The nursing profession continues to be one of the fastest growing cohorts of health care professionals, with growth projected to increase by 9 percent from 2020 to 2030 (US Bureau of Labor Statistics, Department of Labor, 2022). To support this growth, more qualified faculty are needed to educate the influx of nursing students over the next decade. Unfortunately, however, the United States has been experiencing a persistent nursing faculty shortage. According to the American Association of Colleges of Nursing (AACN, 2022), nursing programs across the nation reported over 2,000 vacant faculty positions across both undergraduate and graduate programs. Insufficient faculty numbers are a contributing factor as to why more than 66,000 student applicants are rejected for entry into generic baccalaureate nursing programs (AACN, 2021). Data collected for the 2019 to 2020 academic year revealed that nearly 50 percent of baccalaureate nursing programs in the United States rejected qualified nursing applicants because of insufficient numbers of faculty (AACN, 2021).
As the nursing faculty shortage continues to increase, it is imperative that leaders in nursing education steer their efforts toward attracting a more robust and diverse faculty population. As our student population continues to diversify across a number of demographic variables, so too must our faculty. National data suggest that the proportion of underrepresented nurse educators has increased incrementally over the last few decades. Recent data indicate that only 16.6 percent of full-time nurse educators identify as belonging to a racial/ethnic minority (National League for Nursing [NLN], 2020). By comparison, men continue to be significantly underrepresented in nursing academia, with only 7 percent of full-time educators being male (NLN, 2020). A lack of male representation in leadership positions within schools of nursing is even more alarming as only 46 of the 783 nursing school deans in the United States (5.9%) are men (Smiley et al., 2021).
Arguably, the biggest contributing factor to the gender homogeneity of nursing faculty is that men comprise only 9.4 percent of the nursing profession as a whole (Smiley et al., 2021). One barrier identified is that society continues to view nursing as a gendered profession (Englund et al., 2021; McDavid, 2018). Many in society continue to identify nursing as a "pink-collar" profession in that the focus is to provide services or care to others (Burton, 2020). Conversely, blue-collar work, largely viewed as the province of men, refers to physically demanding trade work or skilled craftsmanship. Finally, those individuals in white-collar professions are believed to hold positions of privilege, with elevated social and economic standing. The distinction between these types of work suggests that pink-collar work is both less skilled and less prestigious than blue-collar and white-collar work, respectively (Burton, 2020). This viewpoint may serve as an additional barrier to men joining the nursing profession as men tend to be drawn to opportunities that enhance their power and social status, provide leadership opportunities, and yield high-impact outputs (Dino, 2021).
Along the same vein, a common barrier to the progression of men joining nursing academia identified in the extant literature is that teaching is still viewed by society as a profession for women (McDavid, 2018; Ortiz, 2018; Palmer, 2019; Smith et al., 2020). McDavid (2018) conducted a qualitative study to explore why male nurses do not pursue careers in nursing academia. The 10 respondents indicated that society's view of teaching as a gendered profession favored by women played a role in their decision-making. Furthermore, male nurses reported feeling that both physicians and their peers expect they will continue their nursing education to become advanced practice providers, rather than educators or entry-level nurses (Carnevale & Priode, 2018; Sasa, 2019; Smith et al., 2020; Younas et al., 2019). The role of advanced practice provider may be more congruent with the male stereotype and, therefore, acceptable by society's standards. Despite this gendered view, both male nursing students and faculty have reported feeling it is highly beneficial to have male educators in nursing programs as they provide a different perspective of nursing than do women (Smith et al., 2020).
Research suggests that men who make the transition to the role of nurse educator experience a number of barriers to their integration and success in nursing academia (Brody et al., 2017; Ortiz, 2018; Palmer, 2019). Brody et al. (2017) investigated male nurse faculty perceptions of navigating a profession largely dominated by women. Participants, all members of the Robert Wood Johnson Foundation Nurse Faculty Scholars Program, identified several barriers or issues faced in nursing academia. The 18 respondents indicated they were often victims to a variety of negative stereotypes, generalizations, and perceptions about men who pursue careers in nursing academia. They reported feeling that their intellectual abilities were called into question because of the misperception that men would naturally choose to pursue careers in medicine rather than nursing. Men also felt that their motivations were called into question and they were often perceived as being competitive, overly ambitious, and domineering toward their female colleagues.
