An Exploration of Career Pathways of Male Nurses to the Deanship Position in Higher Education

AN EXPLORATION OF CAREER PATHWAYS OF MALE NURSES TO THE DEANSHIP POSITION IN HIGHER EDUCATION

THROUGH NARRATIVE INQUIRY

A dissertation submitted

Cecelia Fernan

Benedictine University

in partial fulfillment

of the requirements for the degree of

Doctor of Education

Higher Education and Organizational Change

Benedictine University

December 2015

ACKNOWLEDGEMENTS

This dissertation would not have been possible without the help of so many people.

First and foremost, I would like to thank my husband, Wenceslao Marcelo Fernan. Without his full support and sacrifices, the completion of this dissertation would not have been possible. Also, I sincerely thank our sons, Casey and Anthony, who fully understood my dream and supported me on this journey. Thank you with all my heart.

Next, I would like to express my deepest gratitude to the members of my dissertation committee, Dr. Antonina Lukenchuk, Dr. Eileen Kolich, and Dr. Baudelaire Ulysee, for their expert guidance and thoughtful advice. I would especially like to acknowledge my dissertation advisor, Dr. Antonina Lukenchuk, for her unwavering support, collegiality, and mentorship throughout this project. I am forever grateful to all of you.

I must also acknowledge the nursing deans who participated in my study whose stories and insights provided heart and depth to this dissertation. Your commitment to your students, patients, and to the profession has truly inspired me.

Finally, I am grateful to my most loyal canine friend, Ben. He provided me constant company during those long, late nights while completing this dissertation. Now that this is over, we will have more walks and play time to make up for those months that I was too busy to attend to him.

DEDICATION

I’m not afraid of storms, for I’m learning to sail my ship.

— Luisa May Alcott

This dissertation is dedicated in memory of my parents,

Celso and Marcosa Estrada, who instilled in me the value of education.

I am forever grateful for such an enduring gift that made my life

full of hope and opportunity.

Education has changed my life and the destiny of my family.

