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Choosing and remaining in nursing: Iranian male nurses’ perspectives a

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Vahid Zamanzadeh , Arman Azadim , Leila Valizadeh , Brian b

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Keogh , Morteza Monadi & Reza Negarandeh

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Nursing Department, Tabriz University of Medical Sciences, Tabriz, Iran b

School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland c

Faculty of Education and Psychology, Alzahra University, Tehran, Iran d

Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran Published online: 17 Dec 2014.

To cite this article: Vahid Zamanzadeh, Arman Azadim, Leila Valizadeh, Brian Keogh, Morteza Monadi & Reza Negarandeh (2013) Choosing and remaining in nursing: Iranian male nurses’ perspectives, Contemporary Nurse, 45:2, 220-227, DOI: 10.5172/conu.2013.45.2.220 To link to this article: http://dx.doi.org/10.5172/conu.2013.45.2.220

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Copyright © eContent Management Pty Ltd. Contemporary Nurse (2013) 45(2): 220–227.

Choosing and remaining in nursing: Iranian male nurses’ perspectives VAHID ZAMANZADEH*, ARMAN AZADI*,1, LEILA VALIZADEH*, BRIAN KEOGH+, MORTEZA MONADI! AND REZA NEGARANDEH# *Nursing Department, Tabriz University of Medical Sciences, Tabriz, Iran; +School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland; !Faculty of Education and Psychology, Alzahra University, Tehran, Iran; #Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran

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Abstract: Iranian male nurses’ career-choosing practices have not been well investigated. The aim of this study was to explore the reasons why Iranian male nurses choose nursing as a career. In addition it sought to understand the reasons why they remain in nursing. An exploratory descriptive design, employing a qualitative approach was used. Eighteen semistructured interviews were conducted and analyzed using content analysis. The analysis culminated in the development of three themes which described the participants’ motivations for choosing nursing as a career as well as the factors that influenced their decisions to remain in nursing following qualification. Practical motivations such as job security were important factors in choosing nursing. The most common reason for remaining in nursing was desire to care for others, for God’s sake. Factors that influenced their decision to leave mainly centered on the public view to nursing as a feminine discipline. However, the nurses in this study believed that nursing was a profession appropriate for both men and women because of gendered nursing care and preferences of patient in Iran.

Keywords: male nurses, career choice, gender, recruitment, retention, Iran

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he present and increasing shortage of nurses is a worldwide concern and nursing recruitment and retention are recognized as national and international priorities (De Cooman et al., 2008; Jirwe & Rudman, 2012; Larsen, McGill, & Palmer, 2003; Law & Arthur, 2003; McLaughlin, Moutray, & Moore, 2010; Price, 2009a, 2009b). The nursing staff shortage in Iran is a very important and challenging issue because, despite a considerable number of young nurses graduating annually, nursing staff shortages in the clinical setting are apparent (Zarea, Negarandeh, Dehghan-Nayeri, & RezaeiAdaryani, 2009). Many factors have been determined as underlying causes of the nursing shortage in Iran with job dissatisfaction, socio-cultural and organizational factors being the most prominent. Furthermore current economic restrictions and the policy of downsizing governmental organizations have restricted the recruitment of new health care staff (Farsi, Dehghan-Nayeri, Negarandeh, & Broomand, 2010). In addition the existing argument over the professional status of nurses in relation to that of physicians, together with the ambivalent position that arises from nursing being

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viewed as gendered work, contributes to ongoing recruitment and retention problems (Kouta & Kaite, 2011; Mooney, Glacken, & O’Brien, 2008; Muldoon & Reilly, 2003). In the history of nursing in Iran the majority of the first nursing students were female (Salsali, 2000). Immediately after the revolution in 1979, co-educational academic institutions and health care facilities were ordered to segregate by gender in compliance with the laws of the Islamic Republic. In addition, the Iran–Iraq War demanded more male nurses to provide emergency services in affected areas. Both of these factors significantly increased the percentage of men in nursing (Fooladi, 2003). In the final years of war, from 1985–1988, about 50% of the baccalaureate students admitted to the nursing program were men; however, after the war, it has decreased to approximately 20% (Nasrabadi, Lipson, & Emami, 2004; Zarea et al., 2009). Although Iranian patients have a definite preference to be cared for by nurses of the same sex, many of them are surprised when they are cared for by male nurses (Nikbakht Nasrabadi & Emami, 2006). As a strongly patriarchal society, Iranian people have a poor image of nursing. It has been suggested that those who choose nursing as a profession experience

