Undergraduate nursing students challenge misconceptions towards men in nursing: A mixed-method study.

AIMS: To examine misconceptions towards men in nursing from the perspective of undergraduate nursing students. Specifically, this study sought to explore contributing factors of misconceptions and attributions of the success of men in nursing. DESIGN: A convergent parallel mixed-method study. METHODS: A national survey was conducted (July-September 2021). The quantitative data included demographics and responses to the Gender Misconceptions of Men in Nursing (GEMINI) scale. The qualitative data included responses to a provocative statement related to characteristics of men and their career in nursing. The GRAMMS guideline was used in reporting. RESULTS: Undergraduate nursing students (n = 1245) from 16 Australian schools of nursing responded to the survey. Quantitative analysis demonstrated that most students (96%) did not have misconceptions about men in nursing. Those who did were more likely to be men, born overseas, not in health-related employment and did not have nursing as their first choice. Four broad overarching main themes were generated in response to the statement that suggested men do not have the right attributes for nursing: (1) 'This is a very misandristic viewpoint'; (2) 'Compassion and intelligence are distributed in men and women equally'; (3) 'Men bring a different quality to nursing' (4) 'Anyone can be whatever they want to be'. CONCLUSION: Overall, nursing students did not have misconceptions about men in nursing, despite experiencing ongoing social stigma regarding archaic gender norms. The findings from this study indicate that the next-generation nurses were championing to challenge the gender stereotype and support the needs of a gender diverse society. IMPACT: Attitudes and misconceptions that elicit gender inequalities must be addressed with comprehensive strategies and de-gendered language and imagery within the profession, schools, workplaces and the media. Shifting culture and attitudes towards inclusion, values the diversity in the workforce and supports healthy workplace environments. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nursing practice in modern healthcare environments: A systematic review of attributes, characteristics, and demonstrations.

AIM: To identify Attributes, Characteristics and Demonstrations of nursing practice from both nurses' and people perspectives in today's healthcare environments. A secondary aim was to identify relevant differences between female and male nurses in the context of ACDs. DESIGN: This systematic review was informed by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. METHODS: The search included articles ranging from the years 2000 to 2023 across 10 electronic databases and multiple grey literature outlets. McMaster critical review forms and the Mixed Methods Appraisal Tool were used to appraise article quality. The Convergent Integrated Approach to Mixed Study Systematic Reviews was used to guide data synthesis. RESULTS: Twenty articles were included in this review, 13 qualitative, five quantitative and two mixed-methods studies. Three themes emerged, including knowledge, practice skills and interpersonal relationships. Differences in Attributes, Characteristics and Demonstrations of professional practice between women and men in nursing were also explored. CONCLUSION: Findings suggest that evolving healthcare environments challenge nurses to remain focused on patient-centred and compassionate care. The review also supports nurses caring in a manner that empowers people, increases well-being, and reduces suffering. IMPACT: Identified characteristics and attributes of nursing practice, including emphasis on continuous learning, interpersonal relationships and compassion, have a profound impact on nursing. Nurses should remain adaptable, compassionate and patient-focused in an ever-evolving healthcare environment. These foundational care principles are necessary for improving patient outcomes, enhancing trust between people and healthcare providers, and increasing inclusivity and diversity in the nursing workforce. WIDER GLOBAL COMMUNITY: Nurses worldwide should strive to embody these attributes to provide high-quality, patient-centred care in an inclusive environment in today's demanding healthcare environment. Gender-specific differences in the perception and expression of professional Attributes, Characteristics and Demonstrations can inform inclusion and diversity efforts in the workplace. REPORTING METHOD: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Reliability and validity evaluation of the Chinese version of the gender misconceptions of men in nursing (GEMINI) scale among nursing students.