TABLE OF CONTENTS

ACKNOWLEDGEMENTS...... ii

LIST OF FIGURES...... viii

ABSTRACT...... ix

CHAPTER ONE: INTRODUCTION...... 1

Statement of the Problem...... 5

Research Purposes and Questions...... 7

Significance of the Study...... 8

Definition of Terms...... 9

CHAPTER TWO: LITERATURE REVIEW...... 10

Introduction...... 10

Nursing Profession: Historical Development and Current Trends...... 12

From Inception to Feminization...... 12

Current Trends...... 14

Nursing and Gender: Theories, Perspectives, and Controversies...... 16

Gender and Leadership Styles...... 16

Gender Stereotypes and Controversies...... 19

Gender and Leadership in Nursing...... 22

Gender and Nursing: Theoretical Perspectives...... 23

Tokenism...... 23

Glass escalator theory...... 24

Concrete ceiling theory...... 26

Nursing and Leadership: Career Pathways...... 28

Traditional Pathways to Nursing...... 28

Emerging Pathways to Nursing...... 30

Career Pathways of the Deans of Nursing...... 32

Nursing Profession and Leadership...... 35

Leadership Succession...... 35

Challenges of Deanship in Nursing...... 38

Competencies and Strategies to Succeed...... 41

Summary...... 44

CHAPTER THREE: METHODOLOGY...... 49

Researching Lived Experiences Through Narrative Inquiry...... 52

Designing Narrative Inquiry Through Three-Dimensional Space...... 57

Interactions...... 58

Temporality...... 59

Situation...... 59

Collecting and Analyzing Narrative Data...... 60

Participants...... 61

Interviews...... 62

Additional Sources of Data...... 64

Data Analysis Process...... 65

Validating Narrative Research...... 67

Reflection...... 69

CHAPTER FOUR: ANALYSIS AND RESULTS...... 71

Iterative Cycles of Data Analysis...... 72

Restorying...... 74

The Participants’ Restoried Lives...... 75

Dean Roberts...... 75

Dean George...... 79

Dean Frank...... 84

Dean Smith...... 91

Restorying the Pathways to Deanship...... 96

Impetuses...... 97

Strong work ethic...... 97

Turning obstacles into opportunities...... 98

Altruistic reasons...... 100

Career Trajectories...... 101

Necessary Skills and Attributes...... 104

Effective communication skills...... 104

It’s all about people...... 105

Scholars of highest repute...... 106

Emotionally smart...... 107

Change drivers...... 108

Business literacy...... 109

Leadership Styles...... 109

Summary...... 111

CHAPTER FIVE: DISCUSSION, IMPLICATIONS, AND REFLECTION...... 113

The Road to Deanship...... 113

Once a Nurse, Always a Nurse...... 117

Different Strokes for Different Folks...... 120

Meant to Be a Nurse, Groomed to Be a Nurse Leader...... 123

Implications for Research and Practice...... 127

Reflecting on My Dissertation Journey...... 130

REFERENCES...... 134

APPENDIX A: Interview Guide...... 141

APPENDIX B: Informed Consent Form...... 144

LIST OF FIGURES

FigurePage

1. Representation of the career trajectory of all participants...... 103

2. Leadership characteristics of the participants...... 111

ABSTRACT

The career path to deanship for female nurses is a well-investigated topic. However, the case of male deans is still largely unexplored. Male deans leading nursing schools is a fairly new trend. This narrative study exploredthe career pathways of male nurses to their leadership positions in colleges of nursing and investigated how and why men choose to pursue leadership positions, what meaning they ascribe to their identities, and how they position themselves as leaders in the contexts of their professional lives. Semi-structured interviews were conducted with four male deans of schools of nursing in the Southwestern U.S. The themes that emerged as a result of the analysis of their personal narratives are: (a) impetuses—strong work ethics, turning obstacles into opportunities, and altruistic reasons; (b) career trajectories; (c) necessary skills and attributes—effective communication skills, it’s all about people, scholars of highest repute, emotionally smart, change drivers, business literacy; and (d) evolving leadership styles. This study fills important gaps in existing knowledge regarding barriers men encounter in pursuing deanship. In addition to shedding more light on gender-related issues in nursing practice and its leadership, this study’s findings canserve as a career compass for male nurses aspiring to academic positions;provide encouragement for more men to join the nursing profession; help solve the dean and faculty shortage, thus contributing to a more gender-balanced workforce; and aid educational institutions in planning career development programs.

CHAPTER ONE: INTRODUCTION

If you would know the road ahead, ask someone who has traveled it.

—Chinese Proverb

Is there anyone so wise as to learn by the experience of others?

—Voltaire

I could hear my younger sister standing next to me sobbing silently as she was forcing herself to stop shivering. It must be the sudden gust of freezing cold air that made my sister and me shiver and our teeth chatter while waiting for a taxi outside the airport terminal in California that January night in 1990. After a very long and tiring journey, we finally arrived in the United States of America for the first time. We were all taken aback by how bitterly cold it was for us. The cold air had woken us up from the trance we were in since we had left the island of Cebu, Philippines to migrate to the United States of America in quest of a better life. Standing next to me was my husband, just as lost as I was, while I tried to pacify our four-year-old son who was throwing a fit. I remembered feeling sick to my stomach because I was overwhelmed by the feeling of sudden panic. I wanted so badly to turn around and go back home. The crowd around me was no longer familiar and the magnitude of everything that surrounded me was far beyond what I had ever imagined. It suddenly dawned to me that we were so far away from everyone and everything that we love so dearly. Our journey as foreigners in this land of milk and honey had just started. Everything that was before us was new and outlandish. I remembered feeling overwhelmed and petrified. But I also remembered feeling excited, extremely excited. Going back home was not an option. It was too late now.

