Results

Increasing male participation in nursing education is an important part of achieving gender balance in the Nordic Region, in line with broader goals of equality. This focus was also highlighted by the "Men in Nursing Education" project (Nordfjell & Nielsen, 2019), which serves as a key reference for this initiative. The "Share the Care" project, aims to address these imbalances by gathering and applying best practices to support men in nursing education. The project was implemented at selected nursing programs in Finland, Iceland and Norway. It introduces six targeted interventions at both individual and organisational levels to address the challenges that men face in nursing education, thereby contributing to a more inclusive and balanced health sector.

The "Share the Care" project builds upon the insights and outcomes of the "Men in Nursing Education" initiative, delving more profoundly into specific challenges. Those include fostering an institutional culture where men feel a sense of belonging, navigating the positioning of the nursing profession and masculinity and addressing the interplay between those two concepts. Furthermore, the "Share the Care" project examines the recruitment materials for male nurses, extending beyond the examination of male representation to encompass a broader spectrum of diversity, including age and ethnicity. It is also noteworthy that this report includes a section for self-reflection, which provides a comprehensive account of the recommendations and research approaches and enables the authors to situate their work within a broader context, depicting potential biases and limitations. 

The participating higher education institutions have developed comprehensive action plans with the objective of advancing diversity and improving gender balance. Despite efforts to update the action plan to incorporate project-specific actions, they were not all implemented within the project time frame. However, it was essential for the "Share the Care" project to anchor project activities within the existing diversity frameworks at the higher education institutions to ensure long-term impact and alignment with institutional goals. Furthermore, consideration should be given to the systematic incorporation of those plans into future projects that will follow. While the methodology and processes of the implemented measures are described in detail in the measure implementation report, the main take-aways are listed below according to each of the tasks. 

Terminology and training differences for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs): In Finland, Norway and Iceland, the training and roles of Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) differ. RNs typically require a Bachelor of Science in Nursing (BSN) degree, which takes three to four years, followed by passing a national licensing exam to practice. LPN training varies across the three countries. In Finland, LPNs complete a vocational programme taking two to three years with a focus on both basic and professional skills, including practical training in healthcare settings. Norway offers a four-year vocational programme for Healthcare Workers (Helsefagarbeider), with a mix of general education, health-specific studies and paid practical experience. Iceland's LPN programme is at the upper secondary school level, consisting of 120 credits of theoretical and practical training. All programmes emphasise practical experience, with LPN graduates often pursuing further education in nursing or related fields (Report on Measures and Methods for Gender Diversity in Nursing Education in the Nordic Region).

This project task had three main objectives: firstly, to implement a system to track and document student cohorts' dropout rates, delays and completion; secondly, to develop sustainable data collection methods; and thirdly, to propose routine interviews for students that had dropped out. The project faced several challenges, including harmonising data across countries and ensuring consistent, reliable data collection methods.

Norway demonstrated significant learning and implementation of changes by transitioning from 1) lacking a formal system for tracking at-risk of dropout students, to 2) identifying a university with effective student support practices, emphasising better resource allocation and early intervention and 3) introducing new practices, including permission forms for faculty contact with at-risk of dropout students, and dedicated efforts to retain male students, such as allocating 5% of an employee's time to recruiting and retaining male students, as well as regular updates on enrolment and graduation figures. 

Finland's institutions implemented a follow-up system to address student dropout rates, with a particular focus on timely graduation and the identification of at-risk of dropout students. It also introduced a centralised tutoring service and revised the curriculum based on student feedback, thereby enhancing flexibility to accommodate individual needs. When collecting data on dropout reasons, the key dropout factors for men included issues with internships, feelings of loneliness and exclusion and difficulties with web-based studies, which were further compounded by a lack of support and clear deadlines. The next stage in addressing dropout factors in the given institutions was to focus on those specific reasons.

In Iceland, the absence of formal measures and administrative leadership to promote the education of male students in the nursing profession has resulted in that responsibility being informally assigned to faculty members, who have been instrumental in maintaining low dropout rates among male students. Alternative admissions methods that could lead to more diversity have been discussed, but have not yet been implemented due to a lack of funding. As a result, the majority of nursing students are white females. There is a high level of awareness of the need for diversity in Iceland and it is likely that changes will occur in nursing education in the future.

Summary: Project partners illustrated that change starts with awareness and understanding by the administration and leadership that gender disbalance is an issue and that staff need time, budget, inspiration and good-practice examples to implement certain new structures in their institutions. Qualitative studies or interviews with male students or a personal approach and monitoring by faculty members in smaller educational institutions provide place-based specifics of the challenges and factors leading to dropouts and were therefore highly encouraged as a practice to induce change.

The second task focused on increasing awareness among teachers regarding gender in the nursing profession and the situation of male students in nursing education. 

