Gender equality policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000-2015

Distribution of nursing workforce in the world using Gini coefficient

INTRODUCTION

Unequal Access to human resources for health, reduces access to healthcare services, worsens the quality of services and reduces health outcomes. This study aims to investigate the distribution of the nursing workforce around the world.

METHODS

This is a descriptive-analytical study, which was conducted in 2021. The number of nurses and world populations was gathered from World Health Organization (WHO) and The United Nations (UN) databases. The UN has divided world countries based on the Human Development Index (HDI) into four categories of very high, high, medium and low HDI. To investigate the distribution of the nurses around the world, we used the nurse population ratio (per 10,000 population), Gini coefficient, Lorenz curve and Pareto curve.

FINDINGS

On average, there were 38.6 nurses for every 10,000 people in the world. Nations with the very high HDI, had the highest nurse/population ratio (95/10,000), while the low HDI nations had the lowest nurse/population ratio (7/10,000). Most nurses around the world were females (76.91%) who were in the age group of 35-44 (29.1%). The Gini coefficient of nations in the each four HDI categories varied from 0.217 to 0.283. The Gini coefficient of the nations between the four HDI categories was 0.467, and the Gini coefficient of the whole world was 0.667.

CONCLUSION

There were inequalities between countries all over the world. Policymakers should focus on the equitable distribution of the nursing workforce across all local, national and regional levels.

Gender equity in the scientific nursing journals indexed in Journal Citation Reports: A cross-sectional study

Background

Scientific activity has been connected to the proven inequality between women and men. To examine the state of gender equality in nursing research by analyzing the representation of male and female as editors and as authors of articles published in scientific journals.

Method

A cross-sectional study was carried out between September-2019 and May-2020. All the scientific publications published in 115 nursing journals indexed in the Journal Citation Reports in the years 2008, 2013, and 2017 were chosen as analysis units. The main variables studied were gender of the “journal editor”; gender of the “first author”, “last author”, “corresponding author”, and “first author in funded articles”. Descriptive and inferential analysis was performed.

Results

The proportion of male editors in 2008, 2013, and 2017 was 23.3, 19, and 18.5% respectively, with a male/female ratio of 1:3, 1:4 and 1:5. Male editors are mainly found in the journals of the first quartile (Q1 = 33.8%, ratio1:2), compared to the journals of the fourth quartile (Q4 = 6.6%, ratio1:14), p < 0.01. The male authorship position was “last author” (30.9%, ratio1:2), “corresponding author” (23.3%, ratio 1:3), “first author” (22.1%, ratio 1:4) and “first author in funded articles” (21.8%, ratio 1:4). Furthermore, in 19.5%, of the articles there were more male authors. The percentage of articles with male authorship increased from 2008 to 2017, “first author” (21.1–23.4%; p < 0.01), “last author” (30.0–31.1%; p = 0.22), “corresponding author” (22.5–24.2; p = 0.01), and “first author in funded articles” (18.1–25.9%; p < 0.001).

Conclusions

Men are over-represented in the editor role in the most prestigious nursing journals. There are a higher proportion of male authors in the main positions of authorship.

Analysis of gender perspective in the use of NANDA-I nursing diagnoses: A systematic review

AIM

To identify, describe and analyse the gender perspective in the use of the diagnoses contained in the NANDA-I taxonomy in observational studies published in the scientific literature.

DESIGN AND METHODS

A systematic review has been conducted spanning from 2002 to 2020. The most frequent NANDA-I nursing diagnoses in care plans reported in observational studies, and the defining characteristics and related factors identified for men and women have been described. The Preferred Reporting Items for Systematic Reviews (PRISMA-P) have guided our research. The main findings have been summarized using a descriptive narrative synthesis approach.

RESULTS

Forty-one articles were included in our study. With regard to gender analysis, the percentage of men and women that make up the sample were not specified in all articles, and half of the studies did not identify gender either in the diagnosis label or in their defining characteristics or related factors. Based on the reviewed articles, gender perspectives are not systematically incorporated in the use of the NANDA-I diagnosis. Therefore, gender biases in its use in the scientific literature may exist. This situation poses barriers to determine the health responses that are different and unequal between women and men.

