Gender-related differences in the scope of nursing practice: evidence from a cross-sectional study in geriatric healthcare settings

Nursing is a profession traditionally characterized by a predominance of female nurses [1‐4]. Data available from the World Health Organization (WHO) covering 104 countries, indicate that although the number of male nurses in the field has been increasing in recent years, men are still a minority group in nursing in most countries [5]. In Europe and the Americas, the number of men in the nursing workforce remains relatively low (16% and 14% respectively), with values of 21%, 21%, and 19% in the Eastern Mediterranean, South-East Asia, and the Western Pacific respectively. In contrast, the proportion of male nurses in Africa is a relatively high 35% [5].

Despite being in the minority, male nurses enjoy certain advantages [1]. They are more likely to work full-time and have fewer career interruptions; they also appear to progress quickly to better-paid senior and nursing leadership positions [4, 6, 7]. In addition, recent years have seen an increasing tendency of male nurses to pursue advanced nursing clinical training. According to the Canadian Nurses Association, the number of male nurse practitioners in Canada has steadily increased over the past decade, with a rise from 4.5% in 2010 to 8.3% in 2019 [8]. Similarly, the Nursing and Midwifery Board of Australia reports that the proportion of male nurse practitioners in Australia has risen from 7.7% in 2015 to 10.3% in 2020 [9]. In the United Kingdom, the percentage of male nurses with advanced training has remained relatively stable over the past decade, with 9.6% of nurse practitioners in 2011 being male and only a slight increase to 10.5% by 2020 [10]. Based on data from the Israel Ministry of Health (IMoH), the 9% of licensed male nurses in the healthcare system in 2005 increased to 15% in 2021 [11]. These figures indicate a modest but noteworthy increase in the representation of male nurses within the nursing workforce in Israel.

Given the growing gender representation within the nursing profession, where male nurses, despite being a minority, are increasingly pursuing advanced clinical training and assuming leadership roles, it becomes imperative to understand how these dynamics influence the scope of practice. This context sets the stage for the current study, which was designed to explore how gender may affect the utilization of nursing scope of practice in different healthcare settings, while focusing specifically on both genders in geriatric environments.

The study sample comprised 286 registered nurses with advanced post-basic certification.

This section presents the demographic and professional characteristics of the participants.

The aim of this study was to examine potential gender-related differences in the utilization of nursing scope of practice across various geriatric care settings (acute, long-term, and community care) for activities authorized for all registered nurses and those designated only for advanced post-basic certification graduates. To the best of our knowledge, this study represents the first attempt to investigate such associations among nurses working in various geriatric healthcare settings.

A significant finding in our study is that male nurses outperform their female colleagues in technical procedures such as taking venous blood for routine tests, inserting a feeding tube, and starting a peripheral venous infusion. In the absence of any other research that reports these findings, we hypothesize that this may be at least partly due to the observation that male nurses are more likely to be assigned tasks that require technical skills and expertise, which may be perceived as more traditionally masculine [3, 26‐29, 35, 36]. Moreover, a recent meta-synthesis study [37] reported that male nurses in a predominantly female profession are aware of the challenges related to their visibility. The results underscore the impact of technical proficiency and the career aspirations of male nurses to establish their competence as professionals. The male nurses could be seen to exhibit goal-directed behaviors, such as adjusting their career trajectories, communication methods, and work ethics, while leveraging their technical skills. This adaptation is motivated, in part, by the necessity to address gender-based disparities in the workplace and enable efficient navigation in the nursing profession [37].

Our study also reveals that female nurses are more frequently involved in making decisions about the administration of over-the-counter medications, according to protocols established by medical directors. This pattern indicates that female nurses may engage more extensively in patient education and counseling—roles that align with traditional perceptions of femininity such as nurturing and caretaking [3, 27, 35]. These activities require strong communication skills and a patient-centered approach, qualities often stereotypically assigned to women. Our findings are therefore consistent with the broader literature, which highlights how gender stereotypes can influence professional roles within nursing. For instance, Smith et al. [38] discuss the impact of social stigmas and gender stereotypes on male nurses, suggesting that these factors often channel men into more technical or physically demanding roles, while women are steered towards tasks involving greater patient interaction and care coordination. The tendency to align nurses with roles based on gendered expectations not only reinforces traditional gender roles but may also influence career development and opportunities within the nursing field. Thus, our observations contribute to the growing body of evidence that calls for a reevaluation of how nursing tasks are assigned and the potential for biases that may arise from entrenched gender norms.

