Male student nurse anesthetists: Clinical supervision NANCY J. GASKEY, CRNA, MEd Pittsburgh,Pennsylvania

The author explores the question of whether or not there is a conflict in interpersonalrelationshipsbetween male student nurse anesthetists and female clinicalsupervisors. To obtain information, male student nurse anesthetists were surveyed in 19 anesthesiaschools. A historicalreview of the number of males in anesthesiais also presented.

nurse anesthetists and their female clinical instructors. The purpose of this study was to survey several anesthesia programs to determine whether or not a conflict in interpersonal relations did exist between male student nurse anesthetists and female clinical instructors and, if so, with what frequency it occurred. We also attempted to identify the characteristics which students thought were most desirable in a clinical instructor.

Method A number of articles have appeared in the literature describing the interpersonal conflicts which exist between males and their female supervisors.' We had not experienced this problem in our institution (Western Pennsylvania Hospital School of Anesthesia in Pittsburgh) until recently, when a struggle for role identity between the female clinical instructors and a male student nurse anesthetist created a great deal of frustration and aggravation for both the student and the instructors. Females serve in the majority of schools of nurse anesthesia, both as directors (at nearly a 2 to 1 ratio) and clinical instructors. During the past 10 years, there has been a sharp increase in the number of male nurses applying for admission to schools of nurse anesthesia. The possibility occurred that this might account for a problem in the interpersonal relationships of the male student

280

A questionnaire was prepared, based on the traits which have been identified as characteristic of good instructors by Callahan in his textbook, Successful Teaching in Secondary Schools.2 We divided the questionnaire into four sections. The first section dealt with male-female characteristics, and the student was asked to identify whether the adjectives listed best described a male or female clinical supervisor. The second section of the questionnaire asked students to identify whether the characteristics listed were attributable to females or males. The third section asked students to rate the characteristics which they felt were essential for effective clinical supervision. The final section of the questionnaire asked the respondents to indicate to what extent they agreed with specific statements concerning clinical supervision. A total of 19 schools of nurse anesthesia were contacted and invited to participate in the survey.

Journal of the American Association of Nurse Anesthetists

while 60 (77%) felt it was a characteristic of male clinical supervisors. Twenty-five respondents (32%) thought females were indecisive, while only 2 (3%) felt males possessed the same quality. Thirty-six re-

Though the majority of the schools were located in the state of Pennsylvania, an attempt was made to achieve some degree of regional representation; schools throughout the United States were therefore included in the survey (Table I). Copies of the questionnaire were sent to 109 male student nurse anesthetists. Results Seventy-eight responses to the questionnaire (62% of the total surveyed) were utilized in the computation of the survey. The ages of the respondents ranged between 23 and 36 years of age: the majority were 26 years old (Figure 1). The length of time in the program varied between 3 months and 24 months. The largest number of respondents (21) had been enrolled in a program for nurse anesthesia for only 3 months; there were 10 respondents in the 24-month category. (Table II). In section one (Table III), the respondents were asked to identify whether or not the adjectives listed best described a male or female clinical supervisor. Thirty-six respondents (46%) identified flexibility as a characteristic of females, Figure 1. Male students identified according to age

20

15

10

5

23

24

25

26

27

28

29

30

31

32

33

34

35

36

Years of age

June/1981

281

spondents (46%,) felt that females were consistent, as compared to 62 (79%) who identified consistency as a male characteristic. Favoritism was felt to be shown more frequently by females, 30 (38%) as compared to males, 13 (17%). In the second section (Table IV), males were considered less anxious than females (25 to 40), and less inclined to "nit-pick" unnecessarily (22 to 49). The characteristics which were identified by Table II. Students identified according to length of time in program

Number of students

Length in program

21 7 2 1 4 7 12 3 5 2 4 10

3 Months 4 Months 5 Months 10 Months 11 Months 14 Months 15 Months 16 Months 18 Months 22 Months 23 Months 24 Months

the students as essential for effective clinical supervision (Table V) were rated as follows (with 1 being the highest): 1. Good general knowledge of the subject. 2. Knows how to communicate subject material to students. 3. Is fair and honest. 4. Accurately appraises student's performance and offers corrective criticism privately. 5. Establishes and reaches obtainable goals with student. 6. Understanding and concern for student as an individual. 7. Personality reflects enthusiasm for teaching. 8. Varies instructions to hold student's interest and to allow for individual differences. 9. Exhibits a good sense of humor. 10. Scholarly interest in writing and re search. In the last section (Table VI), 38 respondents (49%) did not feel that "problems with interpersonal relationships are frequently experienced in the clinical area between male student nurse anesthetists and female clinical suplervisors." Sixteen (21%) felt that the statement was true. Forty-four (56%) respondents felt that male and female clinical supervisors get along well in the clinical area, and 54 (69%) (lid not feel that

