Student Nurses Journey through Gender Role Socialization in Healthcare Management: A Qualitative Exploration in Pakistan

Student Nurses Journey through Gender Role Socialization in Healthcare Management: A Qualitative Exploration in Pakistan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Student Nurses Journey through Gender Role Socialization in Healthcare Management: A Qualitative Exploration in Pakistan Sidra Abbas, Rab Nawaz Lodhi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7796539/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In the culturally complex healthcare context of Pakistan, gender role expectations significantly shape the experiences and self-perceptions of nursing students. Objective This qualitative study analyses how young student nurses internalize gendered roles during their professional socialization in health care system. Method Through a phenomenological lens, this research employs in-depth interviews with 25 nursing students from 5 major public hospitals of Lahore. This study utilizes NVivo-14 software for inductive thematic analysis to comprehensively analyze the nursing perceptions about their gender role socialization. Theoretical insights from Judith Butler’s gender performativity, Foucault’s knowledge-power dynamics, and feminist objectification theory frame the findings Results The findings reveal central themes from various perspectives on nursing students’ journey. Gender role socialization happens from the point of view of personal concerns, societal challenges and institutional management exposure that they experience in public health sector of Lahore. The diversified themes are ( 1 ) the personal negotiation of “becoming an ideal nurse-mother” as aspiration following gendered norms ( 2 ) the social normalization on “ethos of good-modest girl” provides emotional labor due to societal expectations ( 3 ) the education offers scripted “femininity of serving lady” who avoids confrontation under cover lack of encouragement, ( 4 ) the health care management demands as “economy compensated caregivers” placement of nurses as under weak leadership and ( 5 ) the clinical setting appreciate “silence to patriarchal voices” under organizational hierarchies, reinforcing a submissive identity. Conclusion This research highlights how socialization processes in nursing reinforce gender hierarchies, thus impacting care quality and student retention. The study recommends gender-sensitive reforms in nursing pedagogy and leadership to promote equity, empowerment, and professional dignity in healthcare settings. To the best of authors’ knowledge, this groundbreaking research describes sole perspective of nursing students from being just a student to qualified nurse. gender roles socialization identity healthcare management Figures Figure 1 Figure 2 Figure 3 Figure 4 1 Introduction Across the globe, nursing is often perceived as a noble yet feminized profession, closely associated with care, compassion, and emotional labor. So as, such associations are not natural but are socially constructed, embedded in longstanding gender norms (Aca, et al., 2025). Historically, In South Asia, these constructions are even more deeply entrenched under the image of the nurse as a nurturing figure remains submissive in professional hierarchies and public imagination. In Türkiye, gender norms are deeply embedded within cultural values and societal expectations. Moreover, nursing old stereotypes favour is feminine domain and not suitable for men (Lapitan, 2023). As a result, student’s nurse’s journey comes into consideration of caring vocation rooted in empathy, patience, and subservience (Masih & Gulzar, 2016). Gender roles are considered as natural sex predates socialization on the basis for gender. Besides, in patriarchal societies, women are obligated to meet the needs of men, and this obligation is deeply ingrained in the societal structure (Abbas et al., 2020). Gendered exclusion has prevented women from accessing the knowledge, skills, education, and credentials necessary to enter professions such as medicine (Lewis, 2022). In addition, societal expectations continue to paint nursing as incongruous with traditional notions and raise echoes of segregation reverberate even in the current landscape. Subsequently, nursing is often perceived as less aligned with these ideal situations, leading to a subtle devaluation of its essential aspects of care (Ghimire & Qiu, 2025). During nurses’ professional journey the significant contributions to patient care remain undervalued because nurses are underrepresented in leadership within the clinical hierarchy (Hellman, 2025). Consequently, inter-occupational power relations between medicine and nursing always influence one another. Zeng et al. (2018) and Kfouri & Lee (2019) posit that patriarchal norms within healthcare institutions expect women to be submissive and silenced. In the Pakistani context, nursing is often viewed as an extension of domestic labor, particularly for women from rural or lower-middle-class backgrounds. As a result, this perception perpetuates a cycle of occupational segregation, poor professional image, and