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Choosing and remaining in nursing low self-esteem (Adib Hajbaghery & Salsali, 2005). They also feel frustration, hopelessness, and some confusion about self-image and social identity (Nasrabadi, Emami, & Yekta, 2003). Even now, many people think of nurses as simply assistants to physicians and this image is worsened by portrayals of nurses in the Iranian media (Vaismoradi, Salsali, & Ahmadi, 2011). According to Nasrabadi et al. (2003) many Iranian nursing students, particularly male nursing students, aspire to get a university degree, they do not wish to become a nurse or get a nursing degree. Thus, there is considerable job dissatisfaction among male nurses and, hence, a high level of turnover. Furthermore, male students also experience higher levels of conflict and burnout while studying nursing than female students (Nasrabadi et al., 2003). Some male nurses choose not to care for patients, but work in hospitals as supervisors, internal managers, in the office of nursing, or on the business side of medicine or medical equipment (Nasrabadi et al., 2004). In order for effective recruitment of men into nursing, exploring the reasons why they choose nursing as a career is important. Furthermore, uncovering the reasons why men choose to remain in nursing could be helpful. This information has the potential not only to guide the content of future enrollment campaigns and improve their usefulness but also to influence their attrition rates from nursing (Mooney et al., 2008). At present, the baccalaureate program is the basic nursing program at academic level in Iran and is the only way leading to registration as a professional nurse. High school graduates are admitted to these programs on the basis of their ranking in the competitive National Higher Education Entrance Examination (NHEEE).The current student recruiting system, in which authorities rely solely on NHEEE ranks, has caused some problems. Students who enter the nursing schools under this system often have little or no information about nursing as a career, and some of them even enter the nursing program with reluctance (Tabari Khomeiran & Deans, 2007). Some of these students are also discouraged from studying nursing and there is a risk that many others have inadequate motivation to endeavor to be a competent nurse. No research could be located in Iran

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to provide data on reasons for men choosing and remaining in nursing. This article presents male Iranian nurses’ reasons for selecting and remaining in nursing and the issues that influenced their choices. Such an understanding has the potential to inform future recruitment, socialization, transition and retention strategies. METHOD A descriptive qualitative study was used for the data collection and analysis processes. A purposive sample of 18 participants who met the following criteria was chosen: (a) male; (b) graduated from a 4-year bachelor program; (c) having worked as a clinical nurse for at least 1 year in Iran; and (d) were willing to share their experiences. Participants were selected from five different hospitals in Tabriz city. All of the participants were full time nurses who worked in governmental hospitals with varied positions. Choosing male nurses from varied wards and with different positions helped the authors to capture a range of perspectives and experiences. In-depth, semistructured face-to-face interviews were used to collect the data. The interviews were recorded with permission, transcribed verbatim, and then analyzed. The interview guide was developed from an extensive literature review, the primary researcher’s experiences as a male nurse, and in consultation with two experts. Iranian culture and nursing education programs for both genders were also considered. Each interview lasted between 45–60 minutes. The interviewer made notes during the interviews and at the end summarized the key issues that emerged. Data were first transcribed from the audiotape in the subject’s native language using written Persian, and then translated from Persian to English and back again into Persian to ensure accuracy. To ensure that codes were grounded in the participants’ real experiences, data were subjected to content analysis using the following steps (Graneheim & Lundman, 2004): (1) The interviews were transcribed verbatim and read through several times to gain a sense of the whole. (2) The text was divided into units of meaning that were then further condensed.

