Women in Higher Education: Nursing Implications

Nurses are highly thought of by the general public. So high, in fact, that nurses are consistently ranked number one among all professions for honesty and ethics according to a Gallup (2015) poll that has been conducted annually since 1999. Yet as a primarily female profession and despite being an increasingly well-educated one, with the proliferation of advanced practice nurses and initiatives to promote doctoral education in nursing, nurses have struggled to cope with issues that women everywhere face: issues of equality, recognition, and advancement. It is the impact of these issues on the university setting, and the relationship of these issues with nursing and nursing practice, that is the focus of this post.

Rest Hour at the Columbia Teachers College, 1921
Rest Hour at the Columbia Teachers College, 1921

There are many topics to consider in this broad issue, and specific information is available elsewhere in this blog. The history of American higher education is important to understand in the context of the institutions in America, and more specifically the history of women in higher education, which provides illumination on the views about women and education in the history of America.  The topic of women in higher education is impossible to examine without specific information about the role of women in society, including an overview of American versus world issues, feminist issues, and significant barriers to women that exist in American society. You are encouraged to review these pages as a prelude to the discussion below.

The role of the nurse and the role of the nurse educator, in the context of the information presented in these pages, is the primary focus of this page.  How does the information presented on these other pages affect nursing education and nursing research?

Where Does Nursing Fit in?

In considering the topic of women in higher education and how it relates to nursing it is clear that this is a topic with multiple interrelated concerns. The education of nurses is impacted by the history of higher education and of women in higher education. Issues that become apparent in reviewing those topics include the role of women in society and the barriers that continue to impact women today. These issues impact nurses as women functioning in a university setting as well as nurses interacting with patients that are impacted by these issues.

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A hospital corridor

An additional area that nurses must manage is their relationship with other health care providers, relationships which are often deeply affected by the issues impacting women in society. A study by Sirota (2007) looked at the relationship between nurses and physicians, specifically trying to identify if the historically notable tensions between the two professions continues. Unfortunately she found this to be true, and respondents to her survey identified four majors issues that they believe contribute to the problem: inappropriate or abusive behavior by physicians, dismissive attitudes towards nurses, power/gender issues, and communication/collaboration issues (Sirota, 2007). It is perhaps not a coincidence that these issues reflect the issues identified as obstacles for women in society.

Nurses as University Students and Faculty

Obviously nurses exist on college campuses and institutions of higher learning both as students as as faculty. As such, female student nurses are exposed to the potential dangers of violence towards women on campus while faculty are engaged in work in what is sometimes disparagingly referred to as one of the ‘kitchens’ in the university setting; that is, colleges dominated by women and  often viewed as less powerful and less important by university officials (Thelin, 2011). Lack of recognition for work performed, failure to be promoted at the same rate as men, and pay inequities are all issues faced by female faculty in the university setting. Awareness of these issues, and the corollary of how these issues impact our patients, is a significant concern for both nursing students and faculty.

Nurses as Holistic Health Care Providers

Nurses are taught a holistic approach to patient care, one that encompasses not only the patient and their family, but also the community, care continuity, chronic disease management, patient education, prevention and wellness care, and information management (ANA, 2010). There are few relationships as intimate as the relationship between a nurse and a patient – nurses attend their patients during births and deaths, through frightening procedures and terrifying outcomes. Nurses often bear witness to the intense suffering as well as the beauty of the authentic person encountered during times of tremendous stress and life change. The care for our patients often encompasses all aspects of their health, including how they are affected by their role in our society.

Additionally, the role of the advanced practice registered nurse (APRN) expands this to care in multiple speciality areas and as potential leaders in integrated care systems (ANA, 2010). In 2011 there were over 3.5 million nurses employed in the United States, about 4% of which were either nurse practitioners or nurse anesthetists (US Census, 2013).

Nurses are often referred to as advocates for their patients.  This is a role that is no less important in the area of women in society and women in higher education. Nurses need to be given the tools needed to address these issues both professionally and personally.

Men in Nursing

US Supreme Court
US Supreme Court

Of course not all nurses are women and the history of men in the profession has not always been a smooth one. Nursing had significant male representation through the 1800’s due to the relationship between nursing and military and religious groups (US Census, 2013).  This changed drastically in the 1900s when men were often refused admission based on gender, a practice that only ended with the finding of discrimination by the US Supreme Court in 1981 (US Census, 2013).

The number of men in nursing has increased steadily in recent years with men making up 2.7% of registered nurses in 1970 and rising to 9.6% in 2011 (US Census, 2013).  Male representation is highest among nurse anesthetists where 41% are men (US Census, 2013).  As in other professions, pay inequity is a concern, with male nurses making more than their female counterparts – this gap continues even among nurses in the same specialty areas.  Female registered nurses make 91 cents for every dollar earned by their male co-workers and female nurse practitioners make 81 cents for every dollar earned by male nurse practitioners (US Census, 2013). More detailed information about pay inequality can be found on the Women in Society page.

