. Daniel Satalino, a nursing student at Seton Hall University in South Orange, New Jersey, says that there aren’t as many men in nursing because of an ongoing stereotype that nursing is solely a feminine field. “Historically, caregiving was thought to be a primarily female responsibility because the female in the family would nurture infants and be responsible for childrearing, while the male would be responsible for hunting,” says Satalino. “However, many men also participated in caregiving as shamans and spiritual healers.”
Satalino also explains that the roots of nursing come from the Catholic Church and the expansion of the Roman Empire where both nuns and monks alike assumed nursing roles in the hospital setting. Likewise, he says, as the plague spread throughout Europe, the Parabolani—a group of men who assumed nursing roles—were the primary nurses for infected people.
“Despite this, many people proclaim that the rise of nursing came with Florence Nightingale, a well-known English nurse who founded standards for nursing care in the mid-1800s, which are still used today. Nightingale also provided education for nurses. However, no males were allowed to enter the profession at this time,” says Satalino. “An influx of males into modern nursing came during and after the second World War, where male nurses were primarily needed in field hospitals and in psychiatric nursing.”
It’s important to know this history, Satalino says, because men have assumed nursing roles in the past, and they can provide great care like their female counterparts. “There have been many campaigns to increase female participation in STEM fields; however, there have been little-to-no campaigns to increase male participation in nursing,” he explains.
Another misconception is the “old school” view that nurses are physician helpers who give baths and hand out medication, says Larry G. Hornsby, CRNA, BSN, senior vice president of operations for the southeast division of NorthStar Anesthesia in Birmingham, Alabama (the company’s home office is in Irving, Texas). “[It] is simply inaccurate and misleading to what this profession has to offer,” he explains. “It is hard to convince the public of the opportunity that exists today with a degree in nursing and the tremendous variation of work choices and the varied job opportunities that exist.”
Besides getting the word out about men working in nursing and what nursing offers, what else can be done to encourage more men to enter the field?
Recruiting more men into nursing begins with educating them. And the earlier, the better.
Carl A. Brown, RN, BSN, is director of patient care services for BrightStar Care of Central Western Riverside County in Menifee, California. Brown has been in nursing for 27 years, having started as a U.S. Navy Hospital Corpsman and a CNA. “It all starts with education. The younger we approach males about choosing nursing as a career path, the more likely they will consider it,” says Brown. “It should be known that nursing is not a female-only career choice. To counteract this notion, I think more male nurses need to participate in community events, career days, or job fairs. More of us need to be out in our communities advocating on behalf of this profession for males. Furthermore, there should be national campaigns launched by nursing organizations to help create more incentives—like a scholarship—to entice more males into the field.”
Matt George, CNA, at the Hospital of the University of Pennsylvania, agrees. “The nursing field could attract more men by such measures as having a mentorship program for male high school students—allow high school students to shadow male nurses. This way, they can see what a male nurse does,” he says. The same thing could be done for freshmen at college. In order to attract more males, they need to see males working and achieving in the field. The only way to get more men interested in nursing is by reaching them at a young age and showing them this is a career where men work and can be great at it.”
Hornsby also agrees that reaching high school students would help. Aggressive marketing to the male population is needed as well. “Certainly, the growing need and the autonomy for advanced practice nurses is exciting news that everyone, including men, should hear,” explains Hornsby. “Salaries and benefits have improved over the years, and the opportunities for special work are ever-expanding.”
Explain the Benefits
Another way to help recruit men to nursing is to have male nurses explain why they love being in this type of work. Learning from someone doing the work already can be quite influential.
“For me, the greatest thing about nursing has been my ability to be successful outside the ‘traditional’ role of a nurse. The ability to become a Certified Registered Nurse Anesthetist and practice to the full scope and licensure in hospitals, ambulatory surgery centers, and physician offices afforded me a tremendous challenge, opportunity for professional growth, and great personal satisfaction,” says Hornsby. “Then moving into a business role and a managing partner/owner of a successful anesthesia management company allowed me to acquire new skills and knowledge, but the opportunity to remain grounded in my nursing roots. Patient care is always at the top of a nurse’s education, clinical training, and a top priority each day. These helped carry me through the business decisions. Other men should really look at the variation of practice roles and how they could fit into an exciting career with growing opportunity.”
Brown has already spoken with a few men who have asked him why he is a nurse. “I tell them that because of my military training, I learned the value of human life and protection our soldiers and sailors. Without those available to fight our enemies, we could not fight to protect those at home,” he says. “In turn, as a nurse today, I tell them that nurses are the most trusted profession there is—more than police, fire fighters, clergy, and educators. We are responsible for ensuring that a father or mother gets back to their children or grandchildren…that we are responsible for ensuring that a family is relieved of the stress of watching their family member pass in distress. Nursing is a field that provides the satisfaction that you have made a difference in someone’s life every day.”
Look around at your coworkers and you’re likely to find a gray hair or two. It’s no secret that the nation’s registered nurse population is not only aging, but also shrinking. Nursing Economics recently reported that over 60% of the current RN work force is over 40. While “40-something” isn’t old, it does mean that over half of our current nurses will hit retirement age by 2025—or even earlier.
At the same time, nursing school enrollments have steadily declined during the last 10 years and the percentage of registered nurses under the age of 30 has dropped by 40% since 1980. When the baby boomer generation of nurses starts retiring en masse, who will take their place?
In an effort to reverse this alarming trend, a growing number of national, state and local initiatives are aggressively working to cultivate the next generation of nurses. Many of these programs are particularly targeting minority young people, both male and female—and for good reason.
The Bureau of Public Health, part of the U.S. Department of Health & Human Services, estimates that while racial and ethnic minorities make up 25% of the country’s population, they comprise only 10% of the nation’s health care work force. And while the number of men in nursing has increased significantly since 1980, they still represent only about 5% of the current RN population. Clearly, these numbers indicate a huge untapped human resources potential that the health care profession cannot afford to ignore if it is to meet the nursing needs of the 21st century.