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(3) The condensed meaning units were then summarized and labeled with codes. (4) The codes were organized into subcategories and categories, based on comparisons regarding their similarities and differences. (5) Finally themes were developed as the expression of the latent content of the text. ETHICAL CONSIDERATIONS The study was approved by the research council that is affiliated with; Tabriz University of Medical Sciences, Tabriz, Iran. All participants were given information about the research so that they could make an informed decision about participating. Any ambiguity was clarified before obtaining the participants’ written consent. Data was stored on a computer that was password protected to which only the researcher had access. Any hardcopy files and interview materials were also securely stored. Steps were taken to ensure that the participant’s freedom of speech, confidentiality and autonomy were respected. RIGOR Several strategies were engaged to improve the rigor of the findings. The content of the transcribed tapes and summary of the analysis were independently confirmed by each of the participants (Graneheim & Lundman, 2004). In addition, the credibility of the data was established with two experts in qualitative nursing, research as a peer check. The researchers also kept an audit trail so that an independent person could also ascertain why certain decisions were made and how the findings presented were reached. RESULTS Eighteen participants were interviewed and their ages ranged from 23–43 years (mean 31.7 ± 6.4). Twelve were married and all had graduated from a 4-year bachelor degree program. Their clinical experience ranged from 2–20 years (mean 8.5 ± 5.6). Participants’ expertise was reported to be in coronary care, psychiatry, emergency care, operating room, surgery and internal medicine. During the analysis of data three main themes emerged: (1) reasons for choosing nursing as a career; (2) remaining in nursing; (3) gender-related stereotypes.

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Reasons for choosing nursing as a career The participants described three main reasons for choosing nursing as a career. Firstly, they chose nursing because of the rank they were awarded in the national university entrance examination; secondly, because of the support and encouragement they received from their family and friends. Finally, the participants chose nursing because they perceived it as a career that would provide them with job security and economic stability. In Iran the process of choosing a career is slightly different from some other countries. Because of the great number of applicants for the restricted amount of university places, applicants to all courses have to pass the competitive NHEEE. Applicants who get higher scores have a greater chance in gaining entry to the university and course of their choice. In general, students who attain the highest ranks, are able to choose from the more publicly prestigious courses, such as medicine, dentistry or pharmacology. The other students have limited options and often select courses, including nursing, without any particular motivation or interest. In addition, all men in Iran, once they reach the age of eighteen, are subject to obligatory military services which can be avoided if they have been accepted on a university course. I hadn’t any time to examine again my chance in Konkor (entry exam) next year, for me going to university was a good fortune to avoid military task. At that time I didn’t care what this university course should be [nursing or anything else]. (Participant 9, 25 years old)

Most of the participants were from middle and middle-to-low socio-economic backgrounds. For some, they had low expectations of their ability to do well in the state entry examination and therefore did not expect to get higher ranks and pursue a career in medicine for example. Therefore, they were satisfied that their ranks had allowed them to get into university, especially if they had an interest in health sciences. For one of the participants, this was the first time that anyone from his family had gone to university and the fact that it was nursing was irrelevant to him and his family’s satisfaction with his achievement.

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Apart from a desire to avoid the military draft, motivations for studying nursing were based on external factors, rather than on personal interest in nursing and caring. Only three participants mentioned that they chose nursing purposely at the time of entry and all of them had worked in others fields before being accepted for nursing courses. For example, one of the participants suggested that regardless of his rank in the state university entrance examination, he was still going to choose nursing as a career. I only choose nursing in Konkor; my goal was to become a nurse, being a nurse was my purpose for entering university. (Participant 1, 32 years old)

Although, most participants stated that they had not thought of being a nurse before entering university, some of them told stories about high school counselors and others such as their friends who were nurses, and parents, playing a crucial role in their career decisions. This encouragement was based on the perception of nursing as a secure job that offered a stable future and in some cases was preferable to other professions. The perception of nursing as career offering security was a common theme in the interviews and some of the support to enter nursing was based on this premise. I admitted in nursing by chance, my high school counselor said me that nursing is good for finding a job in the future and it’s better than some career like agricultural engineering. (Participant 14, 40 years old) Most of my friends and family members who were familiar with nursing encouraged me to choose nursing and they said that nursing is one of those careers you have not any concern for finding a job in future. (Participant 7, 32 years old)

Remaining in nursing The second theme concerns the participants’ decisions for remaining in nursing. The participants gave many different rationales for staying in nursing even though some of them had openly expressed that they were not that interested in nursing as a career. Some participants suggested that they had not any other choice but to remain in nursing once they had commenced the course. This was because, in Iran, if a person withdraws from the accepted course, he or she is not allowed to apply

