Supporting male nursing students – what works best?

In New Zealand in 2021, male nursing students remain a minority in the classroom. While men comprise nine per cent of the New Zealand nursing workforce,¹ male student numbers often sit well beneath this figure in bachelor of nursing (BN) programmes.²

Reasons for these low numbers are unsurprising yet complex, occurring within the historical journey of nursing embedded within society’s constructed gender roles. For male students who do battle through these societal barriers, a disproportionate number, compared to their female peers, drop out early.^{2, 3} The need to diversify the nursing workforce is essential, but more critically, growing the total nursing workforce is desperately needed to meet current and predicted population needs. This article explores strategies to retain male nursing recruits in BN programmes.

In nursing education, the term equity is used frequently within teaching, student support and pastoral care. For good reason, the concept is often applied to Māori or Pacific student populations. Male nursing students are also in the minority as nursing students, and often miss out on the support required to keep them in the BN programme. Judging by their low numbers and high early attrition rates, such support is surely deserved. Reasons for this oversight are numerous, but often involve unconscious assumptions that men do not need assistance.⁴ Because of the socialisation of gender roles in nursing and their minority status in class, many male students may feel pressure to excel and, consequently, are reluctant to seek help.⁵

Educators should not be blamed for inaction, if they leave male students to fend for themselves in the undergraduate environment. There are some strong assumptions fuelling this situation: firstly, that they do not need support; secondly, that they are reluctant to seek help when they need it, preferring to just get on with it; and thirdly, that men in nursing frequently streak ahead of their female peers in terms of career progression and promotion.⁶ You, the reader, probably know male colleagues, or males you trained with, who have rapidly moved into management, or perhaps advanced practice roles. Nevertheless, the critical point here is these males survived the BN through to graduation, when many do not.

It would also be unfair to assume nursing schools do not attempt to address this issue, as effort and resourcing is often allocated for this purpose. This can include staff members keeping tabs on male students, either formally or informally, or the formation of facilitated support groups. However, with the hectic nature of an academic’s workload, exacerbated by staffing shortages and hiring freezes in the current climate, these kinds of initiatives are often not prioritised at the individual and school level. With this in mind, a sustained, equitable support strategy for male students needs to be initiated, evaluated and disseminated to enhance retention nationally.

Meaningful connections between staff and all nursing students is a central determinant of success in the BN degree and beyond.⁷ These relationships are especially important for minority groups of students, such as Māori, Pacific and, of course, males. In a perfect world, staff members, male or female, should be proactively creating meaningful connections with male students from day one. Yet it is not entirely clear how these relationships may differ between female or male staff members.⁷ The quality and effectiveness of the staff member’s approach may be influenced by several factors, such as individual knowledge, both in nursing experience and scholarly activities, and unconscious bias.²

Staff-student mentorship model

Considering this, creating a mentorship model that pairs male staff with male students would be valuable. Having already experienced being the “only dude in the room”, male staff should have built-in experiential empathy. Also, they themselves should possess tried, tested and perfected strategies and coping methods to address issues or roadblocks that exist only for men in nursing. These include practising safely with certain patient cohorts, navigating the feminine-dominated influences within the curriculum and dealing with their sense of masculinity being challenged by others.²

These relationships should also offer general strategies for navigating life as a new student within a BN programme, which may be practical or academic in nature.⁸ It must be stressed, however, that mentoring should not be a platform to offer males an academic advantage over their female peers. Further, these relationships should centre on respect and manaakitanga.⁹ This is especially pertinent, given that in 2016, just 207 male RNs identified as Māori.¹⁰

Anxiety and unease for male students often peaks in the first four to six months of a BN degree, and this is often the time frame for most withdrawals from the course.^{2, 8} While this uncertainty happens for previously stated reasons, there may be another more powerful driver. For many male students, the choice of nursing as a career is far from accidental. Many men enter nursing later in life, as a second or third career change, after interaction with an RN.² Personal experience of having an RN in the family or being the recipient of nursing care themselves, frequently drives men into a nursing career.² The key protective factor here is having had previous real-life exposure to what nursing actually entails in the 21st century.

