The Male Nursing Student as a Token

Research in Nursing and Health, 1984. 7, 287-294 zyxwvut The Male Nursing Student as a Token B. Kay Snavely and Gail Theus Fairhurst The purpose of this research was to test the applicability of Kanter’s theory of tokenism to male nursing students. Kanter’s theory states that numerical underrepresentation, not cultural factors, causes tokens to experience greater performance pressure, social isolation, and role entrapment. Subjects were 322 mole and female nursing students from two similar midwestern nursing schools. Subjects completed instruments measuring social isolation, upward communication distortion, performance pressure, and communication apprehension. This research did not find support for Kanter’s claims. Possible explanations for the findings include sex status differences and the nurturing character of the nursing profession. zyxwvuts Most of the literature devoted to tokens and minority groups in recent years focused on problems faced by minority females entering maledominated professions. Of note, however, is the effect of an accompanying movement by males into female-dominated professions. Nursing represents a primary area for males to branch away from traditionally male occupations. Given the predicted increase in demand for professionals in the health care fields generally, and nursing particularly, it seems economically beneficial to the nursing profession to encourage more males to become nurses. Individuals are identified as tokens when they enter a job environment with a history of their social category being numerically scarce in a given occupation (Kanter, 1977). Social category refers to some master status like age, sex, religion, or other characteristic where a set of assumptions about the relative status, expectations for behavior, andlor qualities possessed by the group are presumed. According to Kanter, such characteristics affect the perception of tokens which in turn results in three outcomes: social isolation, performance pressure, and role entrapment. Isolation of the token occurs because majority mem- bers tend to exaggerate their differences from tokens, a phenomenon which results in the majority tightening its own boundaries and treating the token as an outsider. Because tokens are more visible than majority members, they are under more performance pressure. Finally, when tokens enter an organization, majority members stereotype them based on the token’s ascribed characteristics such as sex or race which then leads to role entrapment. Based on research concerning female tokens in business settings, Kanter (1977) argued that the three token dynamics result, not because of cultural or sexual differences between majority and minority group members, but because of the degree of imbalance in the numerical proportions of the two groups. If this is true then males in nursing ought to experience the same token dynamics reported by Kanter for women in business. The literature about males in the nursing profession suggested that males should encounter the token dynamics Kanter named. Segal (1962) reported that male nurses may feel lower prestige when entering a female dominated occupation. To reduce the amount of role strain, male nurses zyxwvu zyxwvutsr zyxwvu zyxw Ms. B. Kay Snavely is an instructor in the Department of Management, Miami University, Oxford, OH. Dr. Gail Theus Fairhurst is associate professor in the Department of Communication, Speech, and Theater, University of Cincinnati, Cincinnati, OH. This article was received February 25, 1983, was revised, and was accepted for publication on November 2 2 , 1983. Requests for reprints may be addressed to B. Kay Snavely, Instructor, Department of Management, Miami University, Oxford, OH 45056. 0 1984 Wiley 01 60-6891/84/040287-08 $04.00 287 288 zyxwvuts zyxwv RESEARCH IN NURSING AND HEALTH (Bush, 1976; Greenberg & Levine, 1971) and male nursing students (Bush, 1976) choose nursing specialties more closely aligned with traditional male responsibilities (e.g., anesthesiology, psychiatry, urology, etc.). Fottler (1976) reported that sex segregation of nursing is based on social, cultural, and economic values, and the inconsistency of the traditional male image with a traditionally nurturing female role. In addition to the fact that much of the preceding literature is based on anecdotal data or suffers from methodological limitations, such as small sample size, the degree to which the male nurse or nursing student experience is shaped by the token dynamics identified by Kanter is not known. According to Kanter (1977), males are high status tokens when they aspire to a majority group occupation like nursing. This is because western society accords a higher societal status to males than to females. While Kanter said that deferential treatment may be substituted for the patronizing behavior female tokens receive, the outcomes she associated with tokenism should still prevail (i.e., performance pressure, social isolation, and role entrapment). Because status usually is correlated with power (Secord & Backman, 1974), and because status outside the organization (i.e., in society at large) adds to the structuring of control within the organization (Acker & Van Houten, 1974), male tokens apparently have a source of power that female tokens do not. The question thus becomes: What is the significance of this source of status and power to token dynamics? Will males in the nursing profession experience the performance pressure, social isolation, and role entrapment reported in recent