To address this challenge, career education programs such as Health Careers Exploring, Colleagues in Caring and others are reaching out to girls and boys while they are still in high school—or even grade school—to sell them on the idea of nursing as an exciting career option. These innovative initiatives aim to hit early and often in an effort to tear down real and perceived barriers that block minorities and men from entering the nursing field.
One of the most popular and successful of these efforts operates under the umbrella of Learning for Life, a national program with over 300 local offices coast-to-coast. Designed to support the federal School-to-Work employment preparedness initiative, and serving elementary, middle school and senior high school students, Learning for Life is actually two programs in one.
The first component, Learning for Life, is a classroom-based program that provides teachers with action-learning lesson plans for grades K-12. The Exploring component is a worksite-based program with a scouting-like format that lets students visit “Explorer posts,” such as community organizations, to learn about the dynamics of various careers, such as business, engineering and science.
Within the Exploring framework, the National Health Careers Committee sponsors Health Careers Exploring. While this program covers a wide range of different health professions, such as medicine, dentistry and pharmacy, it has a strong nursing component, helping introduce kids to career options such as LPN, nurse-midwife, nurse anesthetist, nurse practitioner and more. As Health Explorers, students not only learn by shadowing health care providers but also through hands-on activities, classroom discussions and volunteer opportunities.
Barbara Broome, RN, PhD, chair of the community/mental health nursing department at the University of South Alabama in Mobile, is just one example of a minority nurse who is helping to reach out to the next generation of nurses by being actively involved in a local Health Careers Exploring program. The university sponsors an Explorer post that strongly targets inner city neighborhoods and currently has 58% minority participation, including many black and Vietnamese youths.
Broome, who is African American, visits area high schools to talk about nursing to young people aged 14-18, an audience she says isn’t as hard to play to as some would imagine. In fact, the students are usually attentive and interested.
“I typically tell them who I am, what my education is and why I decided to be a nurse.” But Broome doesn’t stand at the head of the class and lecture. Instead, she sits in a circle, at the same level with the students.
“I make it conversational and try to pull each of them into the discussion,” Broome explains. “I also expose students to some of the things a nurse actually does—simple hands-on activities like taking a blood pressure or listening to a heartbeat.” While such demonstrations are usually a hit with students, she adds, it’s best not to overdo it: The kids can easily become more interested in taking blood pressures than learning about nursing career opportunities.
Broome encourages other nurses of color who are involved in outreach programs like Health Careers Exploring to make a one-on-one mentoring connection with a student, even if just for a brief period of time—for example, by just talking with the student for a few minutes after class or giving him/her your card in case they have questions. “It doesn’t mean that you spend all of your time talking about careers,” she says. “Just being a friend and helping a student pick the right classes can help that young person succeed.”
Each year, Broome recruits her University of South Alabama students to help with the Exploring program’s efforts. Grace Tolbert, a senior nursing student who is a native of the Philippines, enjoys meeting with the high school students and feels it’s something she owes to her heritage. Even though Southern Alabama has a significant Asian-American population, Tolbert is currently the only Filipino nursing student at the university. She therefore becomes an instant role model to young Asian Health Explorers who may have never seen a nurse with their same skin color.
“Because I work at a community clinic that serves a large Asian population, I feel that it’s important to go to the high schools and talk about nursing,” Tolbert maintains. “I tell the students that this is a field where more Filipinos and Asians are needed.”
Caring About the Future
One national career outreach program that focuses exclusively on nursing is Colleagues in Caring, funded by the Robert Wood Johnson Foundation and sponsored by the American Association of Colleges of Nursing (AACN). The program is based on the mandate that “health care professionals—in particular, nurses and the institutions they staff—must take proactive measures to build a work force with the capacity to adapt to the changes in the nation’s health care system.”
To accomplish this mission, Colleagues in Caring has a strong state and regional focus. Currently the program boasts 26 regional sites, including Alaska, Hawaii, California, New Mexico, Arizona, South Dakota, Texas, Minnesota, Iowa, Mississippi, Maryland, New Jersey, Massachusetts and the District of Columbia.
Colleagues in Caring helps regions build strong networks and alliances that in turn provide support to areas that are having a hard time attracting students to health care careers. Each regional program brings together government agencies, employers and schools along with community leaders, professional associations and health care consumers to determine what nursing work force development strategies will work best in their localities.
South Carolina’s Colleagues in Caring project, housed at the University of South Carolina School of Nursing in Columbia, is of particular interest because it is reaching out to future nurses through the medium of choice for today’s youngsters: the computer. The program’s Web site features a special “South Carolina Future Nurses Kids Club” section (www.sc.edu/nursing/cic/KidsClub/KidsClubIndex.html.)
To encourage area kids to join the online club, “we went into five or six elementary schools to present activities and information about nursing,” explains project director Renatta Loquist, RN, MSN, FAAN. “We gave the students coloring sheets and a postcard for their parents to send in, giving permission for their children to join the club.” From those initial visits during its pilot year, the program received 60 postcards from new members. In return, the children received a certificate of membership.
In addition to answering the question “What is nursing?” the Future Nurses Kids Club Web site includes information on nursing jobs and nursing education. Young people can also find answers to frequently asked questions like “Is nursing only for girls?” and “Do I have to work in a hospital?” The site has links to organizations such as the National Student Nurses’ Association, and the program’s staff is constantly working to add new features and maintain students’ interest in the club.
Launched in May 2000, the South Carolina Colleagues in Caring program’s primary targets are minorities and boys. Loquist estimates that less than 5% of the state’s nursing population is male and only 11% are minorities. She adds that the project isn’t content just to plant the seeds of interest in nursing careers in young people’s minds—it plans to follow these students as they grow older, continuing to provide them with information about nursing as they get closer to making actual career decisions.
“Through the club, we’re developing a database so we can keep in touch with these children,” Loquist notes. “Students receive something in the mail from us four times a year, such as a Valentine’s Day card, to keep reminding them that we’re out there.”