In Norway, teachers actively participated in the discussions and emphasised the importance of regular reflection on these often overlooked issues of gender in the learning environment and inclusion of men in nursing education. Awareness-raising activities among teachers included discussions about the gendered representations and imagery of nurses in the textbooks. The discussion was based on an analysis of one of the textbooks, “Basic Nursing” (2016), used in the programme, in which 18 of 25 pictures depicted female nurses alone or with other female nurses, with most nurses shown being Caucasian, middle-aged women. The analysis prompted useful discussions and reflections on the positioning of teachers and students in the classroom/auditorium based on gender and diversity. If not addressed, female teachers and students will be seen as the norm while male students are singled out as different. The textbook publisher was also contacted; in view of the lack of representation of diversity they had already made improvements in the new edition, including updating the content to use the gender-neutral term “health nurse”. 

In Finland, incorporation of the issue of gender bias in teaching materials into discussions within nursing teams, tutor-teacher meetings and informal conversations was facilitated by the existing structures within the organisation, which allowed for the easy integration of this topic. The online survey on male students' feelings revealed that the wish not to be singled out in class was more important for male students than the issue of gender-imbalanced learning materials. In the discussion, the meaningfulness and diversity of nursing work were described as its main attractions.

In Iceland, educational materials from the United States or the United Kingdom are used in their original English language, with the result that the content is less gender-balanced then the Icelandic materials. A new course focusing on males in education is being developed for all students and will feature expert talks to address gender imbalances in a more engaging and open manner, depending on student interest.

Summary: Many activities are aimed at addressing gender imbalances in nursing education by enhancing teacher awareness of issues such as the presence of male role models and the potential influence of cultural biases. As a result of this initiative, updates were made to educational materials and new courses were developed with the objective of improving gender awareness.

This task involved critical analysis of the ways in which healthcare education institutions portray the nursing profession in their recruitment strategies. It examined the imagery and language used to ensure accurate representation of gender and ethnic diversity, with the goal of providing educational programmes and schools with feedback for improvement. The objective was to ensure that recruitment materials had the potential to attract diverse students and accurately reflected the profession.

In Norway, the analysis showed that the representation of gender on websites and social media remains disproportionate, with the majority of platforms reflecting the actual gender distribution rather than aiming for a more balanced portrayal. After meetings and discussions, including suggestions, with the nursing faculty at Østfold University College, the PR staff significantly improved the gender diversity of the web pages, adding two profile pictures and interviews with two male students. The schools providing Healthcare Worker programmes in the region were given examples of best practices as to how to make their websites and social media accounts more gender-representative.

In Finland, a recent analysis of health education programme marketing demonstrates that marketing materials now emphasise professional competence and international opportunities, with increased use of gender-neutral imagery and diverse student. The integration of simulation pedagogy and practical training highlights real-world applications. However, there is still a need for better representation of diverse ages and ethnic backgrounds. Overall, marketing has improved in terms of reflecting professional roles and educational content, while striving for more inclusive and gender-neutral representations.

In Iceland, the underrepresentation of male faculty members on nursing web pages at universities was identified as an issue and steps were taken to address and correct that gender bias. For instance, a formal reminder was sent out to the universities, urging them to revisit and update their web pages to achieve more balanced representation. Following the project team's assessment and critique of recruitment materials for nursing programmes, notable improvements were made with respect to portraying more balanced gender representation on nursing programmes. Additionally, the inclusion of a narrative about a male nurse who had changed career from law to nursing exemplified the pursuit of a fulfilling and meaningful career. Recruitment materials also showcased male professors alongside male students, reflecting a transition towards a more inclusive hiring process. 

Summary: Although there were disparities between Iceland, Norway and Finland, the initial recruitment materials were markedly gender-biased everywhere. However, once the issue had been identified, considerable progress was made in all countries participating in the project. Nevertheless, to avoid perpetuating the prevailing stereotype of nurses as young blonde females who are compassionate and caring, it is necessary to consider other dimensions of diversity and discrimination, such as age. Although diversity in marketing materials has expanded to encompass all genders and more diverse ethnic representation, there is still a lack of age diversity. In practice, the majority of images depict individuals in their youth or individuals of similar age. Improving that does not require significant additional resources. Instead, it requires awareness of the problem. Therefore, this cost-effective measure should be applied to improve the current status quo of diversity representation.

The objective of the fourth task was to enhance the learning environment for male nursing students. That was achieved by implementing several activities, including the establishment of a national sub-chapter for men in nursing education, the creation of opportunities for male students to be in the same classes or study groups and the identification of meeting points for them.