Table III. List of adjectives describing clinical supervisors

A. B. C. D. E. F. G. H. I. J. K. L. M. N. 0. P.

Abrasive language or tone Soft-spoken Flexible Rigid Positive attitude Negative attitude Indecisive Decisive Intelligent Uninformed Consistent Inconsistent Sarcastic Considerate Fair Showing favorites

Female

Male

Attributable to Neither

19 42 136 36 42 26 25 34 45 14 36 24 27 54 44 30

17 23 60 20 56 11 2 63 61 9 62 11 16 46 55 13

41 19 6 30 8 44 57 8 11 50 5 41 33 9 11 39

The students were asked: Please indicate whether the above adjectives more accurately describe the female or male clinical supervisors you have had.

282

Journal of the American Association of Nurse Anesthetists

there was any difference in the quality of anesthesia administered by male or female nurse anesthetists. Thirteen (17%,) of the respondents felt that males would rather he supervised by male

clinical instructors. Fifty-seven (73%,) disagreed with this statement. A correlation was made between the number and ages of the 16 students who agreed with the

Table IV. Characteristics of male or female clinical supervisors

Present A.

B. C. D. E. F. G. H. I. J. K. L. M. N. 0.

Readily accepts opinion of others Exerts necessary control Acknowledges success of others Offers interpretation of departmental policies Demonstrates positive reinforcement Provides encouragement "Nit-picks" unnecessarily Sensitive to students' needs Competitive Objective Aggressive Self-assured Anxious Insecure Supportive

Females

Males

52 73 58 56 60 67 49 57 39 61 50 61 40 28 60

56 74 62 54 58 61 22 52 51 70 60 71 25 14 61

Absent Females Males 20 4 14 14 15 11 22 14 18 18 19 8 26 37 15

16 4 10 11 17 12 48 16 15 8 12 3 44 56 10

The students were asked: The above characteristics are sometimes attributed to clinical supervisors. Would you indicate whether or not they are or have been present in the males or females who have supervised you in the clinical area.

Table V. Essential characteristics for effective clinical supervision Very Important A.

Good general knowledge of the subject Knows how to communicate subject material to students

Somewhat Important

Unimportant

78

0

0

75

3

0

Accurately appraises student's performance and offers corrective criticism privately

61

17

0

D.

Establishes and reaches obtainable goals with student

54

24

0

E.

Scholarly interest in writing and research Understanding and concern for student as an individual

7

46

23

B. C.

F.

49

28

0

Personality reflects enthusiasm for teaching H. Is fair and honest

42

34

2

72

6

0

I.

22

49

8

39

36

1

G.

J.

Exhibits a good sense of humor Varies instructions to hold student's interest and allow for individual differences

The students were asked: These are specific characteristics which have been identified as essential for effective clinical supervision. Please rank them according to their importance (very important; somewhat important; unimportant) in your opinion.

June/1981

statement, "Problems with interpersonal relationships are frequently experienced in the clinical area between male student nurse anesthetists and female clinical supervisors" It was found that they represented schools from 7 states and their ages ranged as follows: age 23-1 student; age 24-no students; age 25-4 students; age 26-4 students; age 27-2 students; age 28-no students; age 29-2 students; and age 30-3 students. The 13 students who agreed with the statement, "Male student nurse anesthetists wounld prefer to be supervised by male clinical instructors," represented schools from 6 states and their ages ranged as follows: age 24-1 student; age 25-3 students; age 26-4 students; age 27-no students; age 28-1 student; age 29-1 student; and age 30-3 students.