If Loquist succeeds in meeting her objectives, the database will be much larger after the program’s second year as it seeks to reach every fourth and fifth grade classroom in the state. Because her limited staff resources won’t permit Loquist to personally visit every class in South Carolina, she has enlisted the help of nursing organizations, nursing schools and nurse employers to visit schools in their local areas. Again, students will be told about the Web site and given the opportunity to join the Future Nurses Kids Club.
The South Carolina program also has strong ties to community interests, including local Chambers of Commerce and the state’s School-to-Work initiative. The resulting networking contacts have proved invaluable, says Loquist. For instance, when the cost of copyrighted coloring sheets for the Kids Club became too expensive, the program turned to School-to-Work officials for help in designing its own sheets that could be mass reproduced for much less money.
KIHC-ing Off Nursing Careers
In late April 2001, the federal Bureau of Health Professions (BHPr), with support from the Health Resources & Services Administration (HRSA), will launch an exciting new career outreach initiative it describes as “an approach for the 21st century.” Kids Into Health Careers (KIHC) is a multi-tiered program designed to introduce nursing and other health care professions not only to students in grades K-12 but also to teachers, guidance counselors, school administrators and parents. Most importantly, students served by KIHC must be from an underrepresented minority population or from economically or educationally disadvantaged backgrounds.
HRSA’s fact sheet for the program notes that “the current market fails to train and distribute health care workers where they are needed most, in underserved areas. It also fails to ensure adequate, quality care to underserved and disadvantaged minorities…Under these circumstances, it makes sense for HRSA and BHPr to become the focal point for an initiative to expose underrepresented minority youth to health career opportunities.”
While KIHC is not a funded grant program, it will be used in conjunction with BHPr grants to augment the efforts of existing regional and local programs designed to develop a more diverse health care work force. Nurses and other health professionals who apply for and receive Bureau grants are required to visit schools and community organizations in disadvantaged or minority communities and make KIHC presentations to the program’s student and adult target audiences.
The Kids Into Health Careers program provides grantees with a presentation kit, including visual aids, talking points and reporting materials. All you have to do is plug in your own knowledge, experience and enthusiasm about being a nurse.
By tapping into programs like these, or creating youth outreach initiatives of their own, minority nurses can play an important role in helping to increase both the numbers and the cultural diversity of future talent entering the nursing careers pipeline. As the BHPr says, “Young people must be given the opportunity to see who health professionals are, what they do and how their efforts affect the health and well-being of the nation.” And that means letting the next generation see that nurses are male, female, black, white, Hispanic, Asian, American Indian, Filipino, multiracial and more—just like them.
How to Sell Nursing to a Sixth Grader
“It is hoped that by reaching children at an early age, they will choose a health career and will prepare accordingly,” says Sam S. Shekar, MD, MPH, associate administrator for the federal Bureau of Health Professions. Unfortunately, when nurses visit elementary and high school classrooms to encourage students to consider nursing careers, they often find that kids have already formed less-than-positive opinions about the profession—also at an early age.
To help overcome objections that students may have about nursing careers, Barbara Broome, RN, PhD, chair of the community/mental health nursing department at the University of South Alabama and an active participant in a local Health Careers Exploring program, offers these suggestions for responding to some common misconceptions about the profession. She also feels that school guidance counselors need to have good information about nursing, so that they can advise students interested in entering the field.
Students view nursing as a service industry job. Female students especially tend to see nursing as a service job with little responsibility or challenge. To counter this impression, Broome brings a variety of nurses with her when she speaks to classroom groups. A nurse dressed in a lab coat with a stethoscope walks in, followed by a nurse with a laptop, a nurse in a business suit with a briefcase, and so on. Students are asked to pick out the nurse. “Without fail, they all point to the traditional lab coat and stethoscope,” Broome says. Brief skits are then used to show how each of these nurses represents a different nursing career option and to explain the different responsibilities involved in each.
Even though it’s the 21st century, many minorities have never met a nurse of their own color and thus feel it’s not an occupation for them. The success of many of these outreach programs will depend on their ability to provide role models for minority youths. Broome says she’s honest with students who ask about any negative experiences she’s had as a minority nurse, but she’s also quick to share the excitement of dispelling those prejudices and of helping your own people.
Boys think nursing isn’t a masculine occupation. Bringing in male nurses is often critical to involving the entire classroom in the discussion, Broome has found. If only female nurses are present, the boys aren’t even going to listen.
Students don’t think they have the grades. Many youngsters believe they have to be straight A or B students to pursue a nursing career. While nurses should encourage students to do their best and should let them know that science and math courses are not optional, students should also be assured that it’s OK to get some Cs—or even fail a class. Broome always mentions that she failed algebra the first time she took it. That usually perks up a few students who had showed no interest just a few minutes before. “It’s like a light bulb goes on and they think, ‘Hey, I can do this!’” she says.
Students have heard bad things from a nurse. “When a student’s cousin tells them not to be a nurse and has a whole list of reasons, that’s a hard act for us to follow,” Broome admits. Presentations by groups of enthusiastic, successful nurses who love their careers can help students see the other side of the story.
Students don’t know about the possibilities for advancement. “Many students have not had enough exposure to nursing to know the difference between an LPN and a BSN, or even that many nurses have a master’s or doctoral degree,” Broome points out. “I try to explain the different career levels and let them know that they can enter the profession and then move up.”
For More Information
Learning for Life/Health Careers Exploring
1325 West Walnut Hill Lane
P.O. Box 152079
Irving, TX 75015-2079
Colleagues in Caring
American Association of Colleges of Nursing
One Dupont Circle NW, Suite 530
Washington, DC 20036
Kids Into Health Careers (KIHC)
Bureau of Health Professions
5600 Fishers Lane, Room 8-67
Rockville, MD 20857
Contact: Anthony Hollins, Jr.
“Times and rules have changed a lot since I was first in nursing school back in the ’60s,” recalls Eddie Hebert, R.N., B.S.N., director of nurses at Louisiana State University Health Sciences Center in Houma, La. “However, many of the prejudices which males faced back then are still with us today.”
“For example, I was not allowed to enter the delivery room because I was a male student, but had to stand at the door of the room to catch a glimpse of the delivery,” he explains. “I was also not allowed to have a female patient. This all had to do with gender.”