studies of female tokens (Kanter, 1977; Spangler, Gordon, & Pipkin, 1978)? In this report a systematic empirical attempt to answer this question with male nursing students is described. The token outcomes examined were: (a) social isolation in certain interactional domains, (b) upward communication distortion, and (c) performance pressure. In addition, two other outcomes were communication apprehension toward the female majority and toward the male minority. The first outcome investigated was social isolation. According to Kanter (1977, p. 978), tokens should be more socially isolated than majority members. Further, social isolation is most likely to surface in the areas of political information (e.g., ways of getting around formal rules, strategies for impressing superiors, etc.) and personal problems affecting performance. Two other topics, general school and social information, also were studied because there is little information about such variables. Are male nursing students more socially isolated in networks involving political information, personal problems &fecting performance, general school and social information than female nursing students? The second outcome concerns entrapment in stereotypical roles which may force tokens to distort their self-image to coworkers and superiors more than majority members (Kanter, 1977). We focused specifically on upward communication distortion because the greater reward power of superiors might increase the concern for the image one is projecting, and therefore, the tendency to distort. For high status tokens, the distortion would likely enhance rather than detract from the perception of competence. Do male nursing students distort their upward communication more than female nursing students? The third outcome concerns the increased pressure to perform that tokens experience more than majority members. This is brought about by the heightened visibility of tokens. Are male nursing students under greater pressure to perform than female nursing students? There are several behaviors that Kanter said are endemic to tokenism that make communication particularly uncomfortable for tokens. This is because communication is the primary means through which a lowered status is conferred on a token. Some of these status-lowering behaviors are: reminding tokens about their deviance, making the token’s social category the object of humor or defamatory statements, being forced to act in ways which reinforce social category stereotypes, and other self-imposed social isolation. Consequently, tokens should experience communication apprehension, a construct defined as anxiety asswiated with either real or anticipated oral communication (McCroskey, 1977) with the numerical majority. Do male nursing students experience more communication apprehension than female nursing students when interacting with the male minority? Finally, if the males represent a threat to the females, then they may engender communication apprehension in the female majority. If they do not represent a threat, then we should expect little difference between males and females in their reported level of apprehension. zyx Do fernale nursing students experience greater communication apprehension than male nursing students when interacting with the male minority? METHOD Sample zyxw zyxwvutsrqp MALE NURSING / SNAVELY AND FAIRHURST Several nursing schools were examined and a convenience sample was obtained from two midwestern 2-year diploma nursing schools. The two selected schools were similar along the following criteria: (a) type of program, (b) length of program, (c) distribution of ages in the student body, (d) relative percentage of male students, (e) degree of autonomy provided to students, (f) admission standards, and (g) relative competitiveness in the environment. Both schools had a strong emphasis on grades, class honors, and clinical performance. Due to the large number of females and small number of males in each nursing school, pooling of two schools was required for statistical comparison. For one school (with enrollment of 18 males and 202 females) the sample was composed of 17 males and 176 females. For the second school (with enrollment of 26 males and 147 females), the sample was composed of 24 males and 105 females. A sample size of at least 30 males overall was sought to achieve stable parameter estimates. In addition, both first and second year classes within each school had to be combined. Because tenure in the organization could influence certain responses, the effects of year in school were explored. Subjects included 322 nursing students, 41 males and 281 females; all were Caucasian except for 5 females. The average age was 22.5 years for the males and 22.4 years for the females. 289 formance at school, general school information, and social information. Even though a student could name another student as a contact, there was no guarantee that the contact would reciprocate. This was treated as a response error, and thus reciprocation was forced for unreciprocated links. The two indicators of social isolation employed in this study were (a) outputs from a network analysis procedure (Richards, 1975) providing individual, group, and systemic information and (b) an integrativeness score measuring the association of a subject’s immediate contacts. The first indicator of social isolation, at the group level of analysis, is the role assigned to each individual on the basis of their position within the networks. Richards developed an algorithm which distinguishes between (a) isolates, those who have no links or only one other link to persons who are themselves isolated; (b) dyad members, those who are linked to only one other person and in terms of the group function as isolated pairs; (c) group members, those individuals belonging to a group meeting the following criteria: zyxwv 1. There must be at least three members. 