Male Nurse
Male Nurse

Regardless of these issues, however, male nurses face the same issues that female nurses face in terms of caring for their patients and their relationships with other healthcare professions. Male nurses have much to contribute to the profession of nursing, both in the university setting and in the practice of nursing, and the contribution they can make on the issue of women in higher education is potentially huge.

Where Do We Go From Here?

Nursing Education

Many suggestions have been identified for the education of nurses in regards to the issues covered here.  To address the issue of relationships with physicians and other health care professionals Sirota (2007) recommends empowering nurses by providing an excellent education and instilling a desire to stay current with their profession so as to increase confidence and security in their knowledge base. She also recommends that nurses maintain a professional demeanor at all times in relating with physicians and others as equals in a collegial, respectful, and problem-solving manner. These are skills and beliefs that can and should be taught at all levels of nursing education.

All students and faculty on the university or college campus should be provided with information regarding the risk of violence against women on campus and the training to be a proactive bystander. A model for this can be found on the University of Kentucky website on the Green Dot Program. That page contains an extensive list of  strategies appropriate for all people. Immersion in this type of program should be mandatory for all faculty and students.

All students and faculty should also be educated about the information provided in these pages, in the role of women in American society and the impact of that role on women in higher education, including use of many of the materials provided. The application of this information includes anticipating issues in professional life, such as negotiating for salary and position, and awareness of the behaviors required for advancement, as well as being sensitive for these issues in the patients that nurses encounter.

Photo by Odan Jaeger
Photo by Odan Jaeger

In 2011 the Institute of Medicine released its landmark work on the Future of Nursing.  One of the mandates in this work was that nurses be full partners with physicians and other health care professionals in rebuilding health care in America (IOM, 2011). To that end, and as a means of impacting on the role of nurses in the university setting as well as in the hospital setting, leadership skills should be incorporated at all levels of nursing education. Bianco, Dudkiewicz, and Linette (2014) view this as fundamentally important to the future of nursing in higher education and in health care.

Finally, the role of nurses as advocates needs to be emphasized at all levels of nursing education and expanded to include advocating for nursing itself. Nurses need to be involved socially, politically, and individually for the benefit of their patients and the profession of nursing. If we are to truly achieve an egalitarian society, we need the support and work of all professions. As a primarily female profession intimately involved in the lives of so many women, it behooves us to start with ourselves.

Nursing Research

There is a huge need for more research by nurses on the issues mentioned in this blog. This would include the following topics, in particular:

– Nurse/physician relationships in the context of interdisciplinary work and cooperative endeavors.

Photo by Odan Jaeger
Photo by Odan Jaeger

– Ways to incorporate the plethora of social sciences and theories of human behavior into nursing practice. This is for the purpose of improved patient care, improved social interactions, and more effective educational interventions.

– Factors influencing advancement, tenure, pay, and recognition for women in higher education – this is an area that is not fully understood, despite multiple theories.

– Studies on the effectiveness of interventions to prevent violence on campus and to intervene with the perpetrators as well as campus staff.

– Research into the effectiveness of methods of social reform – how can a more equal society be encouraged without loss of individual freedoms?

___________________________________________________

References

American Nurses Association (ANA). (2010). New care delivery models in health system reform: Opportunities for nurses & their patients. Retrieved from: http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Care-Delivery-Models.pdf

Bianco, C., Dudkiewicz, P.B. & Linette, D. (2014). Building nurse leader relationships. Nursing Management, 42-47.

Carter, J. (2014). A call to action: Women, religion, violence, and power. New York, NY: Simon & Schuster.

Gallup. (2014). Honesty/ethics in professions. Retrieved from: http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx?version=print 

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington D.C.: The National Academies press.

Morris, L.V. (2011). Women in higher education: Access, success, and the future. Innovative Higher Education, 36, 145-147.

Sirota, T. (2007). Nurse/physician relationships: Improving or not? Nursing2007, 37(1), 52-55. Retrieved from: http://www.nursingcenter.com/lnc/pdfjournal?AID=686652&an=00152193-200701000-00040&Journal_ID=&Issue_ID=

Thelin, J.R. (2011). A history of American higher education (2nd ed.). Baltimore, MD: The Johns Hopkins University Press.

United States Census Bureau. (2013). Men in nursing occupations. Retrieved from: https://www.census.gov/people/io/files/Men_in_Nursing_Occupations.pdf

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