BACKGROUND: Misconceptions about male nurses not only exacerbate the gender imbalance in the nursing profession but also negatively impact male nurses embarking on their careers. Currently, no tool exists to measure the gender biases toward males in nursing among nursing students in China. Consequently, the primary objective of this study is to assess the validity and reliability of the Chinese translation of the Gender Misconceptions of Men in Nursing (GEMINI) scale among nursing students. METHODS: This cross-sectional study involved 1,102 nursing students from China who participated online. We utilized the Brislin translation technique with a forward-backward approach. To determine the factor structure within the Men in Nursing Gender Misconceptions Scale's Chinese version, both exploratory (EFA) and confirmatory factor analysis (CFA) were applied. The scale's internal consistency was measured through the Cronbach's alpha coefficient, corrected item-total correlation, and a retest reliability assessment. RESULTS: The scale showed a content validity index of 0.938 and a retest reliability of 0.844. EFA indicated a two-factor structure for the translated instrument. CFA revealed a chi-square/degree of freedom of 3.837, an incremental fit index (IFI) of 0.952, a goodness-of-fit index (GFI) of 0.910, a comparative fit index (CFI) of 0.952, and an RMSEA of 0.073, all of which were within acceptable limits. The scale's Cronbach's α was 0.953, and the corrected item-total correlations ranged between 0.539 and 0.838. Gender-based misconceptions about men in nursing among students appeared to be influenced by their gender and whether they considered a nursing program as their first choice when applying for a major. Misconceptions about male nurses are greater among men and those who do not consider nursing programs as their first choice when applying for a major. CONCLUSIONS: The Chinese adaptation of the GEMINI scale showcased high reliability and validity. It stands as a potential instrument to gauge gender misconceptions concerning male nurses among Chinese nursing students.

Are men treated differently in clinical placements during nursing studies? A cross-sectional study.

AIM AND OBJECTIVE: To explore the perceptions of nursing students regarding the treatment of men in nursing during their clinical placement. BACKGROUND: Negative placement experiences of men who are nursing students is a risk factor for student attrition. Hence, exploring gender disparity in treatment during placement from both men and women studying nursing will contribute to improving student experience and reducing attrition. DESIGN: Survey capturing both quantitative and qualitative data. METHODS: Nursing students were surveyed between July and September 2021 across 16 Schools of Nursing in Australia. In addition to the Clinical Learning Environment Inventory (CLEI-19), an open-ended question explored if men received different treatment during clinical placement. RESULTS: Those who expressed difference in treatment of men were less satisfied with their clinical learning experience (p < .001). Of the 486 (39.6%) who responded to the open-ended question, 152 (31%) indicated a difference in the treatment of men, reporting that men received: (a) better (39%); (b) different, not exclusively better or worse (19%); and (c) worse (42%) treatment from either the clinical facilitator or ward staff. While both men and women perceived gender differences in the treatment of men during placement, men were more likely to report worse treatment. CONCLUSION: Despite the advances achieved in recruiting men in nursing, negative experiences during clinical placement are characterised by stereotypes, prejudice and discrimination, adversely impact retention. RELEVANCE TO CLINICAL PRACTICE: Nurse educators need to recognise specific support students require during placement regardless of gender. Our findings reinforce the adverse impacts of inequitable treatment on both men and women nursing students on learning, clinical performance, morale and ultimately on retention in the nursing workforce. Addressing gender stereotyping and discrimination in the undergraduate nursing program is an important step in promoting diversity and inclusivity in the nursing workforce.

Lack of awareness of nursing as a career choice for men: A qualitative descriptive study.

AIMS: This research aimed to identify the factors that impact why men do not view nursing as a career choice. DESIGN: Qualitative description was utilized to capture the rich narratives and insight of participants. METHODS: Through convenience sampling, nine New Zealand qualified male nurses within their first three years of practice were recruited. Semi-structured interviews were conducted between November 2019 and January 2020 via zoom from sites across New Zealand. All interviews were recorded and transcribed, with the data analysed using Braun and Clarke's thematic analysis. RESULTS: The findings reflected the experiences of the research participants as they made sense of a predominantly female-dominated work environment both during their undergraduate training and prior to recruitment. The research identified two key themes: The first found that men in nursing experienced isolation due to the societal gendering of nursing influencing the participant's knowledge and understanding of what nursing was, as a career. The second theme found that for participants, nursing was not prominent in their awareness when leaving school and making career choices. CONCLUSION: This research indicates that nursing as a career choice for men is still underpinned by a lack of understanding of the actual role of the nurse and what nurses do, and is more supported by a societal perception that nursing is still a feminized profession. Findings can be used to make recommendations for change in the profession to strengthen diversity in the workforce and redefine the recruitment of men into nursing. IMPACT: This research reviewed the career choices of men in nursing and why they chose nursing as a profession. Understanding the barriers of why men do not consider nursing as a career choice assists with finding strategies in both the clinical and academic environments that can enable greater gender diversity within the nursing profession. NO PATIENT OR PUBLIC CONTRIBUTION: This applies to this research as the focus was on male registered nurses only.