2. Members must have 50% of their contacts with members in the group. 3. Each member must be linked to every other member within the group (through a path lying entirely within the group). 4. There must be no single individual or link, which when removed, causes the group to fail to meet the preceding criteria. zyxwvutsr zyxwvutsr Measures Social isolation. An instrument to measure social isolation was constructed and pretested on a freshman class (N = 97) at a third midwestern nursing school. After modifications, a revised questionnaire was administered to the four nursing classes in this sample. Students were given a list of the other students in their class and asked to respond to the following: (a) Whom do you get information from regarding the politics of being a student (i.e., how to get around formal rules, strategies for impressing superiors, overall strategies for getting what you want)? and (b) Whom do you give information to regarding the politics of being a student? In addition to identifying the direction of influence, students weighted their responses by specifying both the frequency and importance of the contacts. Similar sociometric questions were posed regarding three other topics: personal problems that could affect per- (d) liaisons, individuals who are linked to two or more groups but do not meet the criteria for group membership themselves; and (e) others, those persons who possess a number of links to other persons but fail to qualify for membership in any identifiable group. Following Richards’ definition, a person was categorized as a social isolate if there were no links to other persons or the links were to isolated people. If an individual was classified as a liaison, an other, or a group member, that person was considered integrated into a network of work relations. Dyad members were analyzed separately because members are not themselves isolates, but as a pair they function as one. The second indicator of social isolation, at the individual level of analysis, was an integrativeness score which is a measure of association of a subject’s immediate contacts. An integrativeness score was based on the number of links between persons connected to the focal person, divided by the largest possible number of such links. 290 zyxwvutsrq zyxw RESEARCH IN NURSING AND HEALTH zyxwv zy zyx The values ranged from 0 to 1 (Goldhaber & Rogers, 1979), with values closer to 1.00 indicating a greater degree of integrativeness into the network. Eight integrativeness scores, one for each network topic, were tabulated for each subject. Upward communication distortion. The measure of upward communication distortion closely followed a procedure developed by Athanassiades (1974). Subjects were given duplicate lists of 36 personality traits. The 36 personality traits, both positive and negative, were selected by the researchers for the two roles of Student and Nurse. For the first list, which appeared early in the overall questionnaire, students were asked to indicate the degree to which they felt the traits were representative of “how they see themselves.’’ For this exercise, students were assured that the faculty would not see their responses. Later in the questionnaire, students again received the same list (although the order was transposed) and essentially asked to do the same thing. With the second list, however, students were told that the faculty would be seeing their evaluations for purposes of counter-evaluating the responses. If students were distorting their selfimage to instructors, then there should be some difference in how they see themselves and how they portray themselves to their instructors. Each student received a distortion score by summing the differences between the first and second responses to each scale. Performance pressure. Two indicators of performance pressure were employed. The first indicator, suggested by Kanter (1977), was that performance pressure would be manifested by a tendency to under- or overachieve. To determine achievement level, high school grades (obtained with students’ permission) and class rank were used to predict nursing school grades. Those students whose grades were correctly predicted were dropped from consideration. Students whose grades were lower than expected were labeled underachievers, while those whose grades were greater than expected were labeled overachievers. The second indicator of performance pressure was drawn from Spangler et al. ’s ( 1978) research on token women in law school. They operationalized this construct in terms of contemplationof withdrawal from school. Accordingly, in a single item response format, the nursing students in this sample were asked, “How frequently have you contemplated withdrawing from nursing school?” Subjects were given a 5-point scale with endpoints ranging from frequently to never. Communication apprehension. The Situational Communication Apprehension Measure (SCAM) developed by Snavely and Phelps (1979) was used to measure communication apprehension. The scale required subjects to state their degree of agreement (on a 7-point scale) with the following statements: When communicating with my male (female) coworkers (1) I feel nervous, (2) I feel shy, (3) I