Nursing Students' Perception about Gender Inequalities Presented on Social Networks: A Qualitative Study

During the COVID-19 pandemic, gender inequalities in nurses have been exacerbated through the images shown on social networks. This study aimed to explore and describe nursing students' experiences and perceptions about gender inequalities in nurses during the COVID-19 pandemic. A descriptive qualitative study was carried out in two universities in 264 undergraduate nursing students. The photovoice method was used to guide the study. Results: Two main categories and four subcategories were described from the data: "gender-related stereotypes", with "male leadership in a female profession" and "sexualization of female nurses" and "women's vulnerability in the pandemic" with "the gender gap in the face of increased risk of contagion " and "women's emotional fragility". Over the years, care has been considered a female task, and nursing continues to be thought of in this way. The nurse has been discriminated against, poorly considered as a professional, and, as a woman, subjected to gender roles.

Measures to improve patient needs assessments and reduce practice variation in Dutch home care organizations

AIM

Worldwide, long-term care tends to shift from institutional care towards home care. In order to deliver high-quality and adequate care, the type, amount and cost of care is determined by a patient needs assessment. However, there are indications that this patient needs assessment varies between comparable patients. In the Netherlands, some home care organizations aim to improve patient needs assessments by implementing improvement measures to reduce this practice variation. The goal of this study was to explore the type and perceived impact of those implemented improvement measures.

DESIGN

A cross-sectional explorative survey study was conducted among Dutch home care organizations between January and April 2021.

METHODS

An online questionnaire with 26 items was developed by the research team, which was distributed through Dutch nationwide home care sector organizations, the Dutch nurses' association (V&VN) and the Dutch society for home care nursing (NWG).

RESULTS

The survey was completed by 184 respondents, including home care nurses, managers and staff who are responsible for training, policy and quality of care. Intervision and peer review for home care nurses were the most common reported improvement measures that were implemented in home care organizations. The experiences of those improvement measures have been perceived as creating greater uniformity in the patient needs assessment, making home care nurses feel more supported and secure performing their patient needs assessment and that the provided care is more in line with patients' demand. Our findings give insights into type and perceived impact of improvement measures that Dutch home care organizations implemented. Further research is needed to find out whether improvement measures actually improve patient needs assessments and reduce practice variation.

Nursing students' perception of gender-defined roles in nursing: a qualitative descriptive study

BACKGROUND

Gender stereotypes influence both women and men who work as nurses as well as individuals considering nursing as a profession. The aim of this study was to explore male and female nursing students' experiences and perspectives regarding gender-defined roles as well as how they view their future professional roles.

METHODS

The study used a descriptive qualitative design. A convenience sample included 72 full-time second- and third-year undergraduate nursing students. Data were collected in 2017 using a self-administered qualitative questionnaire consisting of 11 essay-type questions. As an additional data collection method, a drawing method was applied. The data were analysed by content analysis separately for the male and female perspectives.

RESULTS

Altogether, eight themes emerged, with half explaining the male and the other half the female students' perspectives. Students choose nursing for altruistic, opportunistic and organisational reasons. Among the female students, another reason "family and social incentives" was also identified. Female students' vision of their future professional role included altruism and positive representations of 'being a nurse', whereas the male students' vision included management and leadership, and technical aspects of nursing.

CONCLUSIONS

Both male and female nursing students face the limits of their own gender roles, yet they are prepared to challenge these gender-based perceptions. Tackling stereotypes and raising public awareness, using gender-inclusive language and strategies for recruitment, ensuring gender diversity in nursing teams and revising the nursing curriculum where appropriate, are just some of the implications that arise to help overcome gender differences.

Challenges perceived by nursing professionals in physician-centred organizations: An exploratory qualitative study

AIM

To explore and analyse contextual challenges in nursing that have affected nurses' perceptions and role performance.

BACKGROUND

Health system hierarchy and patient/family-centred care has led to a high demand for skilled nurses. However, patriarchal organizations create challenges for nursing clinicians in Pakistan and elsewhere.

METHODS

A qualitative exploratory research (phenomenology) design was used. Twenty-five participants identified through purposive sampling contributed to the study. The data analysis was conducted using NVivo 12 Plus. We generated six major themes. Reporting was accomplished according to the consolidated criteria for reporting qualitative research checklist.