Navigating an environment largely defined by women can cause male nursing faculty to experience varying degrees of culture shock related to assuming the role of extreme gender minority (Sasa, 2019; Smith et al., 2020). According to Kanter (1977), an "extreme gender minority" can be defined as one gender comprising less than 15 percent of the population in a given enterprise. The lack of male mentorship can make it difficult for male faculty to feel connected to the institution and their peers (Mott & Lee, 2018; Palmer, 2019). Given the profound gender homogeneity of the nursing profession, male faculty have reported feeling pressure to assimilate or conform to dominant social norms (Smith et al., 2020). Adaptation is viewed as vital to their social integration and as a means to ensure professional survival (Smith et al., 2020). Despite this view, a common theme in the literature is that male nurse faculty feel either barely tolerated or completely isolated and excluded in the workplace (Mott & Lee, 2018; Ortiz, 2018; Smith et al., 2020). Lack of social integration and support by female faculty peers can make male nurse educators feel as though they lack an adequate outlet by which to share personal information such as their feelings or concerns (Englund, 2018; Englund & Basler, 2019).
Despite the continued lack of gender diversity within the nursing profession, few studies have been conducted that investigated barriers experienced by men in nursing academia (Englund, 2018; Mott & Lee, 2018; Palmer, 2019). Furthermore, the concept of marginalization has not been investigated as an independent phenomenon in this population. Therefore, the purpose of this study was to investigate the relationship between gender and marginalization in nursing academia.
THEORETICAL FRAMEWORK
Hall et al. (1994) introduced a conceptual framework for the study of marginality within the field of nursing. The conceptual definition of marginalization refers to a process that results in groups being peripheralized because of a number of factors, including a person's identity, experiences, and associations. This multifaceted concept creates a situation in which certain individuals are given limited access to social power; such disparity results in individuals being excluded from tangible and intangible resources, as well as being subject to differential treatment (Hall et al., 1994).
Hall and colleagues (1994) ascribed seven key properties or subconcepts to marginality: 1) intermediacy, 2) differentiation, 3) power, 4) secrecy, 5) voice, 6) reflectiveness, and 7) liminality. Intermediacy is the tendency of human-created boundaries to act as both barriers and connections. Living along the margins carries with it a constant risk of personal or territorial invasion by those in power. Differentiation refers to the maintenance of these boundaries to preserve the distinct identities of individuals or groups; greater physical or social distance from the center correlates with greater diversity of identities.
The third subconcept, power, speaks to the influence exerted by those in power over those individuals who have been peripheralized. Power is bidirectional but also hierarchical in that it dissipates as it extends toward the margins of society. Lack of power causes those on the periphery (i.e., the marginalized) to use secrecy to conceal any differences and avoid betrayal. Secrecy both creates and maintains environments and social groups that are marginalized. Similarly, those in power create an environment where concepts and ideas are expressed in the language of the majority; such an environment results in the devaluation of the voices of the marginalized. Silencing a person's voice alters one's view of the world and facilitates liminality. Liminality speaks to an individual's altered and intensified perceptions of time, worldview, and self-image and results from being repeatedly subjected to being marginalized. Reflectiveness results from the previous subconcepts and describes the psychological effects that result from being marginalized. According to Hall et al. (1994), reflectiveness, or intense introspection, occurs while one constantly relives and analyzes social experiences.
METHOD
Sample and Setting
The researchers implemented a descriptive correlational design to investigate the relationship between marginalization and gender in nursing faculty in the United States. A convenience sample was obtained by accessing the AACN's database of baccalaureate and graduate nursing programs that are accredited by the Commission on Collegiate Nursing Education (CCNE). To establish consistency among programs, only nonprofit nursing schools that offered baccalaureate and graduate nursing were included in the study. The following inclusion criteria were utilized to identify potential faculty participants from each university: 1) be employed full-time as an educator at a CCNE-accredited nursing program; 2) have an earned master's degree or higher; and 3) be proficient in reading English.