Others may have a limited awareness of the true scope of nursing. This is often fostered by the frequency with which certain nursing specialties are portrayed in the media, such as general ward nursing, practice nursing, or high acuity areas such emergency department or intensive care unit nursing. It is noteworthy that even in these portrayals, male RNs are often absent, unless playing a more custodial role as psychiatric nurses.¹¹ Additionally, nurses in television and film are usually painted as subordinate to medicine,¹² which ignores the level of autonomy and skill required to be an RN.

Compounding this is the fact that the practical introduction to nursing is often via placements in aged residential care (ARC) in the first year of the BN. In our view, this is a highly complex area, requiring skilled nursing care, with an increasing level of autonomy. However, students often are blinded to this, as they are placed in ARC with the aim of learning “basic nursing care” from health-care assistants, and not RNs.

The true scope, flexibility and diversity of nursing should be showcased and celebrated early in the degree – for the benefit of all genders. However, this is especially important for males, if we want to retain them beyond year one.² At this time in the BN, staff-student mentorship programmes would prove valuable to enable male students to expand their internalised construction of nursing, which would help enhance resilience during early clinical placements. It would be naïve to expect students to enjoy all their clinical placements; however with a mentoring programme, strategies could be put in place to help students see beyond their current placement and to align learning objectives with their wider nursing aspirations.

Mentorship in clinical practice

A somewhat unsurprising barrier to the implementation of such a mentorship programme is that, as in the general nursing population, male staff members are also thin on the ground in education.¹³ One solution could be the expansion of male mentorship roles into clinical practice. The pairing of male RN mentors to male students in a long-term assignment could help reduce feelings of isolation.

These feelings of isolation can be pronounced early in BN studies, as clinical placements tend to be in areas where there are fewer male roles models, eg aged care. Later in the degree, clinical placements tend to be in acute areas, such as mental health, emergency department and intensive care, where there are more male nurses working.^{2, 13} These mentors could check in on students periodically during their BN studies and could even extend their mentorship into the mentees’ new-graduate year. To enhance uptake and convenience for the clinician mentor, these interactions could be virtual, via chat applications or Zoom, meaning the location of both parties is no barrier.

Grouping students together

The implementation of a peer-mentorship scheme as a stand-alone programme, or in combination with clinician mentorship, may also be valuable. Pairing, or grouping second- or third-year students with those at the beginning of their nursing education, may facilitate resilience and a growing sense of community among new male students, while simultaneously decreasing isolation through the realisation that their own position and journey is not unique.⁸ Ideally, it would be beneficial if these linkages were actively mobilised by staff before the first clinical placement, to ameliorate anxiety related to the unknown.¹⁴

Rather than merely pairing men with men and leaving them to it, staff must aim to provide all mentors (from RN clinicians to student peers) with training, support and ongoing supervision.¹⁴ The provision of mentorship is by no means a one-way process. Both mentor and mentee benefit and grow through enhanced teaching and leadership skills.¹⁵ For those who give up their time to mentor however, professional recognition should be considered, eg, as a minimum, such mentorship should attract professional development hours.

A sustained, long-term commitment must be made to recruit more males into nursing.

A sustained, long-term commitment must be made to recruit more males into nursing. Doing so will not only diversify the workforce, but will help to meet increasing population health needs. In the short term, however, efforts should be made to retain male students currently studying and those about to embark on training. To support this, male-RN-to-male-student mentorships and/or the initiation of male student peer mentorship programmes should be implemented. These initiatives are low stakes and low cost in terms of resourcing but they do require a level of networking and commitment from staff and clinicians alike.

A positive by-product of Covid-19, however, is that networking and communicating via technology has meant remote relationships are now more commonplace and accepted. This same technology should be fully used to enhance male-to-male mentorship programmes, with the aim of supporting men through their BN studies and to graduate successfully as RNs.

Max Guy, RN, MHSc (Nsg), is a tutor at the School of Nursing, Massey University, Manawatū. Shelley van der Krogt, RN, MHC, is a senior tutor at the School of Nursing, Massey University, Wellington.

References

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