By Joanna Hartley
Male nurses are now an important commodity in Middle East healthcare, despite a regional taboo.
Male nurses are fast becoming an important commodity in Middle East healthcare. Medical Times talks to two important role models; Fouad Chebab and Osama Diabat, practice development nurses in cardiology and psychiatry at Rashid Hospital, Dubai.
Tradtional Arab culture does not see nursing as a male occupation. Why did you enter the profession?
Diabat:In our system of education (in Jordan) when you finish your high school degree you have to submit a University application and go for options in many professions - nothing specific in your mind.
I did not go for nursing as my score was high, and I was accepted as a dentist in the capital, and a nurse in my own town. At that time I wanted to be a dentist, but due to some constraints, I ended up nursing. I was the only male nurse in my town of 70,000 people.
When I was interviewed to be a nurse here in 1986 the first question was; ‘why do you want to be a nurse you are a male?’ Because the culture is nursing is for females.
So, I studied general nursing from 1988 to 1992 and after graduation you submit a paper to the government, and they decide your specialty, and they told me to work in a psychiatric hospital. When I heard that it was a big shock for me, because it is our understanding in our culture at the time that this was a place for crazy people. Or people you want to get rid of. It is worse than jail.
But I had to go and when I went the director of nursing told me it's OK, it will be difficult, but they orientated me, and part of me wanted to continue with psychiatric nursing because I liked this area. I wanted to change the stigma in society.
Chebab:I studied accountancy in Lebanon for two years and I came to the United Arab Emirates(UAE) and started work in Al Ain in accounts, and I heard they were needing male nurses in 1986. So I applied to the Department of Health and Medical Services (DoHMS) at Rashid Hospital and studied a nursing diploma there.
At that time there were very few male nursing staff in the whole of DoHMS. There were less than 30 in 1986, and those male nurses had graduated from outside.
Why is it important for there to be male nurses?
Chebab:If we look at our hospital it is a trauma hospital where we deal with 474 beds. We have 58 beds for females and the remainder is all males - 80% of our patients are male and so we need male nurses. The culture here (in the UAE) is that some male patients say they do not want a female nurse, some say that they only want a male nurse.
Some older patients think, from a religious point of view, they don't want the female nurses to touch their beds. They want male with male, and female with female. There are also a few female nurses who are not happy to work with males for some sensitive procedures. But we have a good percentage of males now; there are 207 males out of 1,300 nurses.
Diabat:In terms of psychiatric care it can be very difficult for females because there is violence and aggression, and we need males to deal with some of this.
What nationalities make up the male nursing workforce?
Chebab:There is no internal recruitment here. Most male nurses come from outside. Ten years ago the nurses were all from one nationality, with the majority being Indians.
Then a few more Arabs came in, males and females. For the last two and a half years we have carried out overseas recruitment for male nurses. We went to the Philippines and signed up male nurses, and now there are three main nationalities; Filipinos, Indians and Jordanians. There are also a few Nigerians, Egyptians and Syrians, who work as nurse assistants. But the locals (Arabs) are a very small percentage of all nurses.
Have you seen any changes in the regional taboo around male nursing in recent years?
Chebab:When I was interviewed to be a nurse here in 1986 the first question was; "Why do you want to be a nurse, you are a male?" Because the culture is nursing is for females. The recognition is much better now, we can see the difference - we are equal to females. Diabat:When I went home recently three male relatives came to me to ask me about nursing, I am a role model. Now there are many male nurses (in Jordan), they can go abroad and make good money, the stigma has gone.
What about among the local population in the UAE?
Chebab:There was one registered nurse course for males, and I came for that course in 1986, and from that time they did it every year, but they closed it three years ago.
Diabat:There are no male local registered nurses in the whole of DoHMS. We have a few in the Ministry of Health but the majority is local females. There are no training programme for male nurses, and that needs to be done strategically.
In terms of psychiatric care it can be very difficult for females because there is violence and aggression, and we need males to deal with some of this.
However, I had an interesting experience before coming to work at this hospital. I worked in health education for seven years and our students were all females, 70% were local female students and 30% were expatriate students. We sent out a questionnaire to all the local secondary schools asking; "Are you willing to work in nursing?".
It went to the male locals aged 17 years. We were surprised by the results. Many of the local males said they were interested in studying nursing, and that was just one study.
Is it fair to say that economics is playing a key role in boosting male nurse numbers?
Diabat:Unemployment is a huge problem in Jordan and nurse exporting has become important. They have made nursing a resource because Jordanian nurses are acknowledged throughout the world as good nurses. They are playing a very important role in the economy.
One reason for males to go for nursing is to go abroad and to work outside the country. They go to University and get a Masters degree and as nursing roles are expanding they can become a manager quite quickly. The demand for nursing worldwide is getting more and more, which is encouraging males into the profession.
Chebab:For the past two years or so we have recruitednurses from the Philippines and they get six times the money as at home. These nurses were not nurses before, they studied something else, and then shifted to nursing because they wanted to get a good job.
You have both taken on new practice development nurse roles. What does that entail?
Diabat:When I joined here 95% of staff working in psychiatry did not have any psychiatric education. It is staffed by general nurses with five to 10 years of experience but no education - just three or four staff are certified out of 65.
So as a practice development nurse part of my role is to cover education I have started to educate them in the basic principals of psychiatric nursing, such as interpersonal relationships, therapeutic challenges, psychology education, symptoms care, psychiatric observation skills and de-escalation techniques.
They are very keen to receive this information, because they are receiving it after experience. But there are many misconceptions.
Chebab:We also started professional development as only two to three out of 60 nurses in the cardiology care unit had specialist training. We ran a one month course and we are planning a coronary care nursing course too. When you have education you have power and knowledge, and you can convey that and put yourself in any situation.
One of the things we did for the Joint Commission International acreditation was to have one clear pathway in the hospital for acute myocardial infarction.
The training started in October and we have put it all on the IT system. Part of the practice nurse development role is also about being responsible for spending on resources. I process requests, quotes, and tenders, and do product evaluation, to make sure we get the best.