The Inventory of Male Friendliness in Nursing Programs (IMFNP)

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1 The Inventory of Male Friendliness in Nursing Programs (IMFNP) Background At the 2001 annual conference of the American Assembly for Men in Nursing (AAMN), a nursing student discussed his educational experiences during an open forum. The student reported that men were treated poorly at his school. This created much stress for him, leading to academic struggles and self- doubts about his career choice. Rather than leave nursing altogether, the student transferred to a different nursing school. His new school had a much more supportive environment. The student s motivation and grades improved and was then on track to graduating on-time. The student asked the academics in the audience, Why can t there be a score card for nursing schools? That way, male students could apply to supportive schools. The question (or challenge rather) intrigued Chad O Lynn. Dr. O Lynn surveyed the literature, but found no appropriate resource. He decided to create a tool that would assess a school s level of male friendliness. He defined male friendliness in nursing programs as a supportive environment evidenced by the relative lack of barriers that might impair the successful preparation of men as nurses. Dr. O Lynn hypothesized that the presence of barriers would increase stress and isolation among male students, resulting in increased academic struggles and attrition. This hypothesis was congruent with numerous studies reporting the consequences of unsupportive education environments. IMFNP Development In 2001, much literature was available describing gender-based barriers experienced by male nursing students. The barriers described were consistent among multiple studies spanning several decades. Consistency implied a pervasiveness of the issue, though few authors quantified barriers or correlated barriers with negative outcomes. Dr. O Lynn assembled the gender-based barriers reported in the literature into an assessment tool that asked male nurse respondents a) whether or not a specific barrier was present in their nursing program, and b) whether or not a specific barrier was important in influencing the success of male nursing students. The initial tool included 27 barriers from the published literature. Dr. O Lynn added three additional barriers based on his personal experience and unpublished interviews with male nursing students. Items seeking demographic information were also added. At this point, the tool was sent to 24 nurse educator members of AAMN to review the tool for content validity. Nineteen educators responded, of which 16 were male. The tool was also sent to two deans. None of the 21 reviewers recommended removing any of the items; however reviewers recommended adding two additional items resulting in a 39-item survey tool. The tool was sent to 100 randomly selected male nurses from each of two mutually exclusive populations: the membership of AAMN and male nurses registered in Montana. (No members of AAMN resided in Montana at that time.) One hundred eleven completed surveys were returned yielding a response rate was 55%. The respondents were 89% Caucasian. The mean age at graduation from their pre-licensure programs was 29.8 years (SD = 7.4 years). The men graduated between 1961 and 2002, with 37.8% graduating between 1992 and Most (86.5%) of the men graduated before age 40. Respondents graduated from 90 different nursing programs. Findings were reported in frequencies of responses.

2 The presence of specific barriers in the men s programs ranged between 7.2% (being the only male in the nursing class) to 99.1% (no mentorship program for male nursing students). Percentages of respondents who assessed specific barriers as important ranged from 91.9% (Not welcomed as a male student in the clinical setting) to 20.9% (non-use of competition as a learning incentive). All but 14 barriers were rated as important by over 2/3 of the respondents. Few differences were noted between subsamples of more recent and less recent graduates suggesting persistence of barriers over the past 40 years. None of the respondents recommended removing any of the items on the tool, nor were any new gender-related items recommended as additions. With no recommendations for substantive changes, the tool was reformatted into its final Likert-scale format. The final tool asks respondents their level of agreement as to whether or not barriers were present in their nursing programs. Items are scored, with total scores providing a summary assessment suggesting levels of male friendliness in the academic program. A summary of the tool development was published (O Lynn, 2004). Challenges With Scoring and Development of the Short Version of the IMFNP (IMFNP-S) The scoring rubric of the IMFNP was difficult to use since items were scored variably. Items that were reported to be important carried more weight on the scoring rubric than did those reported to be less important. This seemed reasonable, since unimportant barriers experienced by students are probably less likely to result in high levels of stress and other negative outcomes than important barriers. Some faculty raised questions of validity if unimportant barriers were assessed alongside important barriers. A shortened version of the IMFNP (IMFNP-S) was developed in 2005 (O Lynn, 2007). This version included 17 items that were identified as important by at least 70% of the respondents in the original study. Items soliciting demographic or dichotomous responses were retained. The shortened assessment tool was sent to 170 alumni from five nursing programs. Seventy-eight men responded for a response rate of 46%. These respondents had a mean age of 31.2 years at the time of graduating from their nursing programs (SD = 8.6 years) and were 92% Caucasian. In this study, there were no significant correlations between age of respondent and survey score; however, respondents who reported having male faculty at their programs were significantly more likely to report higher levels of male friendliness (p < 0.05). None of the respondents recommended removing any of the items from the tool. No new gender-based barriers were recommended. Psychometric Properties Content validity was established in the original tool development study (O Lynn, 2004). Respondents from two different studies did not recommend removal or addition of gender-based barriers. Cronbach s alpha for the long version IMFNP was reported as 0.84 (personal communication, N. J. Colby, September 2013). For the IMFNP-S, alpha ranged from 0.80 to 0.84 (O Lynn, 2007). It is important to note, however, that internal consistency analyses for the tool may be inappropriate, since the tool is a checklist-like assessment tool and does not measure the construct of male friendliness directly. Since the tool examines respondents memories of their nursing programs, testretest reliability is important. To date, this type of reliability for the IMFNP and IMFNP-S has not been completed to date.