feel relaxed, (4) I feel intimidated, ( 5 ) I feel afraid of what they will think of me, (6) I find it difficult to talk. Cronbach’s alpha for the scale was .80. After pretesting, the SCAM scale was revised to accommodate three additional items: (1) I feel self-conscious, (2) I feel womed, and (3) I am troubled with shyness. In a pilot study, the principal component analysis showed the first factor accounted for some 73% of the variance, and the reliability was consistent with previous (Snavely & Phelps, 1979) research (Cronbach’s alpha = .92). Students filled out two SCAM scales, the first with males as the referent and the second with females as the referent. Procedure After a signed informed consent was obtained from each subject, a questionnaire containing the four instruments was administered in large group settings ( at different times for each class). The response rates of the questionnaires were 88%, 90%, 94%, and 98% for the four classes. RESULTS Social Isolation zy Role designation. Separate network analyses were performed for each class. The first indicator of social isolation was the network role assigned to each participant. In Table 1 are the percentage of males and females falling into each role classification. Since the two class networks did not differ, the percentages were averaged. An examination of the isolate category in Table 1 shows an extremely low percentage of both males and females playing the isolate role in all four networks; there are no isolates in the school information network for either sex. For males there are no isolates in the Flitics or social networks; for females there is less than 1% in the politics and social networks. The personal problems network is the only network where any isolates exist for either sex, although the percentages are still extremely low. Additionally, no dyad members, who as pairs function as isolates, surfaced. lntegrativeness scores. The second indicator of social isolation was the integrativeness scores assigned to each subject by network. The eight integrativeness scores for each individual were zyxwvu zyxw zyxwv z zyxwvutsrq zyxw 29 1 MALE NURSING / SNAVELY AND FAIRHURST Table 1. Network Role Classificationsfor Male Students (N=41)and Female (N=281) Nursing Group Member liaison Isolate Dyad Member Other YoMales YOFemales 68.3 69.6 3.7 1.1 0.0 0.5 0.0 0.0 28.1 28.5 % Males YOFemales 47.6 69.6 2.5 3.4 3.6 2.3 0.0 0.0 46.4 24.5 91.5 80.8 2.4 2.3 0.0 0.0 0.0 0.0 5.1 16.9 Social Information YOMales YOFemales YOMales YOFemales 6.1 4.5 0.0 0.8 0.0 0.0 9.8 20.3 Combined % Males % Females 72.9 73.7 3.7 2.8 0.9 0.9 0.0 0.0 22.6 22.6 Network PoIit ics Personal Problems School Information 84.2 74.6 zyxwvu _. zyxwvuts subjected to a principal components analysis with iterations to arrive at a more parsimonious set of network variables. Variables that loaded .5 or above on one factor with no secondary loading greater than . 3 on another were retained. This criterion was chosen because factor loadings have been shown to be somewhat unstable (Dorans & Drasgow, 1978), and this criterion gave an indication of the relative unidimensionality of the variables retained. The analysis produced a 2factor solution as shown in Table 2. It is immediately apparent that the directional information for the different topics (i.e., whom do you get information from, give information to?) is strongly correlated suggesting a mutual exchange of information. The factor matrix in Table 2 shows that general school information, social information, and political information correlate strongly with the first factor, although social information also has high loadings on the second factor. The general nature of this topic is thought to be the reason for the dual factor loadings. To aid interpretability, “get information from,” and “give information to” on social matters were dropped from the analysis. The first factor then is composed of the topics school information and political information, both of which involve work knowledge. The second factor is composed solely of the topic personal problems affecting performance. Composite scales for these two factors were formed by adding together the variables that loaded on that factor. This procedure resulted in sacrificing the orthogonality of the factors. Because the correlations between the dependent network factors and some of the other variables were high, multivariate analysis of the data was used to test for group differences. Thus, the effects of sex and year in school on the factored network variables, the communication apprehension variables, and contemplation of withdrawal from nursing school were examined. The multivariate profile analysis (Morrison, 1976), which tested for an overall treatment effect, was significant (F (12,815) = 5.40, p < .0001). The multivariate analyses of variances which followed tested the model for specific treatment ef- Table 2. Rotated Factor Matrix for Network lntegrativeness Scores of 322 Nursing Students School Information School Information Social Information Social Information Political Information Politica I Information Personal Problems Personal Problems Gets information from Gives information to Gets information from Gives informution to Gets information from Gives information to Gets information from Gives information to YOof Variance = Factor 1 Factor 2 .867 ,888 ,673 ,642 .776 ,773 .227 .2 1 5 .141 .1 77 .4 1 5 ,452 .2 13 ,239 .932 ,870 62.4 16.6 zyxwvutsr zyxwv zyxwv zyxwvut zyxwvutsr 292 RESEARCH IN NURSING AND HEALTH fects. The effect for sex was significant (F (5,272) = 