constrained upward mobility for nurses in healthcare management system. Chang and Yeh (2016) say that this economic way of thinking makes nursing a "second choice" profession, especially for women who could not pay for or get into medical school. Actually, gender socialization in healthcare management issues is compounded by structural inequalities and a lack of gender-sensitive training (Khan et al., 2025). This study explores the gender role socialization of student nurses in Lahore's public hospitals. Specifically, it aims to reveal how gendered expectations influence their daily clinical interactions, self-perceptions, and long-term career aspirations. This research aims to offer insights into the power dynamics, cultural stigmas, and identity negotiations that influence the making of a nurse in Pakistan by documenting the lived experiences of nursing students. The present study contributes to this emerging discourse by foregrounding the voices of student nurses and tracing how gendered socialization operates through institutional practices. 2 Methods This study employed qualitative research methods and conducted 30 in-depth interviews with female student nurses from the public health sector in Pakistan. Braun and Clarke's (2006) thematic analysis and NVIVO-14 were used to uncover student nurses internalized gendered roles during their professional socialization. 2.1 Facilitator The facilitator secured the consent of all participants to ensure ethical concerns were addressed. The authorization process ensured that the nursing students shared their knowledge and experiences with gender role socialization freely and consciously, encouraging them to engage in the discussion and share their thoughts on the subject. 2.2 Participants To ensure confident and open communication about gender role socialization in the healthcare management system. Participants were interviewed. The interviews were conducted in their native languages. Urdu, English, and Punjabi. The interviews lasted 60 minutes. They aimed for depth while maintaining focus. Researchers later translated the verbatim transcriptions in English, Urdu and Punjabi into English for analysis and wider dissemination. NVIVO-14 software was used to facilitate a structured examination of the translated interview data. The demographics of the respondents are provided in Table 1. Table No: 1 Demographics of Participants Interviewee Public Hospital Nurses Student Year Qualification Department Years of Experience P1 a 1st year BSN Nursing office 6 months P2 4th year BSN Nursing office 3 years P3 Internship BSN Coronary care unit 4 years P4 1st year BSN Accident and emergency 6 months P5 2nd year BSN Pediatric 1 year P6 b 1st year BSN Nursing office 5 months P7 Internship BSN Nursing office 4 months P8 4th year BSN Ophthalmology 4 years P9 4th year BSN Intensive care unit 3 years P10 Internship BSN Psychiatry ward 4 years P11 c 3rd year BSN Nursing office 2 years P12 2nd year BSN Nursing office 1 year P13 4th year BSN Gynecology unit 3 years P14 4th year BSN Gynecology unit 3 years P15 Internship BSN Nursery 4 years P16 d 3rd year BSN Nursing office 2 years P17 1st year BSN Nursing office 5 months P18 Internship BSN Neurosurgery 4 years P19 2nd year BSN Neurology 1 year P20 Internship BSN Nephrology 4 years P21 e Internship BSN Nursing office 4 years P22 1st year BSN Nursing office 5 months P23 2nd year BSN Pharmacy 1 year P24 4th year Medical unit 3 years P25 Internship BSN Surgical unit 4 years P26 f 1st year BSN Nursing office 4 months P27 4th year BSN Nursing office 3 years P28 Internship BSN Nursing office 4 years P29 Internship BSN Maternal ward 4 years P30 Internship BSN Urology 4 years The demographic profile in Table 1 showcases a varied selection of female nursing students from the public health sector in Pakistan. The participants offered a wide range of viewpoints. These viewpoints were on applications for GRS. Their level of education ranged from first year to final year, and some had completed their professional training. The respondents ranged in age from 22 to 35 and had one to five years of work experience. 2.3 Data Collection The data collection process involved diversity in accessible population to made sure that the investigation of GRS was thorough, covering different roles and levels of expertise within the healthcare system. The interview questions were based on the following: How do student nurses perceive gender norms in nursing during their clinical placements and training? How do clinical instructors, peers, and patients contribute to reinforcing or challenging gendered expectations? How do student nurses come to terms with and navigate conflicting expectations regarding gender roles in healthcare settings? How are their developing professional identities and anticipated future roles influenced by these gendered internalizations? 2.4 Data Analysis The following paragraph describes the six steps of thematic analysis of Braun and Clarke (2006) which is about thematic analysis, a type of qualitative research. It’s a formal framework. This is useful for those who need a structured approach to their work for thematic analysis. 