Looking back now, I realize how gutsy it was, or how reckless it was. Immigrating to the United States 25 years ago was almost a spontaneous, unpremeditated act without a Plan B in case of failure. I took the risk because we did not know better. Indeed, nothing ever becomes real until it is experienced. In the midst of this new life journey, I came to know and rely on many kindhearted people who had gone through what I was going through. They willingly shared their experiences with us, so we could avoid costly mishaps and frustrations and make well-informed decisions. After all, good judgment comes from experience, particularly, from bad experiences that I did not need to experience. We benefited from the wisdom of others. The wisdom and anecdotes they shared informed and prepared us well for the road that lied ahead of us. Looking back, I realize now that I owe tremendous gratitude to those people who wisely guided us when we needed it. Hence, sharing the stories of our life’s journey is so important, for doing so enables us to reach out to other people and make a positive impact on their lives as well. Studying the past, including its challenges and mistakes, could save us from the anguish of choosing the same path to failure. As the adage warns, we need not reinvent the wheel each time. The lesson from this saying is timeless; piggybacking on the experience of others and using it as a roadmap saves years of trial and error and optimizes our chances of success. Often times, success does not come instantly or accidentally. Learning from other people’s experiences and being amenable to sharing one’s own experiences to help others represent the demarcation point and the intention of this study. I explore the stories of male nurses who went through the journey of attaining nurse deanship positions. Their life experiences could be potentially inspiring to others who desire to tread a similar path.

Because only 2.1% of nursing academic leaders in 2006 were 45 years old or younger (American Association of Colleges of Nursing [AACN], 2012), it could be assumed that there will be a shortageof nursing academic administrators in the U.S. because many of these deans will retire soon. This concern is amplified because the average age of a nurse-educator with a doctoral degree was 60.5 in 2010 (AACN, 2012). The paucity of prepared academic leaders involved in nursing education across the country is a reflection of the challenges in higher education today. Altbach, Gumport, and Berdahl (2011) described the 21st century as the most challenging in the history of the nation’s academic institutions. Today’s higher education leaders are forced to deal with high societal expectations, increasing enrollments, more diverse student populations, ever-changing technology, demands for learning outcomes, fiscal accountability, and globalization. These mounting public and governmental expectations make the educational landscape laden with challenges at a time of tight financial constraints. Displeased taxpayers and politicians alike are demanding more accountability, accessibility, affordability, and better graduation rates as institutions are struggling for much-needed funding (Altbach et al., 2011).

The college deans are providing the leadership and direction to withstand these difficulties. In the college of nursing, the role of the dean is very critical to its success. The dean of nursing holds a challenging leadership position that requires consistent operational interactions with faculty, students, staff, clinical partners, and healthcare leaders. The nature of their job requires that a close proximity to where teaching, learning, and research are occurring be maintained. Like any other academic department, nursing deans are frequently hard-pressed by academic responsibilities from the bottom and constrained fiscal resources from above, which makes the day-to-day operation of the department perplexing (Wolverton, Gmelch, Montez,Nies, 2001). Wolverton et al. (2001) described the academic dean as the “leadership linchpin that holds an organization together while at the same time moving it forward” (p. 1). In fact, Morris (1981) conceived the dean as the “critical fulcrum for protecting the mental health of a faculty and student body on the one hand and advancing the integrity and vitality of the larger organization on the other” (p. ix). In order for deans to succeed, the needs of the university administrators, faculty, students, clinical partners, and the Board of Nursing must be met. Furthermore, deans are expected to accommodate the overreaching external function of representing the university to the public. According to Green and Ridenour (2004), “deans serve as the external face of the university and the college” (p. 490) and have an additional responsibility that includes the hospitals, health centers, and schools where much-needed clinical affiliations for their students are secured.

Because the nursing profession is confronted with a serious nursing shortage that could potentially get worse, nursing schools around the country are being pressured to educate more registered nurses (RNs) to meet 21st century healthcare needs (AACN, 2012). This shortage is driven by multiple factors such as population growth, an aging nursing workforce and an aging population, job dissatisfaction, and additional health care consumers as a result of the Affordable Health Care Act. With the passage of the Patient Protection and Affordable Act in 2010, the U.S. health care system is expected to serve more Americans who are gaining access to healthcare services. As the demand for healthcare services increases, it is projected that the nursing shortage could reach an estimated 260,000 full-time equivalents by 2025 (American Health Care Association [AHCA], 2008). However, the American Association of Colleges of Nursing (AACN, 2012) reported that 75, 587 qualified applicants were turned away by nursing schools across the country because of the lack of faculty, clinical sites, classroom space, clinical instructors, and budget constraints. Therefore, most nursing school enrollments are not meeting the current and projected demands for RNs for the years to come in this country.