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for registration in another course for two consecutive years. Furthermore, when the participants graduated from university, unlike other university graduates, it was not difficult for them to get a job and this further enhanced their desire to remain in nursing. These views are exemplified in the following quotation: I had no alternative to give up nursing and I was afraid that others questioned my ability to continue a university degree. (Participant 5, 27 years old) I hadn’t any trouble to be employed immediately after my graduation. There are lots of places for nurses in both government and nongovernment hospitals. This is an important advantage for nursing. (Participant 3, 43 years old)

For some of the participants, there was an altruistic desire to remain in nursing and this was grounded in their personal desires to help others or arose from their cultural values and beliefs. These cultural values and beliefs extended to their roles as providers of care within their respective families and the belief that every family needs a nurse. Being consulted about health related issues by their family provided a level of personal satisfaction which augmented their own personal belief system including their religious belief system (for God’s sake). Some participants suggested that even though they had been offered management positions, they preferred caring for patients at the bedside. Seeing patients get better because of the care that they provided influenced the participants’ decision to remain in nursing and this often compensated for the poorer salaries that they received when compared to doctors. The participants suggested that once they had started their nursing course, they became interested in it as a career, even though it was not their first choice. They found that the reality of nursing was different from what they had perceived prior to their theoretical instruction. In reality nurses were perceived as skilled academics whose practice transcended the traditional views of nursing as physician assistants. Furthermore, working in specialized areas such as CCU further enhanced their perception of nursing as an academic discipline which positively influenced

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their decision to remain in nursing. In addition, some of the participants also discussed the possibly of building on their academic achievements and pursuing an MSc degree or becoming a nursing academic.

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After became acquainted with nursing, I felt it is compatible with my mentality, although most of my male classmate were not satisfied with nursing and some withdrew. (Participant 2, 40 years old) We have nurses who are very expert in specialized wards doing tasks that some physician cannot, for example intubating some complicated patients. Most of times they work independently and physicians rely upon their abilities. (Participant 2, 40 years old).

Gender related stereotypes Gender stereotypes associated with nursing, particularly the traditional view of nursing as a female profession also influenced the participants’ desire to remain in nursing following graduation. In some cases the participants in this study were reluctant to disclose the fact that they were studying to be nurses when they were in college. In addition they avoided situations where their occupation was discussed due to embarrassment about doing a job that was perceived as feminine. The participants believed that the media compounded these problems by presenting nursing as subordinate to physicians and as ampoule-injection technicians. Furthermore, this embarrassment was heightened by the fact that in Iran the word that is given to nurse ‘paraster’ is also the word used to describe nursing assistants and hospital attendants which arguably lowered the credibility of the participants’ qualifications and professional status. In some cases, the participants in this study introduced themselves as a supervisor or medical staff as they believed that if they said they were nurses they would not be respected by other professions. I’ve already embarrassed to say that I am nurse, I don’t know why! maybe because I thought that nurses have no power and you should always take commands. (Participant 5, 27 years old) ... when in the morning I am coming to the patient bedside, he become excited, but when I am introducing

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myself as his nurse, his enthusiasm will disappear and he ask for his physician. (Participant 3, 43 years old)

Some of the participants suggested that they managed these concerns about respect by explaining to others including their patients and colleagues, their professional roles and their motivation for becoming a nurse. For the participants, gaining respect from their peers on a day-to-day basis was perceived as being very important. In one instance, a participant moved to a ward where all of the nurses were male in order to cope with the fact that he believed that all of the female nurses gave the doctors too much respect. Despite this, the participants did recognize that there were greater opportunities for male nurses in terms of career advancement. This means that many of senior positions are taken by male nurses. There was also recognition that male and female nurses will always be needed due to factors related to female nurses not being able to meet all the needs of male patients. DISCUSSION In this study, we attempted to gain a thorough understanding of what motivated Iranian male nurses to choose nursing as a career. In addition we attempted to understand the issues that contribute to why male nurses choose to remain in nursing. The pre-entry stage of Iranian male nurses’ into nursing courses depended on their NHEEE ranking. Out of the 18 participants, only three participants chose nursing as a first choice and all of them worked in other areas before entering nursing. However, the participants chose nursing because they did not have sufficient scores to be accepted in other courses such as medicine. This finding is congruent with other studies that reported passive motives for choosing nursing as a career (Beck, 2000; Duffield, Pallas, & Aitken, 2004). External factors, primarily the entry exam scores, were the most influential factor when it came to choosing a career and further highlights the dilemma confronting most high school students in Iran. This system of recruitment requires high school students to make decisions about their university courses based on a national exam. When coupled with the fear of obligatory military services, male high school students feel constrained to accept any