Approaches of male nurses for degendering nursing and becoming visible: A metasynthesis.

INTRODUCTION: Patient, nurse and public discrimination against male nurses is well-documented. Male nurses encounter challenges in degendering nursing and becoming more visible nursing professionals. However, little is known about male nurses' decisions and strategies to address issues concerning gender-based discrimination and professional visibility. AIMS: To develop a comprehensive understanding of the approaches of male nurses to degender nursing and become more visible in the profession. METHODS: A metasynthesis using the PRISMA guidelines. A comprehensive literature search was performed PubMed, CINAHL, Web of Science and Scopus databases. The search terms included 'lived experiences', 'male nurses', 'clinical practice', 'male educators' and 'male nurse managers'. In total, 16 qualitative studies published from January 2005 to November 2020 were critically appraised and synthesised. Two authors independently extracted data using summary tables. Data were synthesised using thematic synthesis which entails generation of codes and development of descriptive and analytical themes. RESULTS: Male nurses used intrapersonal, interpersonal and strategic adaptation to degender nursing and becoming visible as a nursing professional. These approaches entailed goal-directed behaviours, relationship-building strategies and positive and negative manipulation of resources. DISCUSSION: The approaches to degender nursing enabled men to prove their worth as competent nursing professionals, lessen the gendered stigmatisation and receive autonomy and respect. CONCLUSIONS: Degendering the gendered stigmatisation of nursing and becoming a visible nursing professional is essential for male nurses to promote diversity in the profession. Male nurses used both negative and positive approaches to gain recognition, respect and autonomy. They continued their struggles to promote the role of men as nurses. RELEVANCE TO CLINICAL PRACTICE: Nursing institutions and regulatory bodies could use the findings to develop conducive environments to degender nursing and increase male nurses' visibility. Future male nurses could use the identified positive approaches and tailor them to meet their needs to become more visible and competent nursing professionals.

Professional success of men in the nursing workforce: An integrative review.

AIM: To identify and summarize evidence of objective achievements and subjective indicators associated with professional success of men in nursing. BACKGROUND: Despite being a minority group, men in nursing are purported to enjoy hidden advantages. EVALUATION: In this integrative review, studies from seven databases were retrieved and independently evaluated using the quality appraisal tools in accordance with PRISMA guidelines. Inductive content analysis and narrative synthesis were conducted, guided by the aim of this review. KEY ISSUES: In total, 12 studies published between 1987 and 2021 were included. Two themes with related subthemes supporting or refuting professional success of men were identified. These were (a) evidence of professional success and (b) challenges to professional success. CONCLUSION: As a minority group, men are highly visible in nursing, which is a double-edged sword. Although men were overrepresented in senior nursing positions of higher salaries than women, they also experienced gender stereotyping, prejudice, and discrimination, which reduced the duration of men staying in a specific nursing position. IMPLICATIONS FOR NURSING MANAGEMENT: Findings of this study highlighted the need for nurse leaders to proactively address specific gender issues that are unique to men in the nursing workforce.

Does the nursing curriculum influence feelings of gender-role conflict in a cohort of nursing degree male students?

It is estimated that more than 9% of the global nursing workforce is male and that this share will gradually rise over the next decade. Although there are some positive aspects of having a male nursing workforce, men in the profession still experience discriminatory behaviours and practices. Fortunately, this does not deter a number of men entering undergraduate degree programmes. The aim of this study was to understand the experiences of 14 male nursing students in their first year of the adult Bachelor of Nursing programme. Using the Inventory of Male Friendliness in Nursing Programs and the Gender Role Conflict Scale, this study found that the male students felt welcomed, supported and included into the nursing programme. In addition, they felt no overall gender-role conflict, although feelings of success and achievement caused some challenges. The results of this study suggest that the male students did not necessarily experience those inequitable behaviours and practices reported in the literature. It has been suggested that perhaps the reality of clinical practice may change the perception of nursing for male students. Therefore, implications for further research could include a longitudinal study to ascertain where the perceptions of the nursing programme change for the male nursing students over time.

