As a Fulbright Scholar, I've been a member of the Faculty of Nursing at the University of Jordan for the past year. It's been a wonderful opportunity to participate in nursing education in the small kingdom of Jordan in the Middle East. I teach doctoral students, give guest lectures, and observe doctoral and master's degree students' dissertation and thesis proposal hearings. I also accompany professors and students as they provide clinical care.
This experience has given me the chance to share my expertise and learn from my Jordanian colleagues. It has been a rare and wonderful opportunity to understand the universality of nursing and the ties that bind us in our caring.
NURSING EDUCATION
Nursing education in Jordan has developed rapidly since the first diploma school was opened by the Ministry of Health in 1953 in the capital of Amman.1 In 1998, Ministry of Higher Education reforms led to a transition from diploma education to associate's degree programs.1
Baccalaureate education for nurses in Jordan began in 1972, when the University of Jordan initiated the country's first bachelor of science in nursing (BSc) program. This was a joint program operated by the school's Faculty of Nursing and Faculty of Medicine, in which nursing and medical students attended the same basic science, medicine, and surgery classes; nursing students were separated from medical students to study nursing care. According to Reema Safadi, PhD, RN, an associate professor in the University of Jordan's Department of Maternal and Child Health Nursing, both faculty deans were British, and having a joint system reflected the British medical model of education.
The initiation of a master's degree program in 1986 and doctoral education in nursing in 2005 signaled further advances in nursing education at the University of Jordan.1 The first PhD students graduated in 2009; by 2013, there were 46 graduates.2 Many of these nurses are now faculty members at other universities in Jordan. Today five universities in Jordan offer master's degree programs.2
Jordan appears to be phasing out associate's degree nursing education. The number of associate's degree programs has diminished from 27 in 2012 to 19 in 2015, according to Mohammad Y. N. Saleh, PhD, RN, TVNS, director of development and research at the Jordanian Nursing Council (JNC), and an associate professor in the Department of Clinical Nursing at the University of Jordan.
Only BSc nurses are referred to as "registered nurses" and are eligible for registration with the Jordan Nurses and Midwives Council (JNMC). In addition to being responsible for the registration of nurses, the JNMC is also a constituent member of the International Council of Nurses. It often acts like a union in that it focuses on its members' rights and benefits.
Jordanian nurses do not have to pass a national licensing examination. Prior to graduation, they take university-administered oral and written examinations. Upon graduation, the nurse's qualifications are authenticated by Jordan's Ministry of Health and verified by the JNMC, after which the nurse can practice as an RN. Saleh believes it likely that nurses will need to take a qualifying exam for licensure in the future.
AN OVERSUPPLY OF MALE NURSES
The University of Jordan is the largest nursing school in Jordan, with 65 teaching faculty and 825 undergraduate students.2 This includes students who are in the bridging program, which is for associate's degree graduates seeking a baccalaureate. There are 99 master's degree students in three tracks-critical care, palliative care, and psychiatric mental health-and 46 nurses in the PhD program.2 Nationwide, 1,277 nurses graduated from the country's baccalaureate programs in 2013. This was a decrease from the 2009 high of 2,408.
Although it's been reported that only female students were allowed to enroll when the baccalaureate program started at the University of Jordan in 1972, both Safadi and Inaam A. Khalaf, PhD, RN, a former dean and a professor of Maternal and Child Health Nursing at the university, confirmed that both female and male students were matriculated in the first class. After the first or second class, male admissions were halted until 1982. No one I spoke with was sure why, although men may have been readmitted because of antidiscrimination laws that apply to public universities.
The first group of 12 male and 10 female students graduated with a BSc in 1976, according to Safadi. According to statistics published by the University of Jordan, 684 (48%) undergraduate nursing students were male in the academic year 2007-2008.3 In the 2014-2015 school year, male nursing students accounted for 155 (19%) of the undergraduates, according to Ali Saleh, PhD, RN, an assistant professor and assistant dean for quality affairs in the university's Faculty of Nursing.
Prior to my arrival, I wondered why Jordan had so many male nurses compared with the United States. Although the answer is somewhat elusive, one factor may be the cultural norms throughout the Arab world as they relate to women. Although Jordanian women are more educated and independent than they were in the past, some female faculty and students told me of their family's concerns about their choosing nursing as a career, in particular the necessity of working at night.