2.5 Step 1: acquired yourself with the data The first step in thematic analysis is for the dataset to be immersed in. This involves carefully examining the qualitative data gathered. This data can be interview transcripts or texts. (Maguire & Delahunt, 2017). 2.6 Step 2: generate preliminary codes In the early data analysis phase, data is systematically coded into manageable segments. The coding method is tailored to the study objectives, ensuring accurate and efficient data collection and organization. It involves carefully reviewing transcripts. It also involves the application of codes. The NVIVO tool is used for this. The transcript is read many times before an extensive coding process, which helps to extract important information. Examples of code application to a short data set are illustrated in Table 2, which shows the coding process. 2.7 Step 3: searching for themes Braun and Clarke's (2006) list of codes was compiled based on data collection and served as the starting point for the thematic analysis phase. According to Dawadi (2021), the main objective is to identify patterns and connections across the entire data set. Braun and Clarke (2006) defined themes as significant elements of data that are related to the topic under investigation and have clear patterns. It shown in Fig. 1, the codes created in Step 2 were grouped into three overarching themes and underwent further refinement. Table No: 2 Main Themes, sub themes and frequency about GRS Main themes Subthemes Frequency of coding Personal Concerns about Professional GRS Becoming an ideal nurse-mother Balancing care services at work and at home. Family approval for job Emotional labor of dual roles 5 3 5 Motivation of spirituality belief Serving as a sacred duty Faith is resilience Religious rewards for caregiving 4 3 3 Career advancement perceptions Aspiration to lead and manage Class mobility through nursing Gendered barriers to promotion 7 4 5 Experiencing Societal Challenges about GRS Ethos of good girl modesty Expectations of dress and behavior Self-policing for reputation Respect through silence | 2 6 7 Facing cultural taboos Stigmas and stereotypes, Avoiding night shifts and hospitals Fear of working with male staff Marriage risks 6 5 6 4 Public mockery for nurses Nurse as immoral woman Stereotype Blame in patient interactions Ridicule by community 6 8 4 4 Institutional Management Problems during GRS Education training on femininity Gendered language in instruction Emphasis on obedience/softness Ideal nurse image 4 6 2 Carry serving lady femininity Expected to smile, serve, endure Gendered patient interactions Reduced autonomy 4 2 6 Economy compensated clinicians Underpaid care work Gender pays gap in nursing Limited financial independence 2 6 2 Silence to patriarchal roar Enduring harassment silently Discouraged from reporting abuse Normalization of inequality 3 2 5 2.8 Step 4: reviewing step 3 In Step 3, the themes were reviewed in depth. This included careful consolidation, development, and deletion. The goal was to identify the main general topics and subtopics. These had to represent the data collection accurately. The three implementation stages created in stage 3 were thoroughly evaluated and updated. 2.9 Step 5: defining themes The themes are created and improved in Step 4. Then, the researcher creates a narrative that clearly conveys the results of the thematic analysis. This narrative forms the core of the research paper or report. At this stage, researchers organize the concepts methodically and logically. They usually do so in the order that best fits the study questions or goals. See Table 3 for Step 5 and the refined and defined themes that emerged from the thematic analysis. The themes are created and improved in Step 4.Then, the researcher creates a narrative. This narrative clearly conveys the results of the thematic analysis. 2.10 Step 6: report writing The sixth step in Braun and Clark's (2006) thematic analysis is report writing. This step involves creating a comprehensive manuscript. The manuscript should demonstrate a clear connection between chosen themes, their relevance, and research findings. The final stage provides a detailed analysis of in-depth interviews, exploring each step of the GRS process in healthcare. The analysis was carried out using NVIVO-14 software after completing all six steps of the thematic analysis recommended by Braun and Clarke (2006) on the transcript of the interview with the 30 participants. A more thorough analysis of the outcomes was enabled by the subsequent creation of a graphical representation, or hierarchy chart. 3 Findings The study finds the themes that arose from the interviews to provide a nuanced understanding of the challenges that student nurses face in navigating gender role socialization in healthcare management. The findings, summarized in Table 2, categorize the main themes and subthemes across personal concerns, societal challenges, and healthcare management issues. Table No: 3 Defining Themes S/No Rank Theme Definition of theme Personal Concerns about Professional GRS 1 Becoming an ideal nurse-mother This concept refers to the internalized belief that a "good nurse" must also be a nurturing, family-oriented woman who can balance caregiving both at home and in clinical settings. It reflects the dual burden of professional and domestic responsibilities, which are shaped by gender norms. 