Role expectations and workplace relations experienced by men in nursing: A qualitative study through an interpretive description lens.

AIMS: The aim of this study was to investigate the lived experiences of male nurses in today's healthcare environment to understand the persistently low numbers of men in nursing. DESIGN: This study used interpretive description methodology, which aligns with nursing's approach to knowledge discovery by acknowledging the evolution and complexity of shared and individual experiences. METHODS: Participants, (N = 11), were recruited through the American Association for Men in Nursing using purposive sampling. Focused interviews were conducted between May 2018 - June 2018. Interviews were semi-structured, guided by open-ended questions and video and audio recorded. Data were analysed according to study design with categories and themes extracted using reliability measures. RESULTS: This study's findings reflected the unique experiences of each participant in a primarily female dominated work environment in clinical and academic settings. Our study identified thematic categories of role expectations and workplace relations for the men in the study. Role expectations were influenced by sociocultural views, professional acceptance and patient/family perceptions. Workplace relations were associated with being male, social cliques and peer support. CONCLUSION: Participants shared similar and distinctly individual experiences. Findings from this study indicate there has been progress toward improving male presence in nursing but additional efforts are needed to increase inclusivity. Findings can be used to make recommendations for professional change in nursing, strengthen diversity by refining ways to recruit more men, enhance patients' experiences and improve experiences for future male nurses. IMPACT: This study addressed low numbers of men in nursing. Main findings included role expectations and workplace relations and how they are experienced by men in nursing. Findings from this research have a multidisciplinary impact in the workplace, and affect care of patients and their families.

A historical look at men's involvement in nursing and leadership in GAPNA.

The role of men in nursing is not always evident. Men have been care takers in early societies, military health care, and the religious sector. The perception of men in nursing, however, took a shift from one of honor to one of deviance and failure from medical school. As the contributions of historical men in nursing, such as Walt Whitman, are brought to light, so are the contributions of select men within the Gerontological Advanced Practice Nurses Association (GAPNA). Dr. George Peraza-Smith provides an exclusive interview, shares his dedication and contributions to the care of the aging adult, and provides words of wisdom to those wanting to impact the care of geriatric nursing.

The male of the species: a profile of men in nursing.

AIM: To establish a profile of men in nursing in Western Australia and explore the perception of men in nursing from the perspective of male and female nurses. BACKGROUND: A project team, including some of the current authors, produced a YouTube video and DVD about men in nursing which led to further enquiry on this topic. DESIGN: The study employed a non-experimental, comparative, descriptive research design focused on a quantitative methodology, using an online survey in early 2014. METHOD: A convenience sample incorporated registered and enrolled nurses and midwives in Western Australia. FINDINGS: The range of data included demographic information and the respondents' perceptions of men in nursing were collected. Findings indicated that the main reasons for choosing a career in nursing or midwifery were similar for both genders. Common mis-perceptions of men in nursing included: most male nurses are gay; men are not suited to nursing and men are less caring and compassionate than women. Suggestions to promote nursing to men included: nurses are highly skilled professionals; there is the potential to make a difference for patients; nursing offers stable employment, professional diversity and opportunities for team work. There is a diminished awareness of opportunities for men in nursing and negative stereotypes related to men in nursing persist. CONCLUSION: The study produced recommendations which included: using the right message to target the recruitment for men and promoting a more realistic understanding of the profile and perception of men in nursing.

Boundary violations, gender and the nature of nursing work.

Complaints against nurses can be made on several grounds and orders, including removal from the registry of nurses, can be made as a result of these complaints. Boundary violations generally relate to complaints around criminal charges, unsatisfactory professional conduct or professional misconduct or a lack of good character. This article explores the spectrum of boundary violations in the nurse-patient relationship by reviewing disciplinary cases from the New South Wales Nurses and Midwives Tribunal and Professional Standards Committees. The complaints spanned a spectrum of behaviours, from minor infringements such as inappropriate compliments to intimate touching and sexual intercourse. Furthermore, the majority of respondents were men, although men comprise a minority of the nursing profession. This phenomenon is discussed in terms of gender stereotyping and nursing work. In addition, the possibility that improved supervision may have gone some way to preventing the violations is explored.