Instrument
In addition to completing a demographic survey, participants were asked to complete the Englund Marginality Index (EMI; see Table 1). The EMI is a 19-item scale that addresses the seven subconcepts of marginalization put forth by Hall et al. (1994). Specifically, the tool focuses on the social, personal, and institutional factors present within the domain of education that influence marginalization. Items are measured using a 4-point Likert scale (1 = strongly disagree to 2 = strongly agree); scores range from 19 to 76, with higher scores correlating with stronger feelings of marginalization experienced by participants. Findings from previous studies using the EMI have found the tool to have strong internal consistency reliability with Cronbach's alphas ranging from .89 to .90 (Englund, 2020; Englund & Lancaster, 2022; Lancaster & Englund, 2021). Test-retest reliability of the EMI using Pearson's coefficient was .92, suggesting a high degree of temporal stability (Englund, 2020).
Data Collection
Permission was first obtained from the University of Wisconsin Oshkosh Institutional Review Board (IRB); the study was deemed exempted from full review. An introductory email was then sent to administrators (deans, assistant/associate deans of research, directors, or chairs) at each of the 287 nursing programs that met inclusion criteria. This email contained a number of attachments, including 1) IRB approval letter, 2) demographic survey, 3) EMI, and 4) template for potential participants. The template contained information about the purpose of the study, contact information for the researchers, and a link to the consent page. Administrators were asked to disseminate the template to all faculty employed in both their graduate and undergraduate nursing programs. Once participants consented to participate in the study, they were directed to the demographic survey and then the EMI. All data for the study were collected anonymously using Qualtrics(R) online survey software.
RESULTS
A total of 1,430 participants spanning 39 states comprised the study sample. A descriptive analysis of the data indicates that 313 male (21.9%) and 1,117 female (78.1%) full-time nursing faculty participated in the study. In terms of demographic data, most respondents were non-Hispanic White (n = 1,175, 82.2%), were between the ages of 42 and 64 years (n = 1,079, 75.4%), and had an earned doctorate (n = 1,265, 88.5%). With regard to educator work status, most participants were employed at the rank of assistant professor or higher (n = 867, 60.6%), had indicated they were tenure-eligible (n = 723, 50.6%), and were either tenured (n = 350, 24.5%) or on tenure track (n = 381, 26.6%; see Supplemental Content for table with detailed demographics and an in-depth overview of educator work status, available at http://links.lww.com/NEP/A478).
A psychometric evaluation of the EMI revealed strong internal consistency reliability with a Cronbach's alpha coefficient of [alpha] = .92. This finding is consistent with other studies, which reported alphas ranging from .89 (Englund & Lancaster, 2022) to .90 (Englund, 2020). An independent-samples t-test was completed to investigate the relationship between gender and marginalization of undergraduate nursing students. Results indicate that male participants reported higher scores on the EMI (M = 43.6, SD = 9.9) than female faculty (M = 37.2, SD = 9.6), t(1428) = 6.0, p < .001. Furthermore, mean score differences between male and female faculty for the subconcepts of Differentiation, Power, Secrecy, and Voice reached statistical significance. Table 2 provides a comparison of male and female participants for each of the seven subconcepts of marginalization.
DISCUSSION
Results of this study suggest that male nursing faculty feel more marginalized in academia than do female nursing faculty. Being marginalized can negatively impact job satisfaction as those along the social periphery tend to lack autonomy, support for professional growth, and/or social integration (Ortiz, 2018). A homogeneous faculty population can have far-reaching consequences, as it can be difficult for nursing programs to recruit and retain underrepresented students in both undergraduate and graduate programs (Brody et al., 2017; Ortiz, 2021). A lack of gender diversity in nursing academia has been shown to negatively impact recruitment, retention, and acculturation of male nursing students (Brody et al., 2017; McDavid, 2018). Furthermore, a lack of consistent exposure to male nurse educators may serve to strengthen the misperception that teaching is a gendered profession for women. The retention of qualified faculty is vital to the stability and growth of nursing schools as it helps safeguard the quality of academic programs. Cultivating a stable nursing faculty enables the development of expertise and opportunities for interdisciplinary collaboration (Lee et al., 2017).
