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The discussion of the results is presented in this chapter. More specifically, it presents, the demographic data gathered, the male nurse's point of view in choosing to be in the nursing profession, their experiences as male nurses, and the stereotyping regarding males experienced in the profession. Most importantly, this chapter of the thesis presents relevant literature that supported and disputed the results found by the research. Also, the strengths and limitations of the study are discussed.
5.2 Demographic data
The thesis results showed, in relation to the demographic data, that the majority, 28 nurses, or 80.7% of the male nurses were between the ages of 20 to 35 years old and that 32.2% worked for less than five years. This data conformed to the data collected from a qualitative study of Lou et. al., (2009), where 83.8% of the participants were under the age of 35 years, and 49.4% had been working for less than five years.
The present results revealed that a greater part of the male nurse population was diploma holders (59%) and 26% baccalaureate graduates. These results are similar to Lou's et. al., (2009), studies conducted in Taiwan where 47.1% of male nurses were in the possession of an undergraduate degree The thesis results showed that male nurses usually worked in male wards (58%) and mixed wards (42%) and never (0%) in female wards. These mixed or male wards included the emergency department, operating room, pediatric area, psychiatry, medical area, and intensive care unit (LaRocco, 2007).
Similarly, in Norway and other Western countries, male nurses usually worked within the health sector's limited parts such as the psychiatry and acute medicine ward and administration (Bakken 2001). In terms of "speciality, 24% worked in the operating rooms (Lou, et.al. 2009, p 905)". In fact, psychiatry is one of the most common fields where 15% of all male nurses transfer to (Abrahamsen, 2004). Furthermore, Dassen et.al. (1990) found that in The Netherlands, men were dominating" technical wards, and critical care units"(p.367). It seems that they wanted to be involved in less feminine aspect of nursing. As Evans argues (1997), to compromise his reputation in patriarchal society, men in nursing develop different strategies as to occupy administrative and elite specialty positions in order to protect themselves from the feminine image of nursing .The latest results from UK reveal that "one third of the almost 100,000 nurses who have a mental health qualification are men" (Torjensen & Waters, 2010, p.21).
In the 1960s, men were not allowed to enter the delivery room and this still remains until today. Even though inequity is diminishing, situations like these in areas such as the obstetrics and gynecology departments continue (Chung, 2006). This may then be attributed as the primary reason why the study results found that 0% of the responses worked in female wards. However, it is worth mentioning that in Malta, up to the 1960's female nurses were excluded from the male wards (Camilleri, 1964).
5.3 Challenges that male nurses encounter at work
The present findings indicated that approximately half of male nurses were aware of opportunities in the nursing profession. With increased postgraduate qualifications, pursuance of managerial positions is fast paced (O'Lynn & Tranberger, 2006, Marsland, et al, 2003) among the male nurse respondents, and their propensity to earn more is improved (Hader, 2005). Also, studies found that it is easier or quicker for males to acquire top managerial positions than their female counterparts (Kvande 1998, Hoel 1995). Similarly, Abrahamsen (2002), findings showed that 70% of male nurses after twenty years from graduation were in leadership position, and away from somatic wards. Furthermore, Yang (2004) found that the male nurses' future development has more potential because their careers would not be disrupted by a maternity leave. In addition, an interview done by LaRocco (2007), confirms as one man stated that "being a male in a predominantly female profession sets you up to be recognized" (p.127).
In contrast, most of the respondents in this survey, or 61% disagreed that men in nursing are promoted quickly, which is not in the agreement with the statement of Williams (1992), that men in nursing are privileged minority which enables them to move out of female dominated profession by the "glass escalator" to the most rewarded and respected jobs reserved only for men in this patriarchal society.
In relation to this, LaRocco's (2007), study showed that one man revealed his income to be "below $50,000, while three indicated that theirs was greater than $100,000 per year (p.123)". However, the findings of Stoltenberg et.al.,(2008), suggest that" nursing needs to continue to raise the bar pay, because only 46.67% of male nurses rated nursing as financially rewarding." Hence, these results are in agreement with the thesis results findings where only 32% of male nurses agreed that nursing provides good salary and benefits.
Despite these advantages, some men, however, find inequities in other fields, like obstetrics and gynecology, which put considerable pressure on them (Williams 1995, Tseng 1997). Truly, Hart (2005) found that 56% of male nurses were seen as "muscles"(p.48), and "uncaring" by their female colleagues, just because of their gender. This then puts a strain on how the male and female nurses communicate with their colleagues (Hart, 2005).
Furthermore, some studies found that males perceive that being in a predominantly female profession brings about a low status upon the male nurses (MacDougall, 1997; Williams, 1989). In History of Nursing in Malta, during 19th Century, it was written that "the social class from which nurses were recruited was illiterate and without any education", and that the same conditions existed in other European countries (Camilleri,1964). Also, labeling nursing as an extension of women's domestic role devaluated profession in relation to male occupation. Although this image is changing, many negative images still persist. Further still, in relation to the slight increase of men in the nursing profession, uneven numbers of male nurses are leaving compared to female nurses due to deficient respect from their colleagues, job dissatisfaction and problems arising in a predominantly female profession (Sochalski, 2002).
