Men on Pre-registration Programmes of Nursing in Scotland: an Exploration of Reasons for Attrition and Possible Ways of Improving Retention: Final Report for the Scottish Collaboration for the Enhancement of Pre-Registration Nursing (SCPREN) and commissioned by NES

Aim and Objectives
The study aimed to explore the reasons for higher attrition of men from pre-registration nursing programmes in Scotland and ways of improving retention. The objectives were to:
 interrogate the data about possible reasons male pre-registration nursing students leave programmes of nursing education in Scotland.
 explore the views and experiences of male students who have left a programme of pre-registration nursing about their experiences while on programme and strategies that might have helped them to complete the programme.
 explore the views and experiences of current male and female nursing students on
programmes of pre-registration nursing about their experiences while on
programme and reasons why male students might leave programmes early.
 explore the views and experiences of higher education nursing lecturers about reasons for higher attrition of male pre-registration students from programmes of nursing and ways of helping students to complete the programme.
 develop strategies to address the issues.

Methods
The study was carried out in five phases:
1. Data was sought from NES and individual partner institutions about factors that might affect retention on programmes of nursing education in Scotland.
2. Three telephone interviews with carried out with men who had left a programme of nursing education in Scotland in the past five years.
3. Four focus groups and one interview were held with 13 current male students on a programme of nursing education in Scotland.
4. One focus groups and two interviews were held with 5 current female students on a programme of nursing education in Scotland.
5. Three focus groups were held with 12 nursing lecturers.

Ethical approval was gained for all phases of the study. Analysis of the qualitative data followed the phases of compiling, disassembling, reassembling, interpreting and concluding.
Confirmation of the final themes was through discussion with project team members who all participated in the data collection.

Findings
Data from NES found that male students of nursing are older than female students when they start the programme. They are more likely than women to discontinue and this is regardless of field of nursing. The data identified that men who discontinue the programme are younger than those who complete. There is a lack of reliable and robust data available to investigate other factors that might affect retention and attrition.

The qualitative findings identified that male students feel isolated and somewhat vulnerable on programme. They face challenges in gaining access to learning opportunities, are
stereotyped in terms of their masculinity, physical attributes and feel that they stand out as different in both the classroom and in placement. An accumulation of many minor issues contribute to emphasise these differences. Financial pressures may disproportionately affect male students. Male students require resilience and maturity to cope with these challenges. They appreciate the breadth of opportunity and the rewards of a career in nursing and feel that they bring many valuable assets to the clinical environment in terms of empathy with patients and a different communication style. Female students did not
acknowledge the challenges faced by their male colleagues. Proactive measures are needed to support male students to help them complete their nursing education.

Recommendations
Regarding data:
 More robust and more comprehensive data is needed about students in order to identify factors affecting discontinuation.
 More robust data needs to be collected about the reasons students leave programmes of nursing education, including fitness to practise reasons.
Regarding the image of nursing:
 Publicity about male role models in clinical nursing and academia is needed to provide positive examples of success in nursing.
 National recruitment strategies are needed to change societal perceptions about the female nursing stereotype.
 Outreach work in schools is needed to challenge gender stereotypes of nursing. 
Regarding the University environment:
 Support opportunities are needed for male students to minimise feelings of isolation, such as ‘buddying up’, ensuring that there is more than one male student in a class (where possible), or arranging male student mentors or a male student nurse support group.
 Staff training is needed about unconscious bias to ensure that learning materials, such as in case studies, include gender diversity (of practitioners and patients) and there is careful avoidance of gendered language.
 Staff should encourage and enable opportunities for students to seek support when needed, such as perhaps using a tool to measure student support requirements.
 Provide training for staff to recognise the potential isolation and vulnerability of male students and put in place ‘assertive’ support for male students.
 Acknowledge the financial pressures faced by students and recognise that the (relatively) low income of nurses may be a factor influencing male students dropping out.
 Treat all students equally and as individuals in the classroom (and the clinical area) by moving away from binary assumptions about gender.

Regarding clinical placements:
 Emphasise to mentors and clinical staff the need to give students who are men the same breadth of learning opportunities.
 Encourage mentors and clinical staff to avoid introducing the student as male and not to specifically seek permission for a male to be present.
 Encourage mentors and clinical staff to avoid making assumptions about male students and their ability to carry out ‘manly tasks’.
 Encourage clinical areas to support students in the provision of intimate care regardless of gender  Prepare students for the potential challenges of accessing all learning opportunities
 Identify clinical placements where the facilities (such as changing rooms) may not meet the needs of all students
 Identify clinical ‘buddies’ who are men to provide additional mentorship to male students of nursing