The statistically significant differences in overall mean scores for the subconcepts of Differentiation, Power, Voice, and Secrecy suggest that these facets of marginalization are important contributors to the marginalization of men in nursing academia and require further exploration. The higher scores on the subconcept of Differentiation experienced by male faculty suggest that men are aware of and must navigate the boundaries that separate them from their female colleagues. One explanation put forth in the literature germane to this dissonance and the persistent marginalization of men in nursing is that of patriarchal resistance experienced by women in the profession (Smith et al., 2020). Nursing is one of the only professions in America that is largely defined and influenced by women. It is posited that the patriarchal oppression women experience throughout society may cause them to feel almost territorial or reluctant for men to "infiltrate" the nursing profession (Smith et al., 2020). Chronic social and professional exposure to patriarchal oppression can cause strained professional relationships between men and women in the workplace. Feelings of inequity and oppression in society can lead women in female-dominated professions to either overtly or covertly obstruct men from integrating into nursing academia (Smith et al., 2020). In addition, many in society continue to perceive some professions through a gendered lens regarding the masculine versus feminine traits needed to fulfill them. Although these perceptions have changed considerably for women in historically male-dominated professions, men have not made the same inroads in female-dominated professions such as nursing.
As men continue to be a critical minority in nursing academia, it is not surprising that male faculty feel that they lack power in the academic setting. Their lack of representation in nursing further limits their power as programs are severely lacking in formal and informal male mentors (Ortiz, 2018; Powers et al., 2018; Younas et al., 2019). Research suggests that minority individuals tend to seek out mentors who are similar to themselves with regard to key demographic variables such as race and gender (Oliver et al., 2020; Ortiz, 2021). Mentorship fosters career development through networking, emotional support, promotion of work-life balance, as well as protection against incivility and bullying (Nowell, 2019; Ortiz, 2021). Empirical evidence suggests that faculty who are properly mentored report less job stress and greater career growth, professional advancement, and job satisfaction when compared to faculty who are not mentored (Lee et al., 2017; Ortiz, 2021). Furthermore, faculty who are not supported throughout their faculty careers are far less likely to complete their professional responsibilities and remain in a faculty role (Lee et al., 2017; Ortiz, 2021).
Navigating a complex and unfamiliar environment can be disorienting to new faculty, especially those with a limited peer group (Mott & Lee, 2018). The lack of gender diversity in nursing academia can promote an environment of tokenism experienced by male faculty. According to Kanter (1977), minoritized individuals are often relegated to the periphery of organizations because of their social status (e.g., racial, ethnic, gender, or sexual minorities). As a result, minority individuals often experience limited acceptance in the workplace and profession as a whole; this process of marginalization essentially consigns men to the role of token - in this case, the token male faculty (Sasa, 2019). Those who experience tokenism often describe feeling that they are constantly under a microscope and must continuously prove themselves worthy of their place (Brody et al., 2017; Mott & Lee, 2018; Sasa, 2019). Research suggests that men who are marginalized in nursing can be made to feel isolated and treated as though they lacked the ability and/or intelligence to be effective nursing professionals (Brody et al., 2017). This isolation can also be self-imposed (i.e., secrecy) as a means of avoiding the perceived "hypervisibility" or intense social scrutiny associated with being an extreme minority (Sasa, 2019; Smith et al., 2020). Male nursing faculty may use secrecy to avoid "role entrapment," which can be described as the judgment of a minority based on the stereotype rather than on personal characteristics of the individual (Kanter, 1977).
The subconcept of voice speaks to the notion that the expression of a person's opinions, ideas, and life experiences are valid only to the extent to which they are congruent with the dominant majority. It has long been documented that men tend to communicate differently than women (Christensen et al., 2018; Mott & Lee, 2018; Samulowitz et al., 2018). Men tend to converse in a more direct, decisive, and forthright manner, whereas women tend to favor a softer, more elucidative approach (Christensen et al., 2018). Furthermore, female colleagues and leaders may fail to appreciate an assertive male voice (Brody et al., 2017; Palmer, 2019). As a result, male nurse faculty in a female-dominated environment often find themselves excluded from conversations entirely, or their voices restricted in terms of when and how they contribute to a conversation (Brody et al., 2017; Mott & Lee, 2018; Palmer, 2019). Gender differences in communication styles may lead to misunderstandings, incivility, and isolation from peers (Mott & Lee, 2018; Smith et al., 2020). Furthermore, their role as an extreme gender minority creates an added burden of being "the voice" of the male perspective. Male faculty have described feeling that they are constantly called upon to provide expert opinions on the views, opinions, and norms of the male nursing population in both clinical and academic settings (Sasa, 2019).