Hebert also remembers studying textbooks that made no mention of the male gender—except as the patient. “All educational materials were oriented to the female gender,” he notes. “Males were seen in nursing texts as the anatomy to be studied—the one in need of female assistance. Every picture seemed to identify the nurse as the ‘caring female individual,’ while the patient was always a ‘male in need of care.’”
However, that was almost 40 years ago, some may argue. Certainly the bias and prejudices toward men in nursing that existed at that time no longer exist. Right?
Wrong, according to Gene Tranbarger, Ed.D., R.N., CNAA, associate professor of nursing at East Carolina University in Greenville, N.C. “Open discrimination against men is fast disappearing from schools of nursing but remains imbedded in the school fabric,” he observes. “The faculty still relies on feminine pronouns when discussing nurses. Male nurses who wish to work in obstetrics/gynecology still face obstacles and often have to resort to legal remedies.”
What about male nurses who happen to be racial/ethnic minorities? Do they face similar issues as non-minority male nurses, or do they experience a whole other array of issues? Though there is no single united viewpoint or experience that speaks for all minority men in nursing, theirs is a voice that is growing in strength and numbers. It is a voice that loudly proclaims the importance of the nursing profession reflecting the diversity of its patient population—including gender.
Approximately 5.4% of the 2.1 million R.N.s employed in nursing in the United States are men, according to the National Sample Survey of Registered Nurses conducted in March 1996 by the Health Resources and Services Administration. Of these working male R.N.s, the racial and ethnic breakdown is:
“The last survey showed a progressively aging work force and that we needed to do more to encourage young people from diverse backgrounds to go into nursing,” says Vincent C. Rogers, D.D.S., M.P.H., the HRSA’s associate administrator for health professions. “The 2000 survey results will help us develop policies and programs to strengthen the nurse work force in practice and education.”
The survey also found that roughly 13% of students enrolled in nursing schools are men. Dwight Elliott, a senior in nursing at East Carolina University, is one of two men in his class of approximately 80 students. “I am the only black male in my graduating class,” he notes. “It has been kind of tough being a black male in a predominantly white female profession. I’ve caught some looks like, ‘What is he doing in nursing? He doesn’t look like a nurse.’ I feel like I must work twice as hard as others because one, I’m black, and two, I am a male.”
Elliott is not the only one turning heads as a male nurse. Ifeanyi John Nwokocha, R.N., B.S.N., a staff nurse at La Rabida Children’s Hospital in Chicago, recalls receiving a few strange glances himself while at a previous nursing job. He explains, “When I used to work in med/surg, I got reactions like, ‘Oh—a male nurse?’ I even got questions like, ‘Are you an orderly?’ People do not expect to see a black male nurse.”
Elliott agrees, noting that nursing has traditionally been a white female profession. “I feel that as more men come into nursing, [men as nurses] will become more widely accepted. My family and friends ask, ‘You want to be a nurse? Why not a doctor?’ I guess they feel that traditionally males are doctors and females are nurses.”
Stereotypes of nurses as being female and white have persisted throughout the years but do seem to be lessening as the number of minorities (including men) in the nursing profession has gradually increased.
Francisco Navarro, R.N., a nurse at La Rabida Children’s Hospital, has seen the effects of such stereotypes firsthand. “Some of the kids [I work with] have a hard time dealing with the fact that I am a nurse because they say that only women can be nurses,” he explains. This bothers Navarro, who believes the notion that only women are nurses is an idea the children learned from schoolmates or family. He also notes that society often labels male nurses as being homosexual.
To some extent, male nurses have been viewed as being different or gay due to their close working relationship with women combined with the assumption that nurses are female, believes Hebert. “For many years, nurses were considered the ‘handmaids’ of the physician,” he observes. “Today, things are a little different. Physicians have come to realize that nurses are much smarter than given credit for years ago. Nurses are now moving into higher management roles and are more educated than in the past.”
Hebert also feels that society is slowly becoming more comfortable with men as nurses. “Although people may feel a little uncomfortable at first sight of a male nurse, they will quickly come to trust and respect him for his professionalism.” He also believes that unlike female nurses, male nurses have had to prove themselves before being accepted.
“Because of years of publicity and propaganda, [the image of nurses] is fixed in the mind of the general public as being white and female and trustworthy. Minorities in nursing do not have this image.”
It’s Not Always a Man’s World
So how has the stereotype of the white female nurse affected minority men in nursing? The responses range from “a lot” to “not at all.” For Nwokocha, the stereotype has hurt.
“Right now where I’m working, they treat me with respect,” he says. “But in my experience, when it comes time for promotions, I feel like the male minority nurse lags behind.
“For example, when I worked in psych at another hospital, I was bypassed . Even though I knew the unit very well, they bypassed me and gave the position to another person. I feel like it was because I’m black and I’m male. All the promotions there were given to females.”
Bernard Smith, R.N., M.S.N., clinical educator and recruiter at Benjamin Rush Hospital in Syracuse, N.Y., observes that it is sometimes more difficult for male nurses to work in certain specialties (e.g., women’s health) than others. He remembers, “There was at least one physician (in obstetrics) who did not want us around his patients. He did not want any male nurses around his patients.”
Navarro agrees that it is harder for a male nurse to work in women’s health than in other areas of nursing. “I could never work in a maternity unit,” he says. “There was one instance while I was in school when I was asked to interpret for a new mother who did not speak English. My instructor was showing the mother how to hold her breast and the newborn so that the baby would latch on to her breast. I could tell that the mother was uncomfortable—she would not feed her baby while I was present. Her feeling uncomfortable made me feel uncomfortable; I felt as if I did not belong in that environment.”
Both minority and non-minority men in nursing face similar issues, believes Hebert. As a board member of the American Assembly for Men in Nursing, an organization for nurses to discuss and influence the issues that affect men in nursing, Hebert hears of the discrimination and harassment experienced by some of AAMN’s members.