2 Motivation of spirituality belief The text describes how student nurses use their religious or spiritual beliefs to justify and provide emotional support for their nursing role. People often see nursing as a type of religious service or moral duty, which supports the idea that it's okay to make sacrifices for others. 3 Career advancement perceptions This text explores how gender norms shape student nurses' aspirations for leadership or career progression. It includes concerns about acceptability, feasibility, and societal judgment regarding female authority in healthcare management. Experiencing Societal Challenges about GRS 1 Ethos of good girl modesty The term "modesty, obedience, and humility" refers to the expectation that female nurses embody these qualities. This ethos affects their dressing, speech, interactions with men, and perceived respectability in society. 2 Facing cultural taboos Social and familial disapproval of nursing work is a result of cultural beliefs surrounding night shifts, working with male doctors, and being present in mixed-gender settings. These taboos often threaten marriage prospects and family honor. 3 Public mockery for nurses It highlights the negative stereotypes and ridicule nurses encounter in public discourse, media portrayals, and casual conversations. Nurses are often subject to shaming, which can take various forms, including verbal harassment, online criticism, and even physical assault. They are also subjected to sexual innuendos. They may even be labeled as "immoral." This is due to the nature of their work. Institutional Management Problems during GRS 1 Educational training on femininity It refers to how formal and informal education reinforces feminine ideals such as patience, subservience, and emotional labor. Students are often taught to prioritize obedience, gentleness, and caregiving, but this approach may not always be effective. They are taught to prioritize these things over assertiveness. 2 Economy compensated clinicians The text delves into the economic marginalization of nurses, with a focus on student nurses who are expected to put in long hours but receive minimal compensation. This reflects gendered undervaluation of care work and contributes to financial dependency. 3 Silence to patriarchal roar It refers to the normalization of gendered oppression within clinical settings, such as harassment, exploitation, or discrimination, where student nurses are expected to remain silent and tolerate patriarchal dominance to preserve their jobs or reputation. The table underscores the crucial role of personal concerns about professional GRS by highlighting subtheme frequencies. These concerns encompass three major themes, and specialized subthemes emphasize their importance for organizational readiness. 3.1 Personal Concerns about Professional GRS The nursing students personal concerns about professional gender role socialization emerged as deeply interwoven with their career ambitions, spiritual values and familial responsibilities. Besides, the pressure of becoming an “ideal nurse-mother,” where their nurturing role at home was expected to align with their professional identity, often creates emotional tension with institutional demands. In nursing, women should be in nurturing positions relate to their career expectations and confidence in attaining their desired job. A first year nursing student from accident and emergency department shared her story that: When I enrolled in nursing school, many relatives discouraged me, saying that this profession is not “respectable” for women because of the night shifts and interactions with male doctors. This constant judgment makes me question whether society will ever accept nursing as a professional identity for women instead of viewing it through gendered stereotypes (Participant, 4). 3.1.1 Becoming an Ideal Nurse-Mother Student nurses often reflected on the expectation to balance their caregiving responsibilities at home with their professional healthcare duties. They internalized the notion of becoming an “ideal nurse-mother,” who is patient, self-sacrificing, and nurturing in both the family and workplace settings. This dual responsibility often generated emotional strain because institutional expectations, such as long shifts or night duties, conflicted with cultural ideals about women's domestic availability. A nursing student who was doing her internship in neurosurgery department shared her story that: During my first clinical rotation, one of my teacher said, “A ideal nurse is like a good mother who is caring, patient, and selfless.” I was wondered: Was I getting training to become a nursing professional or to be a mother on the basis of society expectations?(Participant, 15). 