6.68, p < .001), while the effect for year was not significant. The interaction effect for sex and year was not significant. Univariate F tests were subsequently used to probe the meaning of the multivariate difference (Spector, 1977). A Statistical Analysis System (SAS) (Helwig & Council, 1979) Type IV sums of squares solution was used in all cases because the design was unbalanced and the effects were not orthogonal. This solution partials for all other effects in the model, the most conservative approach. The overall F was significant for the work knowledge network factor [F (3,276) = 5.21, p < .002, R2 = .05],with a year effect surfacing (F = 15.23, p < .05). The overall F was not significant for the personal problems network factor. Sex composition of group and individual contact networks. Since a sex effect failed to surface for those falling into the isolate category as well as in terms of their integrativeness scores, a separate analysis of the sex composition of both the group structures that emerged, as well as the contacts named by each student was undertaken. The logic of this inquiry stemmed from the belief that if males primarily associated with other males, this would still be evidence of social isolation and thus the preceding finding would be spu- especially in the area of personal problems affecting school performance where discussion of male-female relationships is likely to surface. The data in Table 3 bear this out. Thus, the finding that males are socially integrated does not appear spurious. Upward Communication Isolation zyxwvut zyxwv zyxwv rious. Of the 76 groups that emerged from the four networks, 1 group contained only males, 30 groups contained only females (partly due to the vast majority of students being female), and 45 groups contained both sexes. When individual data were examined to see the percentage of males and females named as contacts, little evidence of exclusive contact within males were found, as shown in Table 3, males name other males as comprising no more than one-third of their contacts. While this is 27 to 4 times as many males as named by females, this finding is not unusual. That is, we would expect males to associate a little more with other males The upward communication distortion measure was not included in the preceding multivariate analysis because the amount of missing data for this variable, when combined with the other variables, dropped too many males from the analysis. Consequently, a univariate F test was performed. Although the test should be interpreted with some caution, there does not appear to be much redundancy between the upward communication distortion measure and the other dependent variables. The correlations ranged from - .06 to .15. A sufficierit number of males was retained for analysis (N = 29) when this variable was considered alone. The results of the analysis of sex and year in school on upward communication distortion were not significant. However, the effect for sex was the most prominent of the sources of variation (F = 5.54, p < .02). Performance Pressurg Contemplation of withdrawal from school was tested as part of the multivariate analyses reported for Social Isolation. The univariate F tests showed that the effect for contemplation of withdrawal from nursing school was not significant. Under- and overachievement were determined by the residuals yielded by the multiple regression of nursing school grades on high school grades and class rank. The residuals ranged from - 121.514 to 113.433. The top 25% were deemed overachievers and the bottom 25% underachievers. The cut-off points were 31.20 and -31.18, respectively. Class rank and high school grades accounted for a significant [F (2,194) = 19.36, Table 3. Percentage of Males Named a5 Contacts by Male and Female Students Network Politics Personal Problems School Information Social Information Percentage of male students naming males as contacts Percentage of female students naming males as contacts 33% 33% 13% 9% 12% 12% 2 7% 29% z zyxwvut zyxw zyxwvu zyxwv zyxwv MALE NURSING I SNAVELY AND FAIRHURST p < .oOl, R2 = .17], albeit a comparatively small proportion, of the variance in nursing school grades. Consequently, this measure is not as strong an indicator of performance pressure as expected. The ANOVA failed to reveal a significant sex effect. Communication Apprehension Both communication apprehension variables were tested as part of the multivariate analyses reported for Social Isolation. The univariate F tests showed that the effect for communication apprehension towards females was not significant. However, the effect for communication apprehension towards males was significant (F (3,276) = 4.36, p < .005, R2 = .05). When the model was further broken down, a sex effect surfaced ( F = 11.61, p < .001). Females felt significantly more communication apprehension than males. 