Educational and professional experiences of men in nursing: An interpretive description study to guide change and foster inclusive environments for men in nursing.

BACKGROUND: Nursing shortages are occurring due to decreased student enrollment, nurse burnout, staffing deficits, nurse retirements, and increasingly low numbers of nursing faculty. Men are an untapped resource that can offset these crises. However, men's presence in nursing remains underwhelming. Changes aimed at improving diversity and inclusivity related to men's presence is needed in the nursing workforce. PURPOSE: Explore men's experiences in modern nursing environments to identify barriers to men's presence in nursing faculty and clinical workforce roles. METHOD: This study used interpretive description design. Data were collected through individual and group interviews. Interviews were video recorded. Interview questions were semi-structured and open ended. Data were analyzed using thematic analysis. RESULTS: Two themes were identified and reflected men's experiences in nursing: educational and professional change. Subthemes for educational change included increasing numbers of men in student and faculty roles; instructional change; admission, retention, and advising. Subthemes for professional change included inclusive hiring practices; healthy working environments; and leadership outcomes. CONCLUSION: Findings constitute calls for action. Change implementation should address barriers to diversity and inclusivity related to men's presence in nursing. Recommendations and strategies presented can guide change implementation. Change implementation is expected to strengthen the nursing profession.

Addressing Shortages in Nursing with Male Representation: A Literature Review.

The nursing shortage in the US and all over the world continues to skyrocket. An untapped channel of recruitment that some are considering is men in the nursing profession. Currently a large disparity exists in the representation of men in nursing causing issues with quality of care, diversity, and staffing. Research suggests that nursing recruitment should occur before licensure in order to better address gender stereotypes and prejudice. Early exposure is revealed as a defining factor in enticing men into the profession. Further research reveals that issues related to nurse educator staffing must first be considered to include more men into the profession. Without nurse educators, schools are unable to increase class sizes and admit more men into programs.

Men in Female-Dominated Nursing Specialties.

While numbers of men in the nursing profession have slowly increased, men in female-dominated specialty areas have not changed. Male nurses and nursing students encounter gender bias and discrimination in certain specialty nursing environments. This has implications for the quality of care provided, parental engagement, and job satisfaction. By diversifying the nursing workforce, there is a potential to enhance patient comfort, improve satisfaction, and promote a more inclusive, creative, and patient-focused health care environment.

Performative Masculinity: A META-Ethnography of Experiences of Men in Academic and Clinical Nursing.

Gender differences and stereotypes have been widely studied. Performative masculinity or "doing gender" is the adoption of traits considered to be "masculine" to achieve acceptance in society. Performative masculinity, as it relates to career development for men in nursing, could be affected by internal attitudes and career choice, and external influences of culture. There are no critical systematic reviews to describe this process. The aim of this study was to synthesize research on how men in nursing experience masculine identity at work. A systematic literature search and qualitative synthesis using meta-ethnography guided this study. The literature search included studies from the electronic databases of PubMed, CINAHL, Medline, and Airiti Library, published in English or Chinese from 1994 to 2016. Eleven studies met the inclusion criteria. The meta-syntheses identified three themes describing how men in nursing experience masculine identity at work: (1) Nursing could be a gendered-neutral occupation suitable to both genders; (2) performative masculinity; and (3) strategies used when providing bodywork and care. Exploring insights about the tensions of performative masculinity among men in nursing, this study may help to address the challenges encountered in nursing education, practice, and career development. Establishing a male nursing model based on evidence from academic and clinical practice for nursing students and professional nurses could help to meet the increasing demand for nurses.

"Looking for a unicorn": The challenges of studying African American men enrolled in pre-licensure nursing programs.

The purpose of this article is to relay the results of research study about the perceived challenges and successes of African American men in pre-licensure nursing programs, while describing the lessons learned when trying to research an underrepresented population in nursing education. Methodological flaws, poor return rates, and an overall lack of support led to findings which were not usable for the research topic, but might be usable to others interested in nursing education research. The research process highlights the continual struggle that nursing education has with creating and disseminating evidence to help faculty diversify the student body in nursing programs.

A qualitative systematic review on the lived experience of men in nursing.