In Norway, a variety of strategies were implemented with the objective of enhancing the learning environment for male nursing students. One successful initiative was the grouping of male students together to ensure regular peer interaction. That measure has now been permanently adopted. Workshops on gender dynamics and minority positions were conducted to educate students, but had low attendance and could not be made mandatory. Student feedback identified issues such as practice settings in line with gender-stereotypical expectations. A peer mentoring programme was also introduced, overcoming initial recruitment challenges by transitioning to meetings every other month with experienced male nurses. Plans for a more systematic approach are in place for the future.

In Finland, the results of this task highlighted the need for the provision of gender-neutral study materials, the introduction of more male role models, the provision of social support and the implementation of inclusive teaching practices. Students proposed measures to facilitate male interaction and addressed feelings of loneliness that affect motivation. Additionally, the public image of healthcare, the integration of foreign-born workers and workplace violence were discussed, with particular emphasis placed on the importance of open dialogue, collegiality and safe working conditions to attract and retain male nursing students. In addition, an online discussion platform was developed to engage individuals interested in social and healthcare education and careers, with a focus on increasing male participation in those fields. Despite the intention for the original platform to provide valuable information and a discussion space, it faced challenges with respect to user adoption due to its complexity and lack of engagement. As a result, a simpler version was created using the widely used Discord server to benefit from students' familiarity with the platform. The new approach includes integrating the platform into the professional development course and planning expert talks on relevant topics such as salaries and working conditions to support professional development better.

In Iceland, initiatives to enhance the learning environment for male nursing students have included the establishment of a Male Nursing Committee, whose remit is to promote inclusivity and engagement. 

Summary: Instead of focusing on add-on activities for men, it is important to think about how to create a culture that embraces male students in nursing. That culture can be created through open, public dialogue that challenges stereotypes and providing informal meeting and networking points for male students, their mentors and wider society.

The objective was to establish counselling discussion groups in a variety of locations, including lifelong learning centres, unemployment offices, secondary schools and military personnel. The intention was to investigate potential strategies for encouraging men to pursue careers in nursing.

In Norway, despite efforts to encourage men to become nurses, many counsellors felt that their role was to support students in making choices, not to steer them towards particular careers. The pandemic disrupted awareness-raising open days, highlighting organisational challenges and the need for face-to-face meetings to provide reassurance about career choices. A notable finding was that ethnic minority students often pursue healthcare training because of job security and the high status of medical professions in their home country, but language barriers lead to high dropout rates. Discussions highlighted the importance of hands-on experience, such as working weeks in day care centres, in influencing boys to choose programmes in health, education and care and the need for realistic portrayals in recruitment materials. Counsellors emphasised the need for more training, better resources and early systemic approaches to challenge gender norms.

Iceland highlighted the need for an increased budget when planning career opportunities in nursing for male students. Despite efforts to broaden career perspectives, securing funding has proven to be a challenge, as there are significant costs associated with organising all-day events, particularly in terms of transport. A grant was secured to introduce nursing programmes to boys in year ten, although the pandemic limited the scope for activities. Nevertheless, the initiative successfully recruited both male and female participants and sought to challenge the stereotype that nursing tasks are inherently feminine.

In addition to practical visits and introductions, discussions were held with career guidance counsellors to promote gender balance in careers advice given to students.

In Finland, various interventions were carried out to promote healthcare careers. Those included meetings at lifelong learning centres to present the paramedic and LPN programmes, sessions where students interacted with professionals and promotional events such as a public health nurse programme in a shopping centre. Throughout the project, multiple media channels were used to raise awareness and engage with schools, the unemployed and army personnel to highlight nursing and health education as viable career options. While the initiatives were well received, there is room for improved collaboration between teachers and students to increase the effectiveness of careers guidance.

Summary: It is never too early to start addressing gender stereotypes. Early interventions such as exposure to the profession and hands-on experience as early as at nursery school are important, as it will be costly to fill the gaps in exposure to the nursing profession for male students at a later stage, e.g. organising trips to see professionals and full-time study experiences. When targeting the unemployed or other groups of potential male nurses, issues such as job security and the status of the profession are important.

A pan-Nordic reference group of researchers and practitioners convened to share experiences and strategies for addressing gender imbalances in the health sector. Discussions revealed several key findings: the importance of using male role models to attract men to nursing education, the impact of unemployment on men's access to health careers and the need to adapt curricula and job roles to make them more attractive to men. Participants highlighted the challenges of recruiting men into a field where the majority of workers are female and the need to create a supportive environment and build pride among male healthcare workers. Effective strategies discussed included tailoring educational content to men's interests, leveraging their caregiving experiences and improving marketing efforts. Addressing societal and structural factors, such as stereotypes and unemployment, was considered essential. The group concluded that a comprehensive approach, including curriculum changes, a supportive environment and targeted recruitment efforts, is critical to addressing the gender imbalance in the health sector.