RESULTS

Gendered division of labour places nurses in a submissive position in clinical practice. Decreases in nurse-to-patient ratio and increase in patient-focused care adversely affect evidence-based practice. The gap between theory and practice in delivering quality care is increasing due to existing communication barriers among health-related professionals and an inadequate work environment. Comparatively inactive nursing leadership and directorate roles are not improving the social image of nursing, and are promoting role conflict and poor nursing self-concepts among nurses. In fact, cultural shock experienced by young nurses has produced inherent disorientation in their professionalism and fostered displays of horizontal violence towards them by senior nurses.

CONCLUSION

These challenges are influencing nurses' decisions to remain in or to join nursing as a profession that is confronted by severe recruitment and retention shortages due to the social and cultural stigmatization of this female dominated profession.

IMPLICATIONS FOR NURSING, HEALTH AND SOCIAL POLICY

This study promotes the concept of evidence-based practice to deliver quality health services in public hospitals and to improve the social status of nursing in Pakistan. It provides influential evidence to policymakers who should urgently address nurses' workplace health and safety issues as a global right.

Gender equity in medical publications: nurses have smashed the glass ceiling

INTRODUCTION 

Gender equity has become a major concern in many professional fields. The rate of women as authors has to be interpreted according to the rate of women in the related professions. In this perspective, studying nurses' population should be of particular interest since, worldwide, nurses are mostly women. Then, our aim was to study gender disparity in nurses' publications.

METHODS 

We selected the three main journals dedicated to nurse publications: International Journal of Nursing Studies, Journal of Nursing Scholarship, and European Journal of Cardiovascular Nursing. We included 20 recent consecutive papers from each journal. For each paper, the number of authors, their gender, and rank were recorded. Primary endpoint: overall rate of women as authors. Secondary endpoints: rate of women as first, last, second, and third authors.

RESULTS 

Sixty papers including 322 authors were analysed. Overall rate of women authors: 74%. Overall rate of women as first author: 82%. Overall rate of women as last author: 72%. Overall rate of women as second and third authors: respectively, 80% and 70%.

CONCLUSION 

Almost three-quarters of the authors in these main scientific journals of nursing studies were female. This rate is lower than the gender rate in the nursing profession.

Health care workers and migrant health: Pre- and post-COVID-19 considerations for reviewing and expanding the research agenda

The main purpose of this article is to review several ways in which health care workers could either impact migrant health or be directly impacted by migration and, based on this, suggest the expansion of the current research agenda on migration and health to address a range of topics that are currently either neglected, insufficiently researched, or researched from different perspectives. To ground this suggestion and emphasize the complexity and significance of migrant health research, we start by briefly reviewing several migration-related notions including the process of migration and its key facilitators and benefits; existing barriers to the provision of migrant health care; and the intricate links between health systems, health professionals, and migrant health. The three areas of research examined in this article address (i) the specific role of health workers in providing care to migrants and refugees and their capacity to do so, (ii) the health problems experienced by health workers who become migrants or refugees, and (iii) the precarious employment conditions experienced by both migrant and non-migrant health care workers. After summarizing the current available evidence on these topics, we discuss key information gaps and strategies to address them, while also incorporating several relevant COVID-19 pandemic considerations and research implications. Expanding the focus of research studies on migration and health could not only enhance the results of current strategies by supplying additional information to support their implementation but also spearhead the development of new solutions to the migrant health problem.

An Analysis of Past Florence Nightingale Medal Recipients: Insights Into Exceptional Nurses and the Evolution of Nursing

Aim

To examine past Florence Nightingale Medal recipients’ parallels with the evolving nature of the nursing field as a whole.

Design

Descriptive research.

Method

The professional and demographic characteristics of 1,449 Florence Nightingale Medal recipients between 1920 and 2015 were analyzed to develop a high-level overview of the award recipient characteristics.

Result

Medal recipients were primarily female (98.07%), with 36% being Specialist nurses. Awards were mainly conferred for aid work (30.4%) in the context of war or armed conflict followed by Nursing education (17.2%) and disaster aid (14.9%). The majority of recipients were affiliated with the Red Cross and the majority of recipients were those conducting Red Cross duties.

Conclusion

Our results offer statistical validation for the dedication of these exceptional individuals, while also highlighting overall parallels with the ongoing development of the nursing field as it expands to better deliver culturally-sensitive care and to overcome outdated stereotypes that would otherwise constrain innovation.