3 Theoretical Foundation Gender Role Conflict (GRC) Theory provides the theoretical framework for the IMFNP. Since its development in 1981, GRC theory has been tested and refined by over 230 studies (O Neil, 2008). Briefly, GRC is defined as a psychological state in which socialized gender roles have negative consequences for the person or others ultimately restricting human potential (O Neil, p. 362). GRC occurs from rigid, sexist, or restrictive gender roles and masculinity norms constructed within a society and internalized by individuals, families, and peers. Psycho-emotional distress, lower selfesteem, shame, and lower well-being result when men perceive conflict between self-accepted restrictive gender roles and new behaviors and attitudes they are asked to embrace (O Neil). Researchers have documented GRC in men of varying ages, sexual orientations, classes and socioeconomic statuses, and racial and ethnic backgrounds. GRC Theory is an appropriate framework since the literature provides strong evidence that social institutions have facilitated conflicts between masculine gender roles and the roles and images of nursing and the culture of nursing academe over the past 150 years (O Lynn, 2013). Structures, cultures, and climates within schools of nursing that needlessly exacerbate conflict with constructed and self- adopted gender roles are likely to facilitate poor outcomes and higher attrition among male students. How the IMFNP Has Been Used Primarily, the tool has been used by graduate students with small samples for unpublished class or program projects. The tool has also been used by faculty from a handful of schools, including schools in Canada, Turkey, and the Philippines, to assess the levels of male friendliness in individual programs. None of these studies and projects has been published to date. Two replication studies have been completed to date using the IMFNP. Keogh and O Lynn (2007) used a version of the IMFNP modified slightly for Irish male nurses. Le-Hinds (2010) used the IMFNP to survey 76 male RNs in California. Both replication studies reported findings remarkably similar to the original IMFNP study despite having samples different from the original study s sample. Kirk, O Lynn, and Ponton (2014) developed a version of the IMFNP for students enrolled in an on-line BSN completion program. Magateaux has adapted the tool to allow comparisons in perceptions of male friendliness among male nursing students, female nursing students, and female faculty. A manuscript detailing this study is underway. Future needs for Tool Development Future studies assessing the tool are needed. Test-retest reliability should be assessed to determine the stability of memories and perspectives of respondents. Further, since the construct of male friendliness is based on Gender Role Conflict Theory, criterion validity should be assessed using scores from the Gender Role Conflict Scale and the IMFNP. One might expect higher levels of gender role conflict would correlate significantly with lower IMFNP scores.

4 Guidelines for Use Both versions of the IMFNP are free to use, however, Chad O Lynn should be cited as the developer of the IMFNP. Dr. O Lynn requests that any psychometric findings for the tool be reported to him through the AAMN office for on-going assessment of the tool s performance. The original long version IMFNP provides a comprehensive assessment of barriers reported in the literature. Descriptive statistics are appropriate when using the long version. The IMFNP-S includes a scoring rubric. Inferential statistics may be used for data from the IMFNP-S when appropriate and desired. Dr. O Lynn recommends using the IMFNP-S for assessments or studies in which findings will be disseminated to external audiences. The tools and scoring rubric are included in the appendix of this document. Disclaimer AAMN does not endorse the IMFNP or claim its superiority over other assessment tools. AAMN makes this information available simply as a resource for schools desiring to assess the educational environment. References Keogh, B., & O Lynn, C. E. (2007). Gender-based barriers for male student nurses in general nursing education programs: An Irish perspective. In C. E. O Lynn & R. E. Tranbarger (Eds.) Men in nursing: History, challenges, and opportunities (pp ). New York: Springer. Kirk, J., O Lynn, C., & Ponton, M. (in press). Perceptions of gender-based barriers for men in online nursing completion programs compared to traditional on-campus nursing programs. Journal of Online Learning and Teaching. Le-Hinds, N. (2011). Male nurses: Gender-based barriers in nursing school. Ann Arbor, MI: ProQuest. O Lynn, C. E. (2004). Gender-based barriers for male students in nursing education programs: Prevalence and perceived importance. Journal of Nursing Education, 43(5), O Lynn, C. E. (2007). Gender-based barriers for male students in nursing education programs. In C. E. O Lynn & R. E. Tranbarger (Eds.) Men in Nursing: History, challenges, and opportunities (pp ). New York: Springer. O Lynn, C. E. (2013). A man s guide to a nursing career. New York: Springer. O Neil, J. M. (2008). Summarizing 25 years of research on men s gender role conflict using the Gender Role Conflict Scale: New research paradigms and clinical implications. The Counseling Psychologist, 36(3), (Last updated: July 24, 2014)