3.1.2 Motivation of Spirituality Belief Spirituality emerged as a strong motivational anchor in the students professional journeys, guiding them as they navigated the complexities of their chosen careers. In addition, nursing was not only a career but also a moral and religious calling, where caring for patients was seen as an act of ibaadah (worship) and service to humanity. This belief system gave them the resilience to counteract the social stereotypes that demean nursing as "low status" or "women's work." A nursing student who was doing her internship in medical unit shared her story that: During my bad time, my spiritual beliefs made me strong. I found motivation in the idea that caring for the patient was a form of service to God. I thought of it as both a professional duty and an act of worship. My spiritual faith gave me resilience when the emotional demands of nursing work began to weigh heavily on me (Participant, 24). 3.1.3 Career Advancement Perceptions Despite societal expectations that women should prioritize family roles, many student nurses expressed aspirations for career progression, such as specialization, leadership roles, and higher education. Nursing students often negotiate their ambitions by envisioning "acceptable" career paths that align with family approval. A 2nd year nursing student who was doing her internship in neurology ward shared her story that: Nursing school has became negotiation of gender socialisation. Each and everyone I cared for in clinical though I was becoming: a nurse who believed nursing is compassion as worship, but who also questioned why society expected me to always be the nurturing mother, not a leader (Participant, 19). 3.2 Experiencing Societal Challenges about GRS Societal challenges has emerged as a critical dimension of nurses’ gender role socialization within healthcare management as student nurses made their way through their study program. Entering nursing often conflicts with prevailing cultural norms in which caregiving professions are devalued. Nursing is perceived as "helpers" rather than professionals, which resulted in a diminished sense of recognition from family and community members. Female nursing students showed restrictions on mobility, night duties, and interactions with male colleagues, reflecting broader patriarchal expectations that restrict women’s participation in the public sphere. 3.2.1 Ethos of Good Girl Modesty Female nurses embody the image of a good girl which is characterized by soft-spoken behavior and restrained interactions with male colleagues. In case of deviations from this ethos were often judged harshly, leaving them anxious about balancing professionalism with cultural ideals of femininity. They also said that their families play a role in guiding them toward this career path. A 3rd year nursing student who was doing her internship in psychiatry ward shared her story that: During her way back to home, some women in the street questioned why a “good girl” would work night shifts, while a group of young men laughed, mocking her as if modesty and nursing could not belong together (Participant, 10). 3.2.2 Facing Cultural Taboos Nursing profession was linked with cultural taboos especially related to working in mixed-gender environments and performing night shifts. Such responsibilities are an essential part of their training, but they often conflict with conservative family and community expectations. This creates a sense of inner conflict and social pressure. A BSN nursing student who was doing her internship in coronary care unit shared her story that: Cultural taboos wrapped around her like invisible chains and I wondered why my passion has ridiculed in society. I have to learn every day for balancing professional identity against societal judgment (Participant, 3). 3.2.3 Public Mockery for Nurses Nursing students experienced moments of embarrassment and hurt when subjected to derogatory remarks in public spaces, such as being called “male doctors’ assistants” or questioned about their moral integrity. This public mockery not only reinforced gender stereotypes but also undermined their confidence in pursuing nursing as a respected career. A 3rd year nursing student who was doing her duty in nursing office shared her story that: A young nurse come back home in her uniform, a group mocking her profession, calling it “just serving doctors (Participant, 16). 3.3 Institutional Management Problems during GRS Nursing students shows their ability to adjust the expectations imposed by institutional hierarchies and gendered norms. For balancing the traditional perception of nursing as a "female caring role" with the professional demands of healthcare management, it require assertiveness, and leadership, that are often discouraged in women within Pakistan's patriarchal context. These personal concerns were further exacerbated by management issues within the institution during GRS, including the absence of gender-sensitive policies, the unequal distribution of responsibilities. A 2nd year nursing student who was doing her duty in operation theater pharmacy shared her story that: A second-year nursing student, often felt invisible in faculty meetings. When she suggested adding leadership modules for nurses, the committee dismissed her, saying, “Your job is patient care, not management (Participant, 23). 