“The fact that male nurses are not given equal opportunity to move up in the ranks or are being denied equal employment opportunities is repeatedly heard during our annual conferences by our membership,” he states. “Many male nurses are denied [the opportunity to work in] certain areas in hospitals, such as labor and delivery units, or nursery units. In my 30 years as a nurse, I have seen many unfair practices in which male nurses and minorities were passed up for promotions due to gender. This practice continues today and is slowly surfacing in courts throughout the country.”
Neutralizing the Gender Issue
At the same time, some men in nursing have experienced no repercussions from the “nurses are women” stereotype and have actually received positive treatment because of their gender.
For example, Ramon Lavandero, R.N., M.A., M.S.N., director of the International Leadership Institute of Sigma Theta Tau International, headquartered in Indianapolis, had a very positive experience working in obstetrics. As one of the first men to go through an obstetrics class at Columbia University’s School of Nursing in New York, Lavandero found the faculty to be extremely supportive, contacting him even before the course began to see if he had any questions or concerns about being the first (and only) male in the class.
“Some people might consider that favoritism because it wasn’t done for the women,” Lavandero says. “On the other hand, it was an acknowledgment of a new circumstance, and they were planning ahead.”
In fact, Lavandero was offered three different positions within the women’s health service after graduation. He believes his experience working in obstetrics taught him an important lesson about the role of gender in nursing. As he explains, “I learned that in great part, I had the upper hand depending on how I treated and dealt with other people. If I was comfortable and didn’t see my gender as being a distraction, then there was no issue. If I was assigned a woman as a patient and if I was at all unsure as I interacted with that patient, then it would become a question.
“So I would go in and say to the patient, ‘My name is so-and-so, and I’m the nurse who will be working with you today.’ Ninety-nine percent of the time, there was never any question. There were a few times when, for example, a mother in postpartum requested a female nurse because she felt she would be more comfortable with a woman. But we had set a very comfortable tone. I can’t really say I have problems because of my gender any more than a woman nurse might occasionally have a problem with a male patient.”
Lavandero agrees that there are stereotypes of women in nursing but emphasizes that there are stereotypes attached to many other careers. “There are stereotypes that soldiers in combat duty are men,” he points out. “Well, you know where that can lead in terms of stereotypes. In the same way, there are stereotypes of men in nursing just like there are stereotypes of women in nursing—just like there are stereotypes of women who teach physical education and of men in engineering.”
Finding Strength in Numbers
Given these stereotypes, what can men in nursing do to find camaraderie?
Join organizations that support men in nursing, encourages Hebert. “There is voice in numbers, and you should seek your special interest organization and see if they will stand behind you and support your issues of concern.”
One such organization is the American Assembly of Men in Nursing, of which Tranbarger is president-elect. “We are a small group of male nurses and their supporters and represent a wide diversity of age, educational background, work experience, sexual orientation, ethnicity and almost any other characteristics one can think of,” he says. “I look forward to each meeting so I can interact with others who share my work, my experiences, my concerns and my hopes for the future.
“I must also add that I enjoy greatly our dedicated women members who share our beliefs that nursing is a profession, not a gender-based occupation,” adds Tranbarger. “AAMN is a healthy organization of men and women and is better because of all who join us.”
Each year, AAMN holds a conference, rotating the theme so that one year focuses on men’s health issues and the next focuses on issues of gender in nursing. “Diverse Nurses for a Diverse World” is the theme of this year’s conference, which will be held in Seattle from November 30 to December 2.
Another organization which offers support to nurses is Sigma Theta Tau International, an honor society of nursing with over 120,000 active members. As part of the International Leadership Institute, the Chiron Mentor-Fellow Program was started in January 2000 to provide the opportunity for individualized leadership development to members of Sigma Theta Tau. Although there were not any men involved in the program at the time of this article’s writing, Lavandero states, “We very much would like to have men involved. We really would like it to be a very diverse program.” He encourages potential mentors to identify a potential fellow and to apply to the program as a pair, believing it to be a valuable way for an experienced nurse and mentor to help another person to develop.
Other sources of support can be one’s fellow nurses—both men and women; it is important not to adopt an “us against them” mentality and alienate those of the opposite gender. Smith urges male nurses to develop friendships with their female colleagues.
“By far, [female nurses] are going to be your greatest source of support and strength,” says Smith. “They always have been for me—just by the sheer weight of their numbers, if for no other reason. But it’s more than that. I’ve learned so much from the women who are colleagues of mine.”
Reflecting the Face of Society
In order to encourage other men to enter the nursing profession, Nwokocha speaks with high school students on an informal basis.
“I meet the students through my nephew,” he explains. “He introduces me to his friends: ‘This is my uncle. He’s a nurse.’ And the students come to me and say, ‘Oh, you’re a nurse? How do you like it? What’s it like being a male nurse?’ Some of the students are excited—they want to become nurses, too. But they also want to hear what it’s like from someone who’s a man. So I talk to them, giving them advice and telling them what nursing entails.”
Tranbarger believes the best way to encourage minorities (including men) to consider nursing as a career is first to speak well of nursing as a profession. “No one wants to join a group that dislikes their work,” he says. “We also need to make schools of nursing more welcoming to non-females and non-whites. Language, symbols and policies all need to give each person a full and fair chance at success or failure.
“I do not know a man who wants an advantage in nursing,” he continues. “Every man I know just wants a fair chance. I think that is true for other minorities as well.”
Lavandero offers some additional insight on this issue. “Rather than simply saying, ‘We need more minority nurses,’ I would phrase it as, ‘We need more men and more people from varied ethnic and cultural backgrounds in nursing because that is the composition of our society today.’ In general, what nurses really bring to the table is an ability to help identify the health care needs of the patients and families in our communities. If we are not representative of our [patient population], then it becomes a lot more difficult to identify and meet those needs.”
“As nurses, we’re expected to provide quality health care to people from a variety of cultural and socioeconomic backgrounds. Without diversity among our ranks, it’s almost impossible to do that.”
That’s how May Wykle, RN, PhD, FAAN, explains her decision to make diversity the focus of her term as the 24th president of Sigma Theta Tau International (STTI), the Honor Society of Nursing.