In terms of activities authorized for advanced nurses with a post-basic certification, male nurses implemented five out of nine activities to a greater extent than their female counterparts. Despite the absence of comprehensive research in this area, we believe that the notable differences in the scope of practice between male and female nurses may be due to several factors. A compelling element could be the generational effect, where younger nurses, regardless of gender, have been exposed to more contemporary educational practices and regulatory changes in nursing. This modern training might equip them with different skills and approaches compared to their older counterparts, thereby influencing how they practice and what roles they assume within healthcare settings. Moreover, there may be effects of the initiatives and policies by the Israel Ministry of Health (IMoH) that focus on the development and utilization of nursing qualifications. In recent years, the IMoH has emphasized enhancing nursing competencies and has expanded the roles nurses can fulfill, which could contribute to the observed variations in practice scopes between male and female nurses. The targeted efforts to modernize and specialize nursing roles [34, 39] might encourage a more diverse application of skills among newly trained nurses, and may affect how tasks are allocated and performed across gender lines. Furthermore, the higher proportion of male nurses working full time may have provided them with increased opportunities to gain experience and confidence in performing complex procedures.

There is a possibility that "men in nursing might find themselves being pushed towards specialties like emergency or trauma care, which are seen as more 'masculine' and require physical strength, as opposed to more 'feminine' areas like pediatric or geriatric nursing does exist [37]. Specifically, a study in Taiwan by Yang et al. [29] reported instances where "male nursing students were often expected by both peers and supervisors to perform and excel in technically demanding tasks, such as lifting heavy patients or managing emergency situations, which are often unjustly associated with male physicality. However, our results reveal that male nurses are frequently employed in acute and long-term geriatric care settings, which are areas requiring a diverse set of skills and competencies. This trend towards placing male nurses in environments that demand a broad skill set may help explain the observed gender differences in scope of practice. The specialization in areas that require a range of technical and critical thinking skills may afford male nurses more opportunities to develop and demonstrate their competencies, potentially leading to quicker career advancement. This observation aligns with findings from other studies across different cultural contexts. Research by Zhang & Tu [40] in Asia and Smith et al. [38] in Western countries similarly report that male nurses are often placed in roles that are perceived as more skill-intensive, contributing to the perception and reality of a broader scope of practice. Moreover, these studies suggest that male nurses often receive greater recognition from management, which not only fosters career advancement but may also influence the allocation of responsibilities that expand their scope of practice. This pattern of recognition and the subsequent opportunities it affords, appear consistent across various cultural backgrounds, indicating a potentially universal trend where gender influences professional roles and advancement in nursing.

The findings of our study reveal an interesting correlation: female nurses who hold a Master’s degree and have higher levels of seniority are less likely to perform certain index procedures. This pattern suggests that advanced education and a longer tenure in nursing may shift a nurse’s focus away from direct procedural tasks toward roles that emphasize leadership, research, or educational duties. Such roles often demand strategic thinking and managerial skills, potentially reducing the time and opportunity for these nurses to engage in hands-on clinical tasks [41, 42]. This trend resonates with findings in broader nursing research, such as those reported by González-García et al. [43], which indicate that nurses with higher academic qualifications often transition into roles that are less clinically intensive. These positions leverage their advanced knowledge and experience but may distance them from the front-line clinical activities typically associated with nursing. These may involve specific areas of nursing practice that do not involve the index procedures examined in our study. Such a transition can be viewed as a positive career progression; however, the trend also raises questions about the allocation of clinical responsibilities and the utilization of highly skilled staff in direct patient care.

These examples underscore how gender stereotypes not only shape professional roles but also influence expectations and task assignments within nursing. Such biases may hinder the professional growth and satisfaction of male and female nurses, and perpetuate gender disparities in the healthcare system.