Discussion It is interesting to note that the first male nurse anesthetist was certified by the American Association of Nurse Anesthetists (AANA) in 1947. At that time, there were already 3,550 certified female nurse anesthetists. In 1979, there were 19,423 members in the AANA, 5,237 (27%) of whom were males and 14,186 (73%) females (Table VII). In the past, very few men were members of school of anesthesia faculties due to the small number of certified male nurse anesthetists and the fact tlat the majority of the graduate male nurse anesthetists were more inclined to seek employment in areas which offered greater economic reward. There were, therefore, fewer male role models in schools of nurse anesthesia than in other pro-

Table VI. Quality of interpersonal relationships Strongly Agree A.

B.

C. D.

E.

F. G. H. I. J.

K.

Agree

Uncertain

Disagree

Strongly Disagree

5

11

13

38

9

4

16

26

24

7

5

12

12

42

4

Male and female clinical supervisors get along well and have a supportive attitude toward each other.

5

39

24

10

0

Clinical supervisors (male and female) allow male students more autonomy than female students.

3

7

23

36

8

Female clinical supervisors show favoritism toward female students.

1

2

19

49

5

Female clinical supervisors show favoritism toward male students.

2

9

19

43

4

Male clinical supervisors show favoritism toward female students.

2

7

23

42

3

Male clinical supervisors show favoritism toward male students.

1

6

24

39

6

24

30

16

8

0

6

7

20

37

7

Problems with interpersonal relationships are frequently experienced in the clinical area between male student nurse anesthetists and female clinical supervisors. Female supervisors who have raised their own families are more tolerant and supportive than unmarried female clinical supervisors. Male clinical supervisors are friendlier than female clinical supervisors.

There is no difference in the quality of anesthesia administered by male or female nurse anesthetists. Male student nurse anesthetists would prefer to be supervised by male clinical instructors.

The students were asked: Please indicate how well you agree with each of the statements listed above.

284

Journal of the American Association of Nurse Anesthetists

fessional educational programs. This is especially important when we consider that in 1979, the number of male student nurse anesthetists in Council on Accreditation-approved schools of anesthesia was almost equal to that of females (Table VIII). A high percentage of male student nurse anesthetists are between the ages of 22-28 years of age. This is a period of life, according to Erikson 3 , a noted psychologist, when the male in our society is just entering into the adult world and beginning to experiment with his future role. He is faced with making decisions concerning a commitment to a profession, selecting a companion with whom to share his hopes and dreams, and identifying the lifestyle he wishes to pursue. He must make judgments and institute activities that will enable him to live out the role he selects for himself and to pursue the course he has selected. He must plan to develop the "self" 4 that lives within him. This developmental stage is fraught with crisis and contradiction-exciting and frightening. The responsibility for success or complete failure is his alone. He lacks experience and skills in dealing effectively with the tasks associated with this new stage of life and learns by trial and error. In 1954, Erikson pointed out that individuals are not fully grown at age 21, or even at 40 years of age." In fact, he suggests that developmental stages of life begin with birth and continue on up to the eighties or nineties. He describes the process of living as a series of stages-or transitions. He lists seven stages of life and identifies critical developmental tasks which need to be effectively dealt with by each individual at a specific stage of

Table VII. American Association of Nurse Anesthetists Membership: 1979

Males Females

ActivePracticing

Active Non-practicing

Inactive

4,984 10,879

137 867

116 2,440

Table VIII. American Association of Nurse Anesthetists Associate Members: 1979 Males Females

June/1981

1,097 1,246

life. Struggling with the critical tasks of each particular stage of life provides a person with the opportunity to gain experience in making decisions, building self-confidence, and taking responsi)ility for his own life-"/aking charge," if you please. If the tasks associated with a specific stage are not resolved at the appropriate level, they are carried with the individual as he moves on to the next stage. It is this "excess baggage" that causes one to have difficulty with his interpersonal relationships. It is a tail that leaves a trail in the sand as we travel through life, so to speak. Fortunately, Erikson feels that if the tasks related to a specific stage are not dealt with effectively when the person reaches that point in life, they can be attended to at a later date. With regard to this study of nurse anesthesia students, we wondered what effect the individual's particular stage of personal development might have had on our respondents' interpersonal skills (though this could not be measured). Clinical supervision can be a gratifying experience or it can be an ineffective, frustrating encounter between student and instructor. Though the quality of this interaction is dependent on a number of factors, one of the most significant is the degree of success and satisfaction each person has achieved in the role he has identified as his own. Our educational goal in the clinical area is to provide the most effective learning environment possible. How can we best accomplish this task? First, we must recognize that students are human too. They bring their whole personality and all of their own personal biases into the clinical setting, just as do the clinical instructors. Students are complex individuals, motivated by their own special needs and desires. To successfully interact with other human beings, we must exercise common sense. Although we all like to consider ourselves as rational individuals, in stress situations our rational adult thinking is often superseded by the need to protect our egos-and at these times we revert back to the safety of our childhood behaviors. We utilize "protective devices" to overcome our feelings of vulnerability or to guard our safety in threatening situations. The male student nurse anesthetist who feels threatened by the female clinical supervisor may exhibit protective devices either verbally or nonverbally. He may physically withdraw from the situation and wait for the instructor to proceed without him; lie may refuse to respond to a