5 Inventory of Male Friendliness in Nursing Programs (IMFNP) (Chad Ellis O Lynn, 2003) Part I: Introduction Please answer the following questions for some background information. 1. Current age: 2. School / Location you attended that prepared you to take the initial RN licensure examination. 3. Year of graduation: 4. Your identified ethnic or racial category: 5. Prior to nursing school, had you or a loved one ever received care from a nurse who was male? YES NO 6. Prior to nursing school, had you ever known personally a male nurse? YES NO 7. Did your nursing program have a mentoring program exclusively for men? YES NO

6 8. Were there men on the nursing faculty while you were a student? YES NO 9. Were there other men in your graduating nursing class? YES NO Part II: Think back to your time in nursing school. Please respond to each statement with your general recollection as it applies to your school experience. 10. Most of my textbooks/ readings referred to a nurse exclusively as she. Strongly agree _ Agree Neutral Disagree _ Strongly disagree 11. Most of my nursing instructors referred to the nurse exclusively as she. Strongly agree Agree Neutral _Disagree _ Strongly disagree 12. My nursing program included a historical review of the contributions men have made to the nursing profession. 13. My nursing program actively recruited men to enroll as students. Strongly agree Agree Neutral Disagree Strongly disagree 14.There were times in class when nursing faculty made disparaging remarks against men. _

7 15. My nursing program included content on men s health issues. 16. I was provided opportunities to work with male RNs in my clinical rotations. 17. In my nursing program, male students were usually used when instructors wanted to demonstrate an assessment technique to the chest and/or pelvic areas. 18. In lectures, men were portrayed as the perpetrators of crimes, and rarely as victims. 19. My nursing program provided few opportunities for classroom debate of issues and concepts. 20.My nursing program included courses that used individual and/ or team competition as a learning incentive. 21. My instructors provided me, as a man, guidance on the appropriate use of touch.

8 22. There are different behaviors that demonstrate caring towards one s patient. My instructors emphasized caring behaviors, which I perceive as feminine. 23. Some of my instructors did demonstrate caring behaviors, which I perceive as masculine. 24. In the classroom, most instructors relied exclusively on traditional lectures to teach theory and concepts (as opposed to interactive learning activities). 25. During my obstetrics (mother-baby) rotation, I had different requirements or limitations placed on me compared to my female classmates. 26. Many believe that men and women have different communication styles. My nursing program discussed how to overcome communication differences to ensure good therapeutic and working relationships. 27. Most instructors provided opportunities for group/ teamwork on assignments. 28. In my non-obstetric rotations, I was usually assigned to care for male patients.

9 29. My nursing program encouraged me to connect with other male students for peer support. 30. I was invited to participate in all student activities. 31. My nursing program encouraged me to strive for leadership roles. Part III: The following statements pertain to your opinion or belief about various topics. Please think back to your experience as a nursing student and indicate the appropriate response. 32.People most important to me were supportive of my decision to enroll in nursing school. 33.I felt I had to prove myself in nursing school because people expect nurses to be female. 34. I felt isolated from other male college students while in nursing school.

10 35. In my nursing program, male and female students were treated more differently by the instructors than I had originally anticipated. 36.My gender was a barrier in developing collegial relationships with some of my instructors. 37. As a male student, I felt welcomed by most RN staff in my clinical rotations. 38. As a male student, I was nervous that a woman might accuse me of sexual inappropriateness when I touched her body. 39. My nursing program prepared me well to work with primarily female co-workers. Thank you so much for taking the time to respond to this survey. Feel free to enclose any comments you may have.