However, results in this research revealed that majority, or 88%of respondents disagreed that men in nursing feel insecure because it is a female dominated profession. Findings in this thesis suggest that male nurses in Malta do not feel as they are 'crossing segregated work boundaries', and 'infiltrate' in female domain (Bagilhole &Cross 2006, p.35). In addition to, 71% of men in nursing in this survey expressed that they are satisfied with the work they do. As one respondent wrote " nursing is a male's profession as the other profession or jobs are". Hence, this result tally with findings of Rochlen et. al., (2009) where men employed as nurses were satisfied with their work in non-traditional career. According to Avery (2007), despite the feminine image in nursing, "nursing is profession for everyone", due to the fact that men were present in nursing since 250 B.C when "males-only nursing schools opened in India"(p.1). They continued playing an important role in nursing (Meadus, 2000), until Florence Nightingale stated that "Every woman is a nurse", establishing nursing as only one gender profession.(Fitzerald, 2007), and portraying the presence of the men nurse in this profession as an "anomaly"(Meadus, 2000, p.6).
5.4 Respondent's motivation for choosing a traditionally female profession
The present findings indicated that 48% or fifteen male nurses choose the nursing profession to help others. As one male nurse replied there is "nothing better than being able to help people", and " bringing smile to others". However, 16% or 5 respondents stated that the "money kept them in the profession". These results coincide well with previous studies of Bartlett et.al.,(1999) where altruism and job satisfaction, rather than extrinsic rewards, have been found to be the main motivating factor for male nurses. Furthermore, Larocco's (2007) study showed that eight men specifically stated that connecting with patients and aiding people are important factors when nursing is considered. One participant also added that "I just thought of nursing as caring for patients" (LaRocco, 2007, p.126).
Moreover, according to Boughn (1994), Brown and Srones (1971), Bush (1976), Garvin (1976), Mannino (1963) and Perkins et al. (1993), interaction with patients and helping people are important reasons in choosing nursing. Even Taylor et al. (1983), Skevington & Dawkes, (1988), Galbraith, (1991), Cyr, (1992), Kelly, et al (1996), MacDougall, (1997) suggested that caring for others and having the desire to be of help is a main factor for men in choosing a career in nursing.
Family and friends also served as the motivation for the resulting 26% or 8 of the male nurses who took part in this thesis survey. Positive family influence, like a nurse relative, a mother who is a nurse, became a good motivation for men. Moreover, in La Rocco's (2007) study, five of the interviewees had a mother nurse. This response was found to be similar to the results of this thesis where three males had a mother nurse, and surprisingly one respondent had both parents working as nurses. Also, these findings conformed to the data collected from a qualitative research of Whittock et. al., (2003), where positive influence, for most participants, on choosing nursing as a career comes from the parents, specifically mothers who worked in nursing sector or other healthcare profession. Also, friends who gave positive reactions helped with their career choice of being a nurse (LaRocco, 2007). Eleven men in LaRocco's (2007) study, claimed that their family was very pleased with their career choice.
In contrast, some men were discouraged by both family and friends, to enter the field of nursing and other medical fields (LaRocco, 2007). As found in a study done in the UK, only 12% of the male nurses said that their parents were happy about their career choice (Skevington & Dawkes, 1988). Abrahamsen (2004), also stated that most men who decide to qualify as a nurse find themselves problematic because the decision to become a nurse causes family and friend's disbelief and surprise. In a society where nursing is seen as a female profession, very often family and friends ask, 'You want to be a nurse? Why not a doctor?' I guess they feel that traditionally males are doctors and females are nurses."( Chung, 2006, p.1).
Other than that, ten percent of the male nurses who served as the respondents for this study stated that their motivation was good pay and security. It seems that nursing in Malta, according to the data collected from the survey, is being" one of the last secure job posts", as one respondent replied. Furthermore, Yang (2004), interviewed a man who stated "One day I noticed a statement in the newspaper which said, 'Male nurses earn as much as NT$ 50,000 per month', so I put 'nursing department' down on my form as my choice" (Yang, 2004, p.645). In addition, LaRocco (2007), also had a dialogue with a male nurse who stated "I knew I would always have a job, [and] I did it for a steady job that I could handle" (LaRocco, 2007, p.125 ). Most importantly, Boughn (1994) found that money and job security were two major motivations for choosing nursing. On the other hand, Simpson (2005), found several reasons that motivate men to "seek" a non-traditional career, and one of them was" that most were not seeking entry"(p.365). They entered female-dominated occupations almost by"default" in that they were not actively seeking such entry, but simply 'fell into it'.(Williams & Villemez's s, 1993 p. 66.)These results are in agreement with the results in this study where, three or 10% of respondents couldn't give the reason for choosing nursing as a career, which suggests, as found previously, that "they were not actively seeking such job but simply fell into it, either through availability or convenience"(Simpson , 2005, p.365).