Men chose nursing because it was seen as a stable career, with abundant opportunities to work in the wealthier Gulf countries (Saudi Arabia in particular), where the pay is several times higher than it is in Jordan. Jordan is unique compared with many other Arab countries in that the bulk of the nursing workforce is Jordanian. In contrast, one of my students, who works for the Kuwait Ministry of Health and was pursuing her doctorate at the University of Jordan, noted that only about 6% of the nurses in her country are Kuwaiti nationals. A 2009 study published in International Nursing Review supports her observation, noting that only 6.6% of the nursing workforce in Kuwait was made up of native nurses at the time.4
Two professors at the University of Jordan published a study on patients' preference for nurses based on gender.5 They found that 69% of the female patients in their survey preferred female nurses. The majority of male patients (56%) did not have a preference for the nurse's gender, and only 19% preferred male nurses. In response to the statement, "It is not desirable professional practice for a male nurse to be assigned to a female patient," 78% of male patients and 65% of female patients strongly agreed or agreed. Interestingly, two-thirds of female patients agreed or strongly agreed with the statement, "Thoughtfulness and the ability to boost patient morale tend to make women better suited than men for the nursing profession."5 By contrast, two-thirds of male patients agreed or strongly agreed that men were better suited for nursing because they can "avoid panic and live with emotional strain."5 This study quantified what was already common knowledge among nursing leaders.
As a result of the oversupply of male nurses-and the understanding that female nurses were more in demand-universities were told to limit enrollment of male nursing students so that they constituted no more than 30% of the student population. This direction came from the JNC, which focuses on improving the delivery of nursing care and the education of nurses in Jordan. As a result of the JNC's mandate, the University of Jordan created two entry tracks to increase the number of female nursing students. Women are admitted in either the male-and-female track or the female-only track, but men can compete for a spot only in the male-and-female track. This might seem unfair to Westerners, with our culture's emphasis on gender equality, but limiting the number of male nurses helps to create a workforce that meets the needs of the country.
PROFESSIONAL ACTIVITIES
During the 2014 fall semester I cotaught a class in qualitative research to doctoral students, whereas in the spring my teaching assignment was a class called "Special Topics: Professional Writing." I was concerned that the students in the research class would be passive and expect a "sage on the stage," but this was unfounded. The six women and three men attending this course were active learners, voicing opinions, sharing journal articles, giving polished class presentations, and writing well-thought-out papers. Although English grammar was often a problem, the quality of their thinking was evident.
My spring class included eight women, five of whom I knew from the fall. Three of the women were in Jordan's armed forces (two majors and one colonel), teaching in military nursing schools. Again, I found the students to be engaged and excited to learn. I also found that the women were experiencing the same time pressures women around the world do when working and going to school. They also faced cultural expectations of family care. Several of these women expressed concern that they were not being fair to their children because they devoted time to their studies.
My life here has been filled with professional activities. I have been actively involved in the formation of the Jordan Honor Society, which held its first induction ceremony at the end of the fall 2014 semester. After the required one-year waiting period, the chapter will apply for membership in Sigma Theta Tau International (STTI), the Honor Society of Nursing. This is a particularly exciting event in the history of nursing in Jordan as the chapter will be the second STTI chapter in the Middle East. As a longtime member of STTI, I was honored to be one of the invited speakers at the induction ceremony. Her Royal Highness Princess Muna al-Hussein, the mother of King Abdullah II, attended the ceremony. She is president of the JNC and the patron of nursing in Jordan. Although she is not a nurse, she passionately supports nursing and attends many events, including ceremonies honoring nurse graduates.
In April, I had the opportunity to attend the JNC's 5th International Nursing Conference in Amman. The two-day conference featured speakers from Ireland, Saudi Arabia, Australia, Lebanon, Tunisia, the United States, the World Health Organization, and the International Council of Nurses, as well as nursing leaders from Jordan. On the last night, we all sang happy birthday to Princess Muna. Who would have thought that a nurse raised in Buffalo, New York, would be a guest at a birthday party for a princess in the Middle East?
REFERENCES