The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study

Abstract

Introduction: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses. Methods: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons. Results: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses. Conclusion: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care.

Gender Inequity in the Clinical Setting

“…A recent mixed-methods study that utilized qualitative interview-based findings to build a quantitative survey of emergency room nurses and resident physicians found that gender had a significant impact on interprofessional interactions. 14 Although nurses expressed greater frustration with male residents, who they perceived to be more dismissive and less collaborative, female residents reported more frequent questioning of their clinical plans by nurses-especially by female nurses. While nurses may have perceived their interactions with female residents to reflect a greater collaborative ability, the female residents felt that such interactions reflected a decreased confidence in their abilities.…”

Gender differences in emergency medicine resident assessment: A scoping review

“…Title and abstract screening excluded 646 citations, resulting in 21 records eligible for full‐text screening. Five were excluded based on study objectives, 23–27 four for study design, 28–31 one because it was a duplicate, 32 and one for not including EM residents 33 . Ten records underwent data extraction 12,15,32,34–40 …”

“I just assume they don't know that I'm the doctor”: Gender bias and professional identity development of women residents

“…Another common theme was the challenging of resident authority and competency by nursing staff. Previous studies explored the complex, gender‐based relations between EM residents and nurses, demonstrating that women residents perceived gender‐based discrimination perpetrated by nurses 12,26 . Women residents reported the need to provide an explanation when administering orders to ensure completion of said orders as well as general questioning of their abilities by nursing staff.…”