3.3.1 Educational Training in Femininity Educational journey of nursing students was strongly shaped by gendered ideals of femininity that emphasized traits such as care, obedience, patience, and emotional sensitivity. These qualities are socially constructed as feminine and expected of women in Pakistani culture. While these attributes helped develop a caring professional identity, students also said this emphasis limited their exposure to leadership, authority, and decision-making skills. This reinforced their role as "supporters" rather than leaders in healthcare management. A 4th year nursing student who was doing her duty in ophthalmology ward shared her story that Nursing students must have gentle smile during bedside training. Nursing instructors often reminded her, “A nurse should nurture a patient, not too bold (Participant, 8). 3.3.2 Economy Compensated Clinicians Nurses experienced economic marginalization despite their heavy clinical responsibilities because they perceived themselves as underpaid compared to male doctors. However, perception of nursing as women's work in Pakistan's healthcare sector, is considered undervalued and economically devalued. These structural inequality impacted their financial security and shaped their professional sense of worth, making they question whether their contributions were recognized. A 4th year nursing student who was doing her duty in intensive care unit shared her story that: After completing long night and morning shifts, a nurse receive less wage disparity. Despite being clinically skilled, nurses realized that the economy valued her care less, not because of her ability, but because nursing was still seen as “women’s work (Participant, 9). 3.3.3 Silence to Patriarchal Roar Normalization of silence in the face of patriarchal dominance, which is a form of social control that perpetuates the status quo and silences those who would challenge it. Nursing student described situations where speaking against male doctors, administrators, or even senior staff was discouraged and seen as "unfeminine" or disrespectful. This silence led to feelings of frustration and powerlessness for many, yet it was seen as a necessary adaptation to navigate professional spaces. A 4th year nursing student who was doing her duty in medical ward shared her story that: Nursing student mostly felt invisible in official meetings as it your job is patient care, not management.” She realized her institution reinforced gendered hierarchies and female nursing students were subtly socialized to obey (Participant, 24). 4 Discussion In present study, we undertook thorough exploration of GRS of student nurses that revealed deep personal concerns regarding professional gender role socialization that shaped self-concept and future career expectations of nursing students. They have expressed their anxiety over the stereotypical framing of nursing as an extension of feminine caregiving rather than a recognized professional skill. This association often caused them to internalize doubt about their competence and question their career longevity. In Pakistan, nursing students navigate a dual pressure: aspiring for professional recognition while carrying the weight of gendered expectations tied to their personal identities. The pressure to embody femininity through expected softness, compliance, and emotional labor sometimes conflicted with their desire to assert leadership in healthcare spaces. These findings resonate with earlier research that highlights about gender norms infiltrate professional identities, where women in caregiving professions internalize socially constructed ideals of patience and sacrifice. It involves ignoring one's capacities of intellect or acknowledging an improper person just because of gender identity and devalued professional identity. Foucault (1990) argued that biological differences create cultural influences and operate power relations based on gender identity for a woman within the society and organization. From feministic perspective, these approaches appeal to women as mothers, which reinforces the stereotypical view to maintain the essence of nursing women. Butler (1988) and Le Blanc (2017) referred to gender as a constructed identity that is wholly gained through the performativity of roles. Redefining gender roles in caregiving from motherhood to an innovative profession would improve the quality of healthcare and eliminate disparities in its public image (Stattkus et al., 2025). Besides, gender bias plays a role in these female-dominated fields, which are still dominated by patriarchy, perhaps because typical organizational structures are rooted in patriarchy (Hancock & Hums, 2016). Beyond personal struggles, student nurses reported frequent societal challenges that reinforced gender role stereotypes. Families, relatives, and community members often undervalued nursing, describing it as a “female duty” rather than a legitimate profession. Stereotypes and bias can hinder the achievement of diverse results in academic nursing and at all nursing levels (Masibo et al., 2025). Some participants shared experiences of stigma