285

quest ion: or he may merely say, you

can't

raml)ing v'erlbal tect

me!"

make

"I

know-

don't

respond

nay

argument-in

a

to pro-

may

feels

3.

with

an attempt he

which

manhood,

his

He

en-

he

danugered. vise

knowledgeable

and

super-

female

No anesthetic can be admin-

insecurity, and paiin. istered

to

obtund

relieve

our

this

awareness

(liscomfort, and

for

interfere

would

it

with

the

hliat

do

male

clinical

treatel

fairly aind

students

instructors? honestly,

exp~ect They

ly

from

expect

their to

competent,

be

qluali-

fied1 instructors who are considerate of their indiunique

vilual differences an(1 alpreciative of their

They cxpect a clinical supervisor to be a

(lalities.

identified

as

knowledge of the subject;

ability to

subject

and hon-

accurately

material;

appraising

fairness

student's

perfornance

and offering corrective criticism privately. 4. to

the

The

majority of the students

survey

did

interpersonal ienced1

in

not

feel

relationshilps

tlie cliiiical

that

is

a

responding

conflict

frequently

with

exper-

area bet ween male stdlents

and female clinical instructors, but those who did

were between

23

andi

30

years of age.

5.

ability to reach our frill potential.

female

often

communicate

visor responds to the clinical situation, not to the p-ersorality. She understands that living is a continning developmental process, a time of change,

most

good1 general

esty;

1he

Characteristics

dlesiralble for effective clinical stpjervisors incluled:

person worthby of tie position they hold-and to help them attain somiieone who is commlnittedl

The qluality of an anesthetic is indepelldent of the gender of the nurse anesthetist. 6I. Male atnd female clinical supervisors get along well and have a supportive attitude toward one another. REFERENCES Bender,

(1)

89:35-41, (2)

Marylin.

March

Callahan,

28,

When

the

Boss

is

Woman.

Esquire

I'eaching in

Secon-

a

1978.

Sterling C.

1966. .Stuccessful

dary Schools.

their educational goals.

Clenview, Illinois: Scott, Foresman K Co. Erikson, Erik. 1959. !denli/v and the Life Cvde.

(3)

I 'ni'iesit ks Press, Inc. (4) I.evinson, Danicl j. 1979. The ,Se'asons of A New York: Ballant in Press.

York:

4

Conclusion Nineteen schools of nurse anesthesia were surveyel to (letermline whether or not a conflict in

New

International

an's life.

interpersonal relations exists between male studdent

nurse anestlhetists and female clinical

instructors,

and, if so, with what frequency it occurs. Students were

asked

also

which clinical

they

to

thought

identify

instructors. From

the

(ata

for

effective

obtained,

the

leen reached:

following concluIsions have i.

characteristics

the

dlesirable

were

Female clinical instructors were identified

as more inlecisive, anxious, and likely to express favoritism

2.

than males.

Male clinical

inst

ructors

were

identiflied

as being more consistent, flexible, and less inclined to

286

"nit-pick

than

females.

AUTHOR Nancy J. Gaskey, (:RNA, MEd,

is a gradlate of the Mercy Hospital School of A nestht'sia , Pittsb)I rgh, Pennosylvaniia. She has a Naster's de(greeC in Co rrielolut adM Stpers ision from the

lniv'ersity of Pittslnrgh atnd is pr esetIt of

Nurse

Pittsburgh,

Anesthesia

at

te

Westetn

I itc(('tot of the School PennsylIsania Hospital,

Pennsylvania.

Journal of

the American Association of Nurse Anesthetists