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The hidden bias that keeps men out of nursing

The shortage of nurses makes it all the more important to address the profession’s gender imbalance by tackling unconscious bias against men in selections for nursing courses and the workplace, say the University of Nottingham’s Aimee Aubeeluck, Jamie Waterall and Joanne S Lymn.

The shortage of nurses makes it all the more important to address the profession’s gender imbalance by tackling unconscious bias against men in selections for nursing courses and the workplace, say the University of Nottingham’s Aimee Aubeeluck, Jamie Waterall and Joanne S Lymn


Picture: John Houlihan

Nursing is a dynamic and evolving profession that can offer something for everyone. Yet most NHS trusts have substantial deficits in terms of nurse numbers, and since the referendum the number of EU nurses registering to work in the UK has been in significant decline.

The NHS is facing unprecedented challenges in the recruitment and retention of nurses. However, there is a large untapped pool of potential nurses in the UK, if only the profession could reach out to this group: men.

While positive role models for men in nursing are now routinely seen in TV shows with healthcare settings, for example Charlie Fairhead and Jacob Masters in the BBC drama Casualty, the number of men in nursing remains stubbornly low. NMC gender split data show that the proportion of male to female registered nurses in the UK has been 11% to 89% since 2008, with only a 1% variation in 2013-14.

Figures unchanged

This is mirrored in data from the Higher Education Statistics Agency that show the proportion of male to female nursing students in the UK sits at 11.6% to 88.4% and has remained stable over the past decade.

The fact that men still constitute such a small minority of the nursing profession suggests that, despite various attempts to promote nursing careers to men, there remain barriers to them entering the profession.

Recent literature argues that stress, discrimination and stereotyping all affect the ability of the nursing profession to recruit and retain men (MacWilliams, Schmidlt and Bleich, 2013).

Men may face a number of gender-based barriers, including the lack of a narrative about the history of men in nursing, a lack of role models, and isolation (Hodges et al 2017).

On a societal level, ‘touch’ has been normalised as a caring behaviour of women, which often leaves male nurses feeling the need to defend their career choice and their contribution to the profession (Black, 2014).

Bearing in mind that all professions are a product of education, which starts with student recruitment, it is critical to ensure that higher education institutions (HEIs) are not unwittingly reducing the numbers of men entering the nursing profession through an unconscious bias.

Stereotyping

The values or attributes that we view as integral to the role of the nurse may mean that interviewers deselect male candidates on the basis that they are, for example, too assertive, bold, tough or less sensitive to the feelings of others, based on stereotyping rather than on the candidates’ interview performance.

Conversely, interviewers may positively discriminate towards women, who may stereotypically be seen to possess traits and characteristics that align more readily with nursing values and the six Cs, in particular care and compassion.


Picture: Paul Stuart

Issues of gender equality are important for HEIs, encouraged by the Athena SWAN Charter. The charter was established by the British Equality Challenge Unit in 2005 to recognise commitment to advancing the careers of women in science, technology, engineering, medicine and mathematics (STEMM). This was expanded in 2015 to a wider range of subjects with the remit of addressing gender equality more broadly.

Challenge

When we as a higher education institution (HEI) applied for an Athena SWAN silver award we received feedback that challenged the equity of our recruitment practices, with male applicants to our nursing programmes less likely to be made an offer than female applicants.

As the University of Nottingham is an HEI that prides itself on a commitment to ensuring equality and diversity, the identification of potential unconscious bias came as a shock, and has led us to reflect on how we can revise our admissions processes and our selection of applicants to ensure that men are not deterred from training as nurses with us.

We have worked with Public Health England to produce a short video that promotes male nursing careers and is being used in our marketing strategy.

Male representatives

Similarly, we are using photographs of all our award-winning nursing students, male and female, on our website to demonstrate that the nursing profession attracts a range of people, all of whom can flourish within our education and training system.

In addition, we ensure that there is at least one male academic nurse and one male student ambassador at all recruitment and selection and open day events.

To manage any potential unconscious bias in our recruitment and selection processes, we have moved to a multiple mini-interview selection style, which is seen as the gold standard in terms of recruiting for values and is also thought to be less liable to bias than other methods. There is at least one male interviewer on every selection panel, often one of our students.

Attainment

While it is too early to tell whether these actions will make a sustained difference, they do seem to be having a positive impact. The proportion of male applicants offered a place following interview has risen over the past two years and was 26% in 2017, close to that for females (31%).

The percentage of male applicants who accepted an offer from us increased from 5% to 9% between 2015 and 2017. Data suggest that once in training men do as well as women in terms of degree attainment, with 47% of male students gaining first class degrees compared with 39% of female students.

Hopefully these experiences will initiate discussion in other HEIs and encourage them to look at their recruitment and selection processes to ensure that male applicants are not disadvantaged.

Issues in the workplace

There is, however, only so much that HEIs can do to address unconscious bias in the profession. Retention of male students across the duration of their training is affected by their experiences in practice. Similarly, retention after qualification is the responsibility of the wider profession, and raises the challenge of addressing potential unconscious bias in the workplace.

On a positive note, the chief nursing officer for England and the RCN have announced they will lead a programme to look at the future image of nursing. This could provide a real opportunity to address the gender inequalities in the profession, which may be contributing to the high level of nurse vacancies across the country. Although it is a huge challenge, nursing has never been a profession to shy away from challenges and will undoubtedly embrace this one.


Aimee Aubeeluck is director of admissions, University of Nottingham, school of health sciences
Jamie Waterall is national lead for cardiovascular disease prevention & associate deputy chief nurse, Public Health England, and honorary associate professor, University of Nottingham
Joanne S Lymn is national teaching fellow of the Higher Education Academy, and dean and head of school, school of health sciences, University of Nottingham

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