attached to working night shifts, interacting with male colleagues, or handling intimate patient care, all of which were framed as morally questionable in conservative social settings. This not only undermined their confidence but also added emotional stress, as they constantly negotiated between professional obligations and societal judgments. The study results affirms that societal perceptions of nursing reinforce structural inequalities, constraining female nurses’ agency and professional mobility. Foucault (1970) idea of the microphysics of power described that the knowledge-power complex turn human bodies into objects. These challenges highlight how broader patriarchal discourses shape the social standing of nurses in Pakistan, marginalizing their contribution to healthcare management. In clinical management, student nurses encountered systemic management problems that further complicated their gender role socialization. Rotational duties and workload distribution were perceived as unfair, with female nurses more likely to be assigned emotionally intensive care tasks rather than technical responsibilities. Feminism has limelight the gender norms in "patriarchal" societies that disempower to women as socially subservient human which proceeded gradually with notions of objectification. In educational setting, the lack of formal mentorship and insufficient-sensitive training created barriers in their professional growth. Institutional cultures often normalized gender hierarchies, discouraging nurses from voicing concerns about harassment, workload imbalance, or career advancement. These institutional dynamics not only perpetuated gender marginalization but also hindered the development of confident, skilled nursing professionals (Toreid et al., 2025). In Pakistan, government policies often underinvest in nursing leadership and development, thereby institutionalizing a compensated yet subordinate identity for nurses. Nurses are often socialized to be silent in hierarchical systems. The result is a cohort of nursing students trained not only in clinical care but in emotional suppression, conflict avoidance, and deference to authority (Afsin 2025). The study demonstrates that student nurses journey through gender role socialization is multi-layered, involving the interplay of personal insecurities, societal stigma, and institutional inequalities. Together, these forces construct a gendered professional identity that both limits and motivates student nurses to challenge stereotypes in healthcare management. The findings align with feminist organizational perspectives that emphasize how management structures reproduce social inequalities, embedding gender hierarchies within healthcare governance. 5 Conclusion 5.1 Theoretical Implication From the view point of theoretical implication, student nurses added deep concerns about gendered expectations shape their learning, practice, and identity. While many internalized femininities as part of nursing, they also struggled with limited recognition as competent professionals in a healthcare environment dominated by hierarchical and gendered norms. Their narratives highlighted both pride in care-oriented roles and frustration at being undervalued, particularly when their work was framed through cultural stereotypes of women as naturally “caring” rather than skilled professionals. Nurses consistently encountered societal biases rooted in patriarchy and traditional views of women’s roles. They reported stigmatization, limited mobility, and lack of respect, which influenced their confidence and career progression. Gendered socialization often reinforced silence and obedience, restricting their ability to negotiate authority within healthcare teams. These challenges underscored how broader social structures marginalize nursing as “women’s work,” further reinforcing inequalities within healthcare management. 5.2 Practical Implication In terms of practical implications, at the institutional level, student nurses faced management practices that perpetuated gender disparities. Issues such as unequal task distribution, lack of supportive mentorship, rigid hierarchies, and absence of gender-sensitive policies reflected systemic gaps. Institutions often reinforced traditional gender roles rather than challenging them, leaving student nurses to navigate professional growth within constraining frameworks. The absence of formal platforms for student voices further deepened feelings of marginalization. Overall, the study concludes that student nurses’ gender role socialization is not merely an individual experience, but a process shaped by entrenched cultural norms, societal stereotypes, and institutional limitations. Their journeys highlight the urgent need for reforms that integrate gender-sensitive training, equitable management practices, and societal awareness campaigns to uplift the professional identity of nurses in Pakistan. Recognizing nurses as skilled professionals rather than gendered caregivers is essential for building an inclusive healthcare system where their contributions are valued, respected, and empowered. Declarations Ethical Considerations Ethics