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Choosing and remaining in nursing courses to which they can gain admission based on their NHEEE ranking. Contrary to other studies who report an intrinsic need to care as the primary reason for choosing nursing as a career by male nurses (Boughn, 1994, 2001; Meadus, 2000), in our study desire to care for others was not the primary reason for choosing nursing in most cases. This is supported by Fooladi (2003) who reported that Iranian male nurse students lack interest in compassionate nursing care and view nursing as a source of income and security. In addition, as reported elsewhere, men’s career choices are influenced by motivations such as salary, security and image more than their female counterparts (Zysberg & Berry, 2005). Furthermore, most of the participants in this study had little knowledge of what nursing entailed prior to starting the course apart from information gleaned from family, friends and acquaintances. This further supports the theory that the men in this study generally made uninformed choices about their career. It is suggested that entering nursing based on influence of more controlled motives such as job security or advice from family and friends is unlikely to be beneficial to the nursing profession in the long term. This is because graduates are less likely to yield direct need satisfaction, and therefore leave the nursing profession quickly, thinking that nursing had been neither their greatest aptitude nor their own decision (Cho, Jung, & Jang, 2010; Jirwe & Rudman, 2012). However, in this study none of the participants, whose first career choice was not nursing, had any regrets about choosing nursing and only some of them suggest that if they had appropriate knowledge about nursing they might have made a different choice. As high school students, some of participants declared that they had an idealistic image of university in their mind and when they had to do what they perceived as low prestigious body work like changing bed sheets, they felt incongruence between their ideal image of a university course and the reality of nursing. According to Law and Arthur (2003) the decision to choose or not choose nursing by high school students was significantly influenced by the congruence between students’ perception of an ideal career and nursing as a career. The congruence model

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suggests that people choose careers because they see a good fit between who they are and what the job is about (Zysberg & Berry, 2005). Because of the public image of nursing as feminine, some of the participants did not disclose their career choice. This is comparable with Mooney et al.’s (2008) finding in Ireland and this contributed to a feeling of powerlessness for the participants in their study. The public image of nurses as physician-subordinates or as ampouleinjection technicians is reported in other studies in Iran (Nasrabadi et al., 2003; Vaismoradi et al., 2011). However, in this study, as the participants became more confident and experienced they gained a more realistic view of nursing. After gaining knowledge and skills in nursing, especially after employment as a licensed nurse, a desire to care for others for God’s sake and their own emotional satisfaction were important factors for remaining in nursing, a motivation that is reported in other studies (Boughn, 1994, 2001; Meadus, 2000). In this study most participants believed that in spite of public perceptions, both genders are needed for nursing because of gendered nursing care in Iran. In addition, there are many patients who desire to be cared by nurses of the same sex. Male nurses do not face severe gender discrimination in Iran because of gendered nursing practice and a predominantly patriarchal society. However, they do experience feelings of isolation and lack of comradeship, and feel that they need to gently defend their masculinity in the Iranian nursing system. Nasrabadi et al. (2004) reported no significant gender differences in how nurses view the importance or characterization of nursing in Iran. Nevertheless, Fooladi (2003) found that gender influences the nature and experience of caring. Furthermore, the use of genderconscious education concepts and Islamic and Iranian cultural themes, significant variations in educational style and practice performance can be observed. The tendency for male nurses to work in specialized areas and the emphasis on task-oriented behaviors in some of our participants can be due to their inclination to distance themselves from female colleagues and the feminine image of nursing and as a way of elevating their own reputation and power (Evans, 1997).