The society, whose mission is to provide leadership and scholarship in nursing practice, education and research in order to enhance the health of all people and improve nursing care worldwide, has 120,000 active members in 90 countries. Yet, like the nursing profession itself, STTI remains predominately white and female. When Wykle, who is African American, began her two-year term as president in 2001, its membership was 96% female and 93% white.
“Since we are the international honor society of the profession, we should take the lead in defining diversity and making a commitment to achieving it,” asserts Wykle, a distinguished scholar, researcher and geriatric health specialist who is currently dean and Florence Cellar Professor of Nursing at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland. “The diversity in nursing should mirror that of the general population. My definition of diversity is a broad one that includes cultural diversity, but also diversity of gender, backgrounds, resources and talents.”
To achieve these goals, the honor society has launched an ambitious initiative designed to increase and celebrate all forms of diversity within its membership ranks and in the nursing profession as a whole. The push began last year with the creation of a Diversity Task Force, whose responsibilities included drafting the organization’s official position statement on the subject, “Community Through Diversity: A Diversity Statement for Sigma Theta Tau International.”
In stating STTI’s overall motivation in pursuing diversity, the position paper notes that “diversity creates an opportunity to support a mosaic of cultural distinctiveness and nursing excellence through inclusivity, personal and professional development and the stimulation to think in different ways.”
Diversity at the Top
Sigma Theta Tau’s commitment to “the value and active engagement of diversity in achieving the society’s vision” encompasses 10 points, beginning with encouraging dialogue at the both the individual and chapter levels. The society’s more than 400 local chapters and their members are charged with finding ways to enhance diversity, such as developing educational programs that promote diversity, cultural competence and community building.
The initiative also stresses the importance of reflecting diversity in the society’s leadership by seeking officers and committee members from culturally diverse backgrounds. This “starting at the top” approach is vital to any organization’s efforts to build diversity, according to STTI Vice President Carol Picard, RN, PhD.
“You diversify an organization from the top to the bottom and horizontally,” explains Picard, associate director of the Graduate Program in Nursing at MGH Institute of Health Professions in Boston. “Having a diverse leadership makes a difference in [attracting more minority nurses and men] into the organization and in how we present Sigma Theta Tau to the world.”
This year, in addition to Wykle, the organization’s board of directors includes one other African-American woman and three men, including one European. And for the first time, the organization has elected a man, Daniel Pesut, RN, PhD, CS, FAAN, to the position of president-elect. Pesut has been involved in Sigma Theta Tau since his 1976 induction as a nursing student.
“For STTI, diversity is a means to building a community,” he says. “We want a diverse membership so that we can attract the best of the creative minds and backgrounds to build a stronger community within the organization.”
Pesut, who is professor and chair of the Department of Environments for Health at the Indiana University School of Nursing in Indianapolis, feels that attracting more minority and male nurses into the organization can best be accomplished on a one-on-one basis backed by national media coverage.
“We need more coverage of the different kinds of things that men are doing in nursing,” he adds. “The reason I am a nurse is that it gives me creativity and flexibility in career roles. You can be a consultant, you can practice, you can teach. You can do a variety of things with the same fundamental education.”
While the honor society’s national leaders are spearheading the diversity initiative, much of the responsibility for actually changing the demographics of the organization will rest with its local chapters. At the chapter level, diversity doesn’t just mean attracting more male and minority members, but also providing education programs on cultural competence to help all local nurses better meet the needs of the diverse patient bases they serve.
Many STTI chapters have found success in attracting more nurses from underrepresented populations into their membership by jointly sponsoring educational and networking events with other local and regional nursing organizations.
“In Boston, our chapter has partnered with the New England Black Nurses Association to hold a luncheon with a guest speaker,” says Picard. “From those types of events, nurses learn about us and we can establish relationships with [minority] nurses who might be interested in joining Sigma Theta Tau. In turn, these new members take our message back to their nursing colleagues.
“I hope to see more such partnerships engaged in dialogues at the local level,” she adds. “That will give us the broadest impact across the world.”
The honor society will learn more about how well its chapters are implementing the diversity plan at the local level when chapter annual reports are submitted in July.
Encouraging Diversity Today–and Tomorrow
Attracting more men and nurses of color into its current membership is just one aspect of Sigma Theta Tau’s diversity goals. The honor society is also exploring ways to increase the racial, cultural and gender diversity of the nursing profession in the future. One local chapter, for example, is sponsoring a Girl Scout troop.
“We have to talk about the importance of nursing [careers] in the early grades,” Wykle explains. “Nursing has always been held in the highest esteem among racial and ethnic minority groups. We need to build on that.”
One barrier she hopes to challenge is the career advice many minority students interested in nursing careers receive from guidance counselors. “So many of them are counseled to go into two-year [nursing] programs,” she says. “These programs are fine, but students need to be encouraged to keep going and earn a higher degree.”
Wykle believes the low number of associate-degree and diploma students who choose to continue their nursing education at four-year universities can be blamed on the misconception that “a nurse is a nurse is a nurse.” Disproving that myth by demonstrating the career advantages a BSN degree brings would play a key role in drawing more minorities into nursing leadership roles, she adds.
“Once we have attracted a diverse group of students into nursing programs, we want to make sure they have access to faculty and practicing nurses who can provide mentorship and other types of support that help retain minority students,” the STTI president continues. “It’s one thing to bring in people [from diverse backgrounds], but we also have to ensure that they’ll stay in the profession.”
Still another key item on the Honor Society of Nursing’s diversity agenda is to address the disparities in health outcomes and quality of care between Caucasian populations and persons of color. As Wykle puts it, “We want it to be an even playing field.”
To meet this challenge, Sigma Theta Tau hopes to influence the nursing research community so that more members of underrepresented minority groups will be included in research studies.
“To change [health care] practice, you have to have the evidence,” Wykle points out. “Nursing needs research not only to discover improvements in patient care but also to contribute to the growth of the profession. STTI envisions research being conducted not just by nurse scientists with PhDs, but by nurses at all levels who value research and want to solve clinical problems. If nurses don’t do the research, who will?”