AIM: This qualitative systematic review was conducted to describe the lived experience of men in nursing. DESIGN: A systematic review of qualitative studies. METHODS: Five databases (Scopus, CINAHL, MEDLINE, PsycINFO and Embase) were systematically searched. The PRISMA guideline was used for reporting the literature search in different phases, and the Critical Appraisal Skills Program, a qualitative research checklist, was used to evaluate the studies that met the inclusion criteria. Thomas and Harden's thematic analysis approach for qualitative research was used for data synthesis. RESULTS: Six qualitative studies were included. Five analytical themes related to lived experiences of men in nursing emerged: value in nursing, the double-edged sword of gender, being accepted in the nursing profession, attractions of nursing and coping strategies.

Development and psychometric testing of the gender misconceptions of men in nursing (GEMINI) scale among nursing students.

BACKGROUND: Misconceptions about men in nursing may influence recruitment and retention, further perpetuating the gender diversity imbalance in the nursing workforce. Identifying misconceptions and implementing early intervention strategies to address these deep-rooted stereotypes remain challenging but is considered critical to support students who are commencing a nursing career. OBJECTIVE: To develop and evaluate the psychometric properties of the 'Gender Misconceptions of meN in nursIng (GEMINI) Scale. DESIGN: Cross-sectional survey. METHODS: Pre-registration nursing students enrolled in undergraduate nursing programmes across 16 nursing institutions in Australia were surveyed from July to September 2021. The 17-item self-report GEMINI Scale measured the gender misconceptions of men in nursing. RESULTS: Of the 1410 completed surveys, data from 683 (45%) women were used for exploratory factor analysis showing a one factor structure, while data from 727 men (47%) were used for confirmatory factor analysis of the 17-item GEMINI Scale, which showed a good model fit. The scale demonstrated high internal consistency (Cronbach's alpha of 0.892). Men were found to have higher gender misconceptions (p < 0.001) while respondents who: (a) identified nursing as their first career choice (p = 0.002); (b) were in their final year of programme enrolment (p = 0.016); and (c) engaged in health-related paid work (p = 0.002) had lower gender misconceptions. CONCLUSION: The GEMINI Scale is a robust, valid, reliable, and easy to administer tool to assess misconceptions about men in nursing, which may potentially influence academic performance and retention. Identifying and addressing specific elements of misconceptions could inform targeted strategies to support retention and decrease attrition among these students. IMPACT STATEMENT: Genderism harms nursing, as well as the men and women working in the profession. Recruitment and retention of men into nursing is needed to cultivate male role models and diversify the workforce, however this is impeded by negative portrayals in popular culture and misconceptions entrenched in society.

Development and validation of a scale to measure attitude of people toward men in nursing profession.

BACKGROUND: Ancient history mentions the dominance of men in nursing; however, now nursing has a feminine image, and globally more than 90% of nursing workforce is females. Recently, more number of males are attracted to nursing, but there is a paucity of literature on the attitude of people about men in nursing may be because of a lack of measurement scales available for this purpose. The aim of this study was to develop and validate a new scale measuring attitude of people toward men in nursing. MATERIALS AND METHODS: The present study was conducted at a tertiary care hospital and used an exploratory sequential design with an instrument development model. A total of 400 participants were selected using the simple random sampling technique. The reliability, content validity, face validity, and construct validity of this newly developed scale were computed. For data analyses SPSS AMOS version 23 was used for performing exploratory and confirmatory factor analyses. RESULTS: The new scale "AMnQ" consists of 15 items under three factors: (I) nursing is feministic and professionally low, (II) higher suitability of male nurses in technical and challenging situations, and (III) synonymy of empathy and care with a female. The final model with 15 items of AMnQ scale was validated by confirmatory factor analysis and showed a good fit to data. The Cronbach's α for the overall scale was 0.87, and for Factors I, II, and III, it was 0.80, 0.88, and 0.89, respectively. CONCLUSIONS: The "AMnQ" is a valid, reliable scale to assess the attitude of patients, nurses, physicians, and nursing students toward men in nursing. There is an assumption that nursing is a feminine profession; therefore, a valid and reliable scale to measure the attitude of people toward men in nursing will help to generate pieces of evidence on this subject, so that policymakers can make unbiased decisions on liberalizing entry of men in nursing.