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This may be perpetuated by patriarchal cultural institutions in Iran that create and maintain male advantage (Fooladi, 2003), as well as by women nurses themselves, who, intentionally or unintentionally, nurture the careers of male colleagues. Despite the fact that some participants tended somewhat to identify care and compassion as the feminine part of nursing and the critical practice areas as the masculine sides of nursing, they did not perceive caring as an inherently feminine trait and suggested that male nurses can be as caring as females. Some participants believed that males still have many opportunities to develop in this profession and pay more attention on career development because most female nurses have social tasks such as bringing up children and taking care of the entire family. It is argued that an increasing proportion of male nurses can help to promote the socio-economic status of nursing as a profession (Xu, 2008; Yang, Gau, Shiau, Hu, & Shih, 2004). CONCLUSION The present study reported the perspectives of Iranian male nurses regarding factors affecting their decisions to choose and remain in nursing. Men and women should not be limited to passive acceptance of nursing as a career choice because of their NHEEE ranking or see nursing as a way of avoiding military service. Rather, nursing should be positively marketed to draw those who truly have an interest in such a sensitive and dedicated profession. This is supported by Mooney et al. (2008) who argue that a more detailed selection method would recruit more motivated students and thus decrease the potential of withdrawal. Furthermore, the media must avoid showing stereotypical images of nursing as a predominately female profession and portray positive images of male nurses. High school counselors, health care institutions, and schools of nursing should be encouraged to promote nursing as a profession for men as well as women. Nursing administrators and educators should be aware of male nurses’ needs, motivations, professional preparations, and career planning and provide them with appropriate opportunities for professional development. Although there are challenges in relation to resources and changing public perceptions of the traditional view to nursing, it

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is expected that more men will enter nursing as a career because of its stable employment and reasonable salaries in an otherwise unstable economy. Despite the participants’ unawareness of the nature of nursing at the time of entry, their relative satisfaction demonstrates that male nurses could be the appropriate population for rectifying the nursing shortage. However, as this study is limited by its small sample size, more research is needed to explore reasons for choosing and remaining in nursing by male as well as female nurses. ACKNOWLEDGMENTS This is a report of a database from Thesis entitled ‘socialization of men to nursing profession’ approved by Tabriz University of Medical Sciences. The authors wish to acknowledge all of the male nurses, whose contribution enabled the production of this article. ETHICAL APPROVAL The ethical approval of the Tabriz University of Medical Sciences was obtained for the present study (Ethics Reference No. 5/4/675). REFERENCES Adib Hajbaghery, M., & Salsali, M. (2005). A model for empowerment of nursing in Iran. BMC Health Service Research, 5(1), 24–35. Beck, C. T. (2000). The experience of choosing nursing as a career. Journal of Nursing Education, 39(7), 320–322. Boughn, S. (1994). Why do men choose nursing? Nursing and Health Care, 15(8), 406–411. Boughn, S. (2001). Why women and men choose nursing. Nursing and Health Care Perspectives, 22(1), 14–19. Cho, S. H., Jung, S. Y., & Jang, S. (2010). Who enters nursing schools and why do they choose nursing? A comparison with female non-nursing students using longitudinal data. Nurse Education Today, 30(2), 180–186. De Cooman, R., De Gieter, S., Pepermans, R., Du Bois, C., Caers, R., & Jegers, M. (2008). Freshmen in nursing: Job motives and work values of a new generation. Journal of Nursing Management, 16(1), 56–64. Duffield, C., Pallas, L. O., & Aitken, L. M. (2004). Nurses who work outside nursing. Journal of Advanced Nursing, 47(6), 664–671. Evans, J. (1997). Men in nursing: Issues of gender segregation and hidden advantage. Journal of Advanced Nursing, 26(2), 226–231.

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Accepted 08 March 2013

N O W AVA I L A B L E MIGRATION AND MENTAL HEALTH A special issue of Advances in Mental Health – Volume 9 Issue 3 – ii + 94 pages – ISBN 978-1-921729-08-9 – December 2010 Guest Editors: Nicholas Procter (Mental Health Nursing, University of South Australia, Adelaide, SA), Monica McEvoy (Multicultural Mental Health, Child Adolescent Mental Health Services, Adelaide, SA) and Irena Papadopoulos (Research Centre for Transcultural Studies in Health, Middlesex University, UK) http://amh.e-contentmanagement.com/archives/vol/9/issue/3/marketing/ www.e-contentmanagement.com

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Volume 45, Issue 2, October 2013

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Choosing and remaining in nursing: Iranian male nurses' perspectives.

Iranian male nurses' career-choosing practices have not been well investigated. The aim of this study was to explore the reasons why Iranian male nurs...
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