293 that male nursing students knew “how to play the game” and manipulate the system toward their own ends; thus, males were described as politically astute. (b) Female majority members felt more communication apprehension toward token males than the token males felt toward females. The apprehension felt by majority members may be a recognition of the power of the tokens due to their high status. The implications of this argument suggest that being numerically dominant is only one among many sources of status and control within an organization and these sources must be considered when examining token dynamics. Future research should continue to explore the extent to which token dynamics intensify when other sources of status and control (e.g., race, age) favor the majority and lessen when such sources favor the token minority. A second explanation comes from Cook’s (1969) work on race relations. Organizations go through stages with regard to the integration of any specific minority group. These stages are marked by the degree of contact with the minority. They range from a rather uncertain preinteraction period to a postinteraction stage where the experience with minorities has been sufficient to draw conclusions about them. Fromkin (1974) made the point that proportional imbalance may be most critical in the early stages of integration rather than later on. If the male nurses in previous studies or the women in Kanter’s study were newer, as a minority group, to their setting than this study’s male nursing students were to theirs, this may explain why token dynamics surfaced for the former groups. While Kanter (1977) argued that token dynamics will surface whenever the relative numbers are sufficiently imbalanced, she allowed that the newness of a token minority to a setting may heighten token dynamics. It may be, however, that scarcity is necessary but not sufficient to produce tokenism with newness also being a necessary condition. A third and final explanation for these results stems from idiosyncracies introduced by the nursing profession itself. Consider the following: First, nursing by its definition and duties demands a nurturing approach of its members. People who enter nursing must have some need to help others. That helping nature very likely permeates the socialization process when new members enter the profession. Thus, the majority group members may seek to reduce any uncomfortable dynamics that male nursing students are likely to face. This nurturing approach is not endemic to other professions where tokenism has been studied; compare, for example, the difficulties faced zyxwv DlSCUSSlON This research failed to find the token dynamics reported in studies of female tokens (Kanter, 1977; Spangler et al., 1978). When male nursing student behavior was compared to the female majority’s behavior, the males were neither more socially isolated, nor distorting in their upward communication, nor under greater pressure to perform. Under- or overachievement was not as strong an indicator of performance pressure as expected, perhaps because the average age of the sample was 22, some 4 to 5 years after high school graduation. If Kanter’s theory applies to all tokens, then we should have found significant differences in the amount of performance pressure, social isolation, and role entrapment between male and female nursing students in this investigation. One intuitively appealing explanation for these results could be sex status differences (i.e., the higher status of males and the lower status of females in society). According to Acker and Van Houten (1974), a sex based status difference outside the organization adds to the structuring of control within the organization because organizations tend to reflect the cultures they are a part of. For the high status male nursing students, this translates to a token minority that has a power base from which to resist majority group assertions of control, like social isolation, role entrapment, and performance pressure. Other findings in this study supportive of this argument include the following: (a) The nursing school faculty, the male students, and the female students reported zyxwv 294 zyxwvutsrq zyxwv RESEARCH IN NURSING AND HEALTH by female tokens in competitive business settings. Second, there may be other token dynamics outside the coworker relationship which impact the majority-minority interaction. Specifically, it seems likely that larger societal roles may greatly affect token dynamics because it is outside the hospital setting where the male entering nursing finds considerable prestige loss. Parents, particularly fathers, are most overt in their attempts to dissuade males from becoming nurses (Bush, 1976). Outside the family, it is generally “first contact situations and superficial relationships” (Schoenmaker & Radosevich, 1976) where disapproval of male nurses is highest. Though these may not be the most important relationships males face, the sheer numbers of superficial relationships and first meetings encountered could be substantial. Patients in hospital settings, though initially uncomfortable with male nurses, tend to ‘‘come around” eventually according to selfreports by male nurses (Greenberg & Levine, 1971). Nevertheless, the need to examine token dynamics which may accrue from outside the immediate organization may be important because both this study and Kanter’s (1977) examined dynamics within the organization and, by their design, largely ignored the outside environment. In light of the findings in this study which suggest the relative lack of token dynamics as far as coworker relationships are concerned, and previous research suggesting the relative presence of token dynamics, the nursing profession should encourage and participate in further study of token dynamics faced by males in the profession. Such study could: (a) potentially prompt an increase in the number of males in the profession, a profession currently faced with a shortage of personnel; (b) lead to a clearer explanation of the situation faced by males and females in minority and majority groups; and ( c ) contribute to our understanding of token dynamics in general. Cook, S. W. 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