Finally, the least percentage of participant stated that they considered nursing as a last resort and one even said: "I didn't get accepted by any school except for that nursing one, so it was my only choice, and I studied there" (Yang 2004, p.645). The findings in this thesis revealed that two nurses or 6% didn't have other career opportunity, which supports the previous research results of Yang (2004). The findings also showed that these nurses were age over 40 and with working experience of more than 20 years. These two respondents stated that "fear to change", and "lack of a good opportunity" where the reasons for remaining in nursing profession.
5.5 Perceived stereotypes of men in nursing
In addition to the problem that nursing is a female profession, male nurses also have to face the problem of overcoming the stereotype that they are gay or effeminate (Williams, 1995). Some of the stereotypes that these male nurse have to contend with were presented in the thesis results that 52% of male nurses were not embarrassed of their choice of profession. These results are similar to the findings of Hart (2005), where 40% of respondents sometimes feel "awkward or defensive when asked about their profession"(p.47). According to the thesis results, most of the respondents or 64% strongly disagreed that men in nursing are being questioned if they are a 'real men'. Furthermore, 77% disagreed that men in nursing are too gay or feminine. These findings revealed that they are not in agreement with the results of several studies that have found supporting data regarding these stereotypes. For example, because of inequities, male nurses' sexuality is usually questioned and they are labelled as homosexuals (Kelly, et al, 1996). Moreover, Wingfield also reported that men in nursing consider themselves as sufferers of homophobic abuse, with a respondent even claiming that "I've been called awful things-you faggot this, you faggot that" (2009, p.23). Furthermore, Harding (2007), explored "discourses which stereotyped or labeled male nurses as gay and conflate homosexuals and sexual predators"(p.639). Also Harding (2007) reported that majority of men in nursing are heterosexual but public perception is still that most male nurses are gay. This stereotype persists only in general nursing, men working as psychiatric nurses are perceived as masculine due to need of physical strength. Although society is becoming more comfortable with men as nurses, nearly half or 48% of the respondents experienced the stereotype that men choose nursing because they failed to enter a medical course.
Because of the situations and stereotypes, a more serious stereotypical belief was formed that male nurses are not appropriate caregivers (Evans, 2002). Truly, different societal norms have created concepts of caring as something that is not included in masculine images of males, and that caring falls under a female conception (Evans, 2002). Evans (2002) found out that for men nurses" touching patients is potentially dangerous", and that men are "vulnerable caregivers"(p. 7). Similar results were found by Abrahamsen (2004), where male nurses were minority in somatic wards due to the fact that they were pressurized by their friends and family to apply for more 'masculine jobs or seek a leadership positions', because it is not natural for men to undertake intimate nursing tasks (p.12).
Gender stereotyping creates a compound and conflicting situation of rejection, acceptance and doubt for male nurses' ability as caregivers and nurturers (Evans, 2002). Thus, as a sad effect of this, and to avoid tight situations, some male nurses alter their caring principles and nursing roles (Egeland & Brown, 1989; Kauppinen-Toropainen & Lammi, 1993). Even though, studies of Ekstrom (1999) resulted that male nurses exhibit lower caring behaviours, they in general, do not effect the care given to the patients. As Mac Doughall (1997) stated, man do have ability to care, but they need to be shown how. (p.813). Lately, society is becoming more comfortable with men as nurses. As Cyr (1992), stated, "the art and science of nursing has not always been a predominantly female profession"(p.54).
In all, this chapter has presented a discussion of the findings of the study. The various demographic profiles of the respondents, the reasons for choosing nursing, the experiences, and the stereotypes among male nurses in Malta were presented, with subsequent presentations of other relevant studies. At the end of the analysis and discussion, it was found that various related literatures, both old and new, confirmed the results of the study, while there were a few others that disputed it. Overall, the findings suggested that men employed in nursing, are just as committed to the profession as women.
5.7 Strengths and Limitations of the study
It should be noted that this study has several limitations and strengths. Firstly, the chosen sample does not represent male nurses as a whole. The male nurses that work in Gozo, and other different hospitals in Malta were not included in this research. Moreover, a satisfactory response rate (88.6%) helped strengthen the outcome of the study.
However, the purpose of the study was not intended to allow generalisation among the male nurses working in different hospitals in Malta and Gozo.
Secondly, a self- administered questionnaire was used to collect data, and thus all data that were used in this study were self-reported. Although the questions for the survey were carefully chosen and modified by the researcher reading an extensive literature especially Smith (2008), it seems that some of the respondents did not understand that their sexual orientation was not questioned, but only concept of gender stereotype. To avoid similar misunderstandings, in future studies, a focus group design method could contribute to explain the motivation for choosing nursing as a profession, and career development of male nurses in a female dominated profession.
The rather high response rate of 88.5% indicated that male nurses were interested in subject, and this helped strengthen the outcome of the study. Although in this study, the research tool was a questionnaire, some qualitative data were also obtained.
Despite being time limited prior to specific deadlines, this study has educated and motivated the researcher to understand more nursing as a science.
Although this study was purely quantitative, some findings provided valuable information about male nurses in a female dominated profession. Further qualitative research could give clearer picture about the real perceptions of men in nursing, and establish the extent to which the findings from this research can be applied in more general context. The next chapter shall conclude this dissertation with recommendation for further research, and implications in nursing.