Diversity on a Global Scale
Because Sigma Theta Tau is an international society, efforts to promoting diversity within its membership must take a global approach. The organization has chapters in Canada, Brazil, The Netherlands, Hong Kong, Korea, Pakistan and several other countries. This can sometimes cause STTI’s leaders to reexamine membership policies that work well in North America but may not be effective in other parts of the world.
The society’s traditional chapter model is one such structure currently under examination. In the past, STTI chapters have always been affiliated with a university. Now, several nurses in Africa have expressed an interest in forming a Pan-Africa chapter. The nurses involved are national leaders in the profession and members of an association that meets regularly but is not affiliated with a university.
“They came forward to the eligibility committee and said, ‘this is how we connect [professionally] and we would like our association to be the way we bring Sigma Theta Tau to our nurses,’” Picard explains. “So we’re working with them to establish a new chapter model that will fit their needs.”
Being able to interact with international nurses from a diverse range of countries and cultures is a big draw for STTI members, according to Richard Smith, RN, MSN, who has held various local and national positions in Sigma Theta Tau and now serves on its national Public Relations Committee. “You have the opportunity to work very closely with people throughout the world who are working toward a common goal of promoting professional aspects of nursing, whether it’s research or another objective,” he says. “You benefit from gaining their [international] insights and perspectives.”
To Be Continued
Wykle knows that all of her goals won’t be accomplished before her term as president expires next spring. She’s hoping, however, that her two years at the helm have laid the foundation for Sigma Theta Tau International to not only increase its own racial, ethnic and gender diversity but also change the way nursing care is delivered to people of color.
“I think this initiative will eventually impact nursing significantly,” she explains. “Having an international honor organization step up and call for more diversity in nursing is going to improve the image of the profession. It’s going to attract a more diverse group of people into nursing and also attract more young people. We can’t do all of this in two years, but we can have people become more aware of the differences in care [available to white versus minority populations] and work toward a goal of erasing those disparities. We can help people understand that nursing is a wonderful, open profession.”
Becoming a Member
The opportunity to help increase the racial, cultural and gender diversity of one of nursing’s most respected professional organizations isn’t the only reason why nurses of color and male nurses should think about joining Sigma Theta Tau International. Membership in this prestigious international honor society, whose name is synonymous with excellence, leadership and scholarship in nursing, offers many benefits that can help advance your career and foster the achievement of your personal goals, whether your interest lies in clinical practice, education or research.
A 10-Point Plan for Diversity Sigma Theta Tau International’s “Community Through Diversity” initiative encompasses these 10 principles and practices, which the honor society is encouraging at both the chapter and individual member levels throughout the organization: 1. Encourage ongoing dialogue and learning in the area of the richness of diversity and its contributions to building community. 2. Develop and value the organization’s definition, policies and procedures related to diversity. 3. Support and encourage chapters to reflect the richness and diversity of their local and global communities. 4. Encourage chapters and members to find ways to enhance diversity and build community. 5. Stimulate dialogue to learn about cultural criteria for excellence, educational distinction, and ways and means to honor achievements in nursing practice, education, research and community leadership. 6. Respect the richness and diversity of traditions and heritage as the society creates and designs future plans and programs. 7. Seek diversity in nominations and appointments to committees, task forces and key policy and leadership positions. 8. Build a culturally diverse cadre of leaders, officers, board members and staff. 9. Create and use advisory groups to inform and advise the leaders of the organization regarding diversity as a means to create and support a global community of nurse leaders. 10. Develop and promote educational programs that inform and educate members on issues of diversity, cultural competence and community building.
Adding STTI membership to a resume or vita sets a nurse apart as someone who is interested in playing a leadership role in the profession, says Richard Smith, RN, MSN, who serves on the society’s national Public Relations Committee. “The organization stands behind research and supports evidence-based practices,” he explains. “STTI’s emphasis on scholarship and professionalism is its most outstanding feature.”
Smith, an assistant professor at the University of Arkansas for Medical Sciences College of Nursing in Little Rock, notes that his involvement with STTI has benefited him in every stage of his career: as a student, a clinical nurse and now as a faculty member.
“Sigma Theta Tau has opportunities for you no matter what your particular career focus is–whether you’re a clinician who works in a hospital or even a self-employed nurse entrepreneur,” he states. “There’s a heavy emphasis on research, which is necessary for good evidence-based practices. If you’re a faculty member, you want to prepare your students with the latest information for achieving better patient outcomes. Sigma Theta Tau is a good vehicle for that.”
Currently, more than 60% of the organization’s active members are clinicians, 23% are administrators or supervisors and 17% are educators or researchers. Sixty percent of STTI members hold advanced degrees.
How does the honor society recruit new members? Most of them are invited to join while still in nursing school. Undergraduate students must have completed at least half of the nursing curriculum, have a GPA of 3.0 on a 4.0 scale, rank in the upper 35 percentile of their class and meet the society’s expectation of academic integrity. Graduate students must have completed 25% of their curriculum and have a GPA of at least 3.5.
“Student members have access to the same benefits [of STTI membership] that are available to nurses who have been working in the field for many years,” says Smith. “Plus, students have the added advantage of being able to develop a mentor relationship with more experienced STTI members. For graduate students, it’s an opportunity to be involved with faculty as a peer member of the same organization, not just as a student.”
Membership in Sigma Theta Tau isn’t just open to students–practicing nurses are often invited to join as well. They must be RNs, be legally recognized to practice in their country, hold at least a baccalaureate degree in nursing and have demonstrated achievement in the profession.
For these nurses, there is less emphasis on the grade point average they may have earned years ago, emphasizes STTI Vice President Carol Picard, RN, PhD. “We’re looking for people who are community leaders. I can remember having someone come to me and say, ‘my GPA was only 2.9 but I’d like to join.’ This person happened to be running the HIV action committee for a large city,” Picard says, adding that the nurse’s professional accomplishments and contributions to health care outweighed her lack of a 3.0 average.