Statement of the Problem

Dean and faculty shortages are hindering U.S. nursing schools from expanding and accepting more nursing students at a time when the need for RNs is increasing. According to an AACN survey that gathered an almost 80% return rate from 680 schools of nursing across the country, there were 1,358 faculty vacancies identified as unfilled in October 2013. These schools attributed faculty shortages to an aging faculty, budget constraints, and increasing competition for clinical sites (AACN, 2013). In addition to faculty shortages, nursing schools are also experiencing the same struggles when it comes to recruiting nursing deans. AACN attributed this crisis to a limited pool of nursing education faculty with doctoral degrees and non-competitive salaries when compared to positions in the practice arena. Green and Ridenour (2004) contended that the scarcity of leaders trained to assume nursing deanships is hindering the needed growth in nursing education. For instance, Patton (2013) reported that an assistant dean position for graduate programs at the University of Indianapolis, a private institution that employs 39 nursing faculty, remained vacant for almost four years. Academic leader shortages are threatening our nation’s health professions educational infrastructure. A survey in 2007 by the Association of Academic Health Centers (as cited in AACN, 2013) showed that most chief executive officers considered academic leader shortages as most severe in nursing, more than pharmacy and medicine.

One of the many ways to expand the nursing workforce is by fostering more gender-balanced nursing leadership. With predictions that the nursing shortage will be more severe and longer lasting than had been previously experienced, traditional recruitment strategies will not suffice. Unfilled dean and faculty positions due to resignations, retirements, expansions, and scarcity of RNs with doctoral degrees pose a serious threat to the nursing education workforce. It is imperative that there be a more coordinated innovative solution for tackling this problem on the part of various stakeholders such as nursing leaders in practice and education, government, healthcare institutions, and the media. According to Tranbarger (2007),

“the growing shortages of nurses . . . cannot be met with the traditional White female applicants. The history of nursing indicates that men can be recruited to nursing and most will serve with distinction when permitted to do so.” (p. 60)

A fresher look at recruitment strategies and leadership development could lead to more sustainable solutions to ensure a sufficient supply of RNs for years to come. In fact, Tranbarger believes that the nursing shortage is relatable to the profession’s limited candidate pool because men have been underrepresented in the nursing profession for a very long time. Although women make up 34% of physicians and surgeons (Williams, Pecenco, & Blair-Loy, 2013), men only make up less than 10% of RNs (AACN, 2012). Particularly in academia, the percentage of female medical school faculty has increased to 20% of full time professors (Williams et al., 2013) whereas men remain underrepresented, making up only 5% of nursing school professors (AACN, 2012). To ignore this untapped resource in nursing is not just impractical but also unfair. It is like saying that women should not be encouraged to become doctors, engineers, and lawyers.

Research Purposes and Questions

Existing scholarship on male deans in nursing is scarce, or unavailable; most existing studies are done on female deans (Blass, 2011; Green and Ridenour, 2004). Therefore, this study can be indispensable in terms of filling important knowledge gaps regarding the experiences of male deans in the nursing profession. This inquiry sheds additional light on the academic discourses on gender issues in the nursing profession. An exploration of the narratives of male deans of nursing will add to the scholarship centered on gender-inclusive models of leadership in nursing and inform recruitment strategies and career development programs in the nursing profession. Role models and career road maps for male RNs are especially useful because career planning involves a great deal of preparation and forethought. Learning from someone narrating his experiences on his career path is reassuring to anyone who wishes to do the same. Because career changeover from a professorial role to a dean role requires major cognitive, emotional, and career readjustments, having others show the way to emulate would make this feat plausible to aspiring male nurse leaders.

The purpose of this study is to explore the career pathways of male nurses to their leadership positions in the colleges of nursing in the Southwestern U.S. Iexamined how and why men choose to pursue leadership positions in nursing and what meaning they ascribe to their professional identities as leaders.