It should be noted that we can perceive a shift toward more inclusive perceptions of the nursing profession in recent reports, suggesting a blurring of gender stereotypes in certain regions and institutions. A Q-methodological study by Kim, et al. [44] in South Korea revealed an increasing acceptance of male nurses as competent healthcare providers. Similarly, an integrative review by Teresa-Morales et al. [27], concluded that institutional policies promoting diversity and inclusion are crucial in diminishing gender biases and in fostering a culture that values all nurses irrespective of gender. Furthermore, a study in Saudi Arabia by Salvador & Alanazi, [45] reported that newer healthcare institutions with international affiliations tend to be more progressive in combating traditional gender roles, creating environments where male nurses feel more accepted and valued.

Our findings validate previous research indicating a significant relationship between job satisfaction and the utilization of the full scope of nursing practice. As described by studies such as Han et al. [46], Déry et al. [47], and Wood et al. [48], nurses who are content with their work environment and conditions, exhibit higher levels of motivation, engagement, and commitment to their roles. A satisfied nurse is more likely to show initiative, participate in decision-making, and perform complex procedures that require a high level of expertise, thereby effectively expanding their scope of practice. The positive association between working in long-term care and acute geriatric facilities and the utilization of index procedures may be attributed to the specific characteristics of the complex patients treated in these settings. The condition of patients in these facilities often involves a higher level of complexity and multiple comorbidities, requiring nurses to be more comprehensive in their approach and to perform a broader range of procedures within their scope of practice. This may include procedures related to specialized geriatric care, chronic disease management, rehabilitation, palliative care, and other aspects specific to the needs of elderly or long-term care residents. As a result, nurses working in long-term care and acute geriatric facilities may need to utilize their full scope of practice in order to satisfy the complex needs of the patient population they serve.

Overall, the results of our study emphasize that understanding gender-related differences in nursing practice is of utmost importance at the organizational, educational, and policymaker levels within healthcare institutions. At the organizational-clinical level, it is crucial to promote equal opportunities for male and female nurses so that they may engage in a diverse range of activities within their scope of practice. By recognizing and capitalizing on the strengths of both genders, healthcare institutions can foster more comprehensive and effective patient care while promoting gender equality in nursing practice. At the educational level, nursing programs need to ensure that curricula are designed to provide all students with comprehensive training and exposure to a broad range of activities regardless of gender. This includes providing them with diverse clinical experiences and opportunities that reflect the full scope of nursing practice. Educators should actively challenge gender stereotypes and biases within the classroom and clinical settings, with the aim of promoting an inclusive learning environment that encourages all students to explore and develop their skills across various specialties and practice areas. Furthermore, educational institutions can also support ongoing professional development programs that enable nurses to expand their scope of practice and acquire specialized skills in areas where disparities may exist.

Since policymakers play a vital role in shaping the nursing practice framework, they should collaborate with nursing associations and organizations to develop policies that explicitly address gender disparities in the scope of nursing practice. This could involve advocating for guidelines that promote equal distribution of tasks and responsibilities among nurses, regardless of their gender. Policymakers should also encourage research and data collection to monitor and track progress in addressing these disparities and use evidence-based findings to inform policy decisions. Acknowledging these initiatives, it is equally important to acknowledge the limitations of the current study, as they could influence how the findings are interpreted and their applicability to broader contexts.

The results of our study suggest that male nurses tend to practice a wider scope of nursing responsibilities than female nurses, both at basic and advanced levels of nursing. Our findings shed light on the unique gender-related challenges and opportunities faced by nurses, and highlight the need for a concerted effort to address and rectify any gender associated disparities that may exist in geriatric healthcare settings. It is important to recognize that both male and female nurses have valuable skills and expertise that should be utilized to the fullest extent possible. Healthcare organizations should work to create policies and practices that enable all nurses to implement their qualifications to the full and provide opportunities for professional development and advancement. In addition, efforts should also be made to promote gender equality in nursing education and training and ensure that all nurses have equal opportunities for learning and growth.