Even though membership in STTI is invitational, Daniel Pesut, RN, PhD, CS, FAAN, who next year will become the honor society’s first male president, encourages qualified nurses to be proactive about becoming involved in the organization, rather than waiting for an invitation to join. “Visit our Web site and find a chapter near you,” he recommends. “If someone is actively making a contribution to the nursing profession, he or she can certainly seek membership by getting connected with the local chapter.”
For more information, contact:
Sigma Theta Tau International
550 West North Street
Indianapolis, IN 46202
Fax (317) 634-8188
In this country, approximately four out of every 100 young people who enter high school will not graduate. Among racial and ethnic minority populations, the dropout rate is even higher. According to data from the U.S. Department of Education’s National Center for Education Statistics, in 2005 dropout rates for African American and Hispanic high school students were 7.3% and 5% respectively, compared to 2.8% for Caucasian students and 1.6% for Asian American/Pacific Islander students.
Another cause for concern is the growing number of young people who do earn their high school diplomas but are not prepared academically to succeed in college. Universities and colleges throughout the country have been forced to establish remediation programs in response to incoming students’ lack of math and science knowledge.
Nursing schools have been particularly impacted by this trend. Many prospective students cannot pass the nursing entrance tests due to their deficiencies in math and language skills. A 2006 survey of nursing education programs in Michigan, conducted by the Michigan Center for Nursing, found that one of the most significant barriers students faced in trying to finish nursing school–second only to financial and family issues–was “inadequate preparation before entering the nursing program.”
In Michigan, the state has invested over $30 million in university and community college programs aimed at increasing the number of nursing graduates. The severe shortage of nurses in the state, and in the nation as a whole, is a crisis that will not be easily solved. However, one of the most inexpensive and expeditious ways to increase the number of nurses is to introduce young people to nursing careers while they are still in high school.
The Department of Nursing at Madonna University in Livonia, Mich., recently received a two-year, $68,150 grant from the Blue Cross Blue Shield of Michigan Foundation to fund a project called Diversity in Nursing–High School-University Partnerships: Preparing Secondary Students for Nursing Careers. Its purpose is to increase the number of students from diverse backgrounds entering nursing programs and, through a series of academic activities in their sophomore, junior and senior years of high school, prepare them for success in a college/university curriculum. The project focuses on increasing high school students’ interest in choosing nursing as a career by bringing nursing educators and clinicians directly into the schools to help students gain a better understanding of the profession as well as better academic preparation.
The nursing school established a partnership with three urban high schools in the metropolitan Detroit area whose large students bodies represent a variety of ethnic backgrounds. Each high school was assigned a faculty mentor from the university, who worked with academic and career counselors at the school to schedule individual and group information sessions about nursing careers. There were also opportunities for students’ parents and guardians to meet with the mentors to discuss financial assistance and nursing scholarship programs.
The grant funding also enabled us to make opportunities available in each school for students to take the Nursing Entrance Test (NET), which tests students in areas such as math skills, reading comprehension and test-taking skills. Upon receipt of the results, the mentor and counselor met with each student individually, reviewed the student’s educational record for past, current and future coursework, and offered suggestions about the best program of study for a person considering entering a nursing program. This was an eye-opening experience for the students, as many of them did not realize the importance of taking algebra, biology and chemistry in high school.
Instructors from Madonna University taught workshops on Saturdays and in the summer to help students improve in previously identified weak academic areas, such as math. Students were paid a $50 stipend upon completion of the workshop. The students responded enthusiastically to the intense assigned work. As a result, 98% of the workshop attendees improved their NET scores significantly on the retests. The high school teachers reported evidence of increased confidence among the students, as well a more realistic approach to their coursework.
Guiding the Counselors
Another strategy we used in the project was to hold health fairs and nursing career nights at each of the three schools. In addition to the faculty mentors, students enrolled in Madonna University’s nursing program also participated in these events. This gave the high school students an opportunity to meet real nursing students and ask them questions.
In the course of working with the high school counselors, the mentors noted that much of the counselors’ day was taken up with federal and state-mandated testing. As a result, they had limited time to assist students with career counseling. Fortunately, the state of Michigan had recently formulated and released a new directional mandate for counselors, to encourage them to better prepare students to fill job shortages in the state. At the same time, the state had announced fresh initiatives and increased funding for nursing education. The grant project’s advisory board, which consists of counselors, mentors and school administrators, as well as nursing, science, math and sociology faculty from the university, decided that the time was right for a conference that would invigorate counselors.
The free conference was held in November 2006. Carole Stacy, MSN, RN, MA, director of the Michigan Center for Nursing, spoke to the counselors about the informational support and resources they could obtain through the center, such as literature about nursing careers and speakers who could come to the schools and give presentations to the students about trends in nursing. A panel of Madonna University nursing students discussed their experiences of being inadequately prepared when they entered nursing school and the kinds of information it would have been helpful to have received while still in high school. The students’ explanation of the money and time lost because of their need for remedial academic advising had a tremendous impact on the counselors.
One of the newer trends in student retention at many colleges and universities is an Office of First-Year Experience. Minority students in particular are more likely to drop out during the crucial first year of college. To address this problem, these offices work to assist struggling students by providing special services, such as tutoring and peer counseling groups. After speaking at the conference, Christine Benson, director of the Office of First-Year Experience at Madonna University, received many requests from the counselors to speak to students at their high school about realistically preparing for a nursing career.
The initial results of the Diversity in Nursing–High School-University Partnerships project are encouraging. To date, three students from the partner high schools have enrolled at Madonna University and another 12 are enrolled in nursing programs at local community colleges. To build on this success, the university is looking at ways to sustain the project after the two-year grant period ends. The Nursing Department has formed very strong relationships with the high schools, who have pledged their support to help make sure the program continues. Plans are also in the works to expand the program to elementary schools.
The success of this project proves that when secondary school students are given the opportunity to learn that nursing is a rewarding career, and that being academically prepared for nursing school is critically important, they will work hard to achieve that preparedness. However, it is nurses who must reach out to the community, parents and schools to encourage students from all backgrounds to consider nursing as a career and help ensure that the nursing profession truly reflects the culturally diverse world in which we live.