11 Inventory of Male Friendliness in Nursing Programs-Short (IMFNP-S: O Lynn, 2007, 2013) Part I: Introduction Please answer the following questions for some background information. 1. Current age: 2. School you attended that prepared you to take your initial RN licensure examination. 3. Year of graduation: 4. Your identified ethnic/racial category: 5. Were there men on the nursing faculty while you were a student? YES NO 6. Were there other male nursing students in your graduating class? YES NO

12 Part II: Think back to your time in nursing school. Please respond to each statement with your general recollection as it applies to your school experience. 7. Most of my nursing instructors referred to the nurse exclusively as she. 8. My nursing program included a historical review of the contributions men have made to the nursing profession. 9. My nursing program actively recruited men to enroll as students. 10. There were times in class when nursing faculty made disparaging remarks against men. 11. My nursing program included content on men s health issues. 12. I was provided opportunities to work with male RNs in my clinical rotations. 13. During my obstetrics (mother/baby) rotation, I had different requirements or limitations placed on my compared to my female classmates.

13 14. Many believe that men and women have different communication styles. My nursing program discussed how to overcome communication differences to ensure good therapeutic and working relationships. 15. I was invited to participate in all student activities. 16. My nursing program encouraged me to strive for leadership roles. Part III: The following statements pertain to your opinion or belief about various topics. Please think back to your experience as a nursing student and indicate the appropriate response. 17. People most important to me were supportive of my decision to enroll in nursing school. 18. I felt I had to prove myself in nursing school because people expect nurses to be female. 19. In my nursing program, male and female students were treated more differently by the instructors than I had originally anticipated.

14 20. My gender was a barrier in developing collegial relationships with some of my instructors. 21. As a male student, I felt welcomed by most RN staff in my clinical rotations. 22. As a male student, I was nervous that a woman might accuse me of sexual inappropriateness when I touched her body. 23. My nursing program prepared me well to work with primarily female co-workers. Thank you for taking the time to respond to this survey. Feel free to enclose any comments you might have.

15 SCORING KEY: Short Form Inventory of Male Friendliness in Nursing Programs-Short (IMFNP-S) (O Lynn, 2007, 2013) Scores Range from 0 to 68 points (High scores reflect higher levels of male friendliness and a more receptive education climate for male students.) Part I: Introduction Please answer the following questions for some background information. 1. Current age: 2. School/ location you attended that prepared you to take the initial RN licensure examination: 3. Year of graduation: 4. Your identified ethnic/racial category: 5. Were there men on the nursing faculty while you were a student? YES NO 6. Were there other male nursing students in your graduating class? YES Number NO Part II: Please respond to each statement as it applies to your school experience. 7. Most of my female nursing instructors referred to the nurse exclusively as she. _0 Strongly Agree _1 Agree _2 Neutral _3 Disagree _4 Strongly disagree 8. My nursing program included a historical review of the contributions men have made to the nursing profession.

16 9. My nursing program actively recruited men to enroll as students. 10. There were times in class when female nursing faculty made disparaging remarks against men. _0 Strongly Agree _1 Agree _2 Neutral _3 Disagree _4 Strongly disagree 11. My nursing program included content on men s health issues. 12. I was provided opportunities to work with male RN s in my clinical rotations. 13. During the obstetrics (mother/baby) rotation, there were different requirements or limitations placed on male compared to my female classmates. _0 Strongly Agree _1 Agree _2 Neutral _3 Disagree _4 Strongly disagree 14. Many believe that men and women have different communication styles. My nursing program discussed how to overcome communication differences to ensure good therapeutic and working relationships. 15. I was invited to participate in all student activities.

17 16. My nursing program encouraged me to strive for leadership roles. Part III: The following statements pertain to your opinion or belief about various topics. Please think back to your experience as a nursing student and indicate the appropriate response. 17. People most important to me were supportive of my decision to enroll in nursing school. 18. I felt I had to prove myself more than my female classmates in nursing school because people expect nurses to be female. _0 Strongly Agree _1 Agree _2 Neutral _3 Disagree _4 Strongly disagree 19. In my nursing program, male and female students were treated more differently by the instructors than I had originally anticipated. _0 Strongly Agree _1 Agree _2 Neutral _3 Disagree _4 Strongly disagree 20. My gender was a barrier in developing collegial relationships with some of my instructors. _0 Strongly Agree _1 Agree _2 Neutral _3 Disagree _4 Strongly disagree 21. As a male student, I felt welcomed by most RN staff in my clinical rotations.

18 22. As a male student, I was nervous that a woman might accuse me of sexual inappropriateness when I touch her body. _0 Strongly Agree _1 Agree _2 Neutral _3 Disagree _4 Strongly disagree 23. My nursing program prepared me well to work with primarily female co-workers. Thank you for taking the time to respond to this survey. Feel free to enclose any comments you might have.

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