RECOMMENDATIONS
Despite the known barriers faced by men in the nursing profession, little is being done on a national level to enhance gender diversity among academic nurse leaders. There needs to be diversity, equity, and inclusion plans based on measurable metrics and outcomes in every college of nursing in the country. Embracing diversity of thought and perspectives facilitates a deeper understanding of cultural differences and the unique lived experiences among all underrepresented and marginalized populations. Identifying commonalities regarding a number of demographic variables, including race/ethnicity, gender, and culture, is vital to the process of innovation and ensures that a variety of voices and opinions are heard (Brody et al., 2017). Not only is it vitally needed, but it is a metric used for credentialing and accreditation purposes.
There must be a concerted effort to increase the number of men in academic leadership roles. Male leaders can then mentor both faculty and students to increase the visibility of underrepresented members in leadership roles within nursing. When faculty and students see people who share the same profile, they will see themselves in the role. Targeted efforts to increase leadership training for underrepresented groups (including men) should be a pipeline priority. The Robert Wood Johnson Foundation is one of the only national organizations that systematically recruits male faculty to their scholars program. The Faculty Scholars Program provides junior faculty the opportunity to develop their leadership skills, enhance their visibility, and collaborate with other minoritized nursing faculty (Brody et al., 2017).
Another example of a national initiative to enhance the gender diversity of the nursing profession is the Best Schools for Men in Nursing award put forth by the American Association for Men in Nursing. Schools can win this award by demonstrating a strong, sustained commitment to increasing the number of male students and faculty in both undergraduate and graduate nursing programs. Schools must meet several metrics, including 1) demonstrate that male students and faculty have comparable outcomes when compared to females, 2) utilize marketing strategies that display images of male students and faculty, and 3) host recruitment and retention events that target men. This award can be used for accreditation purposes to demonstrate a commitment to increasing diversity within the nursing workforce.
Marketing campaigns need to be targeted toward men, focusing on the positive aspects of working in nursing academia such as the flexibility to meet family goals and other benefits. With a more binary vision of gender, the hypermasculine recruitment approach used in the past lacks inclusion and serves to reinforce the sexualized image of female nurses on the opposite end of the continuum. Caregiving is a gender-neutral concept that should be the baseline for all marketing campaigns, helping to reimage the profession focused on what nurses do, not on what they look like.
LIMITATIONS
There are several limitations that must be noted with this study. First, the sample of male faculty obtained for the study was relatively small (n = 313) when compared to the total population of men who teach full-time in undergraduate nursing programs in the United States. Despite utilizing a robust probability sampling plan, the relatively small sample size limits the generalizability of the findings. A second limitation, nonresponse bias, pertains to the belief that there may be important differences between study participants and those individuals who elect not to participate in a study. Nonresponse bias can diminish the representation of the sample, limiting the generalizability of the study's findings within the larger population. A final limitation is that data were collected using survey methodology, which can yield a less robust data set when compared to other modalities.
CONCLUSION
National efforts to diversify the nursing student population have resulted in inroads across nursing programs. Increasing the diversity of the student population, however, must bring forth with it a reciprocal diversification of nursing faculty as students tend to desire interacting with individuals from similar backgrounds. Faculty members who can understand and empathize with the unique struggles that male nursing students experience can be vital to their academic and professional careers. Unfortunately, marginalization of male faculty continues to exist in nursing academia. Faculty and administrators within colleges of nursing need to be cognizant of the environment that pervades their departments. Creating and sustaining an inclusive environment requires intentionality that embraces differences and not just tolerates them.
REFERENCES