approval was sought from the internal board of review studies, University of the Punjab, Quaid-A-Azam Campus, Lahore. Participants were informed that they could withdraw at any time without penalty. To ensure confidentiality, participant names were replaced by codes throughout the analysis and presentation of the results. Each participant gave written informed consent before data collection, as obtained by the first author. Conflict of Interest The authors declare that they have no actual or potential conflicts of interest. Funding statement This research received no supporting funds from any funding agency in the public, commercial, or not-for-profit sector. Author Contribution The interviews were part of the PhD thesis conducted by SA. SA conducted data collection and RN worked on data analysis in NVIVO. All authors reviewed the final version of the manuscript. The author(s) read and approved the final manuscript. Acknowledgments The interviews were part of the PhD thesis conducted by SA. SA conducted data collection and RN worked on data analysis in NVIVO. All authors reviewed the final version of the manuscript. The author(s) read and approved the final manuscript. 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Class and cultural capital in Pakistani nursing schools: A study of private and public sector differences. Asian J Social Sci. 2022;50(2):243–59. Toreid HE, Sjølie BHM, Bjørbæk SA, Köhler M. (2025). Digital peer mentoring in higher education: Results from a qualitative study involving digital part-time nursing students. Heliyon, 11(4). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7796539","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526130519,"identity":"6870fc1b-7699-44f9-bc8f-ac05a05cfebd","order_by":0,"name":"Sidra Abbas","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBAC+WYGAxCdACQZH4CFDgBZDXi0GBxGaGE2IE4LA0ILmwRxWtiZt334wWCXZ85+/Fk1bxuDHN+NBLaHM/D6ha14Zg9DcrFlT47ZbaAWY8kbCeyGG/BoYTjMY8zAw8CcuOFADtvNmW0MiRuAtkg+IKCF8Q9DfeKG88+fFQK11BOlhZmH4TDIcDOGj23AcABpwecwg8NsxcwyBseLLWe8MZb4cE7CcOaZh+2GeL3ff3gz45uK6jxz/vSHHxLKbOT5jicfe9iDz2EQu+AsUNQwthHUgAHYSNcyCkbBKBgFwxkAAFeuTcNTFc6rAAAAAElFTkSuQmCC","orcid":"","institution":"Virtual University of Pakistan","correspondingAuthor":true,"prefix":"","firstName":"Sidra","middleName":"","lastName":"Abbas","suffix":""},{"id":526130520,"identity":"e232cd50-4383-4b84-9627-a49cf8ef8790","order_by":1,"name":"Rab Nawaz Lodhi","email":"","orcid":"","institution":"University of the Punjab","correspondingAuthor":false,"prefix":"","firstName":"Rab","middleName":"Nawaz","lastName":"Lodhi","suffix":""}],"badges":[],"createdAt":"2025-10-07 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16:32:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1547878,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7796539/v1/b7a40439-4afa-45ee-bc48-81cb0bb3730e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Student Nurses Journey through Gender Role Socialization in Healthcare Management: A Qualitative Exploration in Pakistan","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eAcross the globe, nursing is often perceived as a noble yet feminized profession, closely associated with care, compassion, and emotional labor. So as, such associations are not natural but are socially constructed, embedded in longstanding gender norms (Aca, et al., 2025). Historically, In South Asia, these constructions are even more deeply entrenched under the image of the nurse as a nurturing figure remains submissive in professional hierarchies and public imagination. In T\u0026uuml;rkiye, gender norms are deeply embedded within cultural values and societal expectations. Moreover, nursing old stereotypes favour is feminine domain and not suitable for men (Lapitan, 2023). As a result, student\u0026rsquo;s nurse\u0026rsquo;s journey comes into consideration of caring vocation rooted in empathy, patience, and subservience (Masih \u0026amp; Gulzar, 2016).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eGender roles are considered as natural sex predates socialization on the basis for gender. Besides, in patriarchal societies, women are obligated to meet the needs of men, and this obligation is deeply ingrained in the societal structure (Abbas et al., 2020). Gendered exclusion has prevented women from accessing the knowledge, skills, education, and credentials necessary to enter professions such as medicine (Lewis, 2022). In addition, societal expectations continue to paint nursing as incongruous with traditional notions and raise echoes of segregation reverberate even in the current landscape. Subsequently, nursing is often perceived as less aligned with these ideal situations, leading to a subtle devaluation of its essential aspects of care (Ghimire \u0026amp; Qiu, 2025).\u003c/p\u003e\u003cp\u003eDuring nurses\u0026rsquo; professional journey the significant contributions to patient care remain undervalued because nurses are underrepresented in leadership within the clinical hierarchy (Hellman, 2025). Consequently, inter-occupational power relations between medicine and nursing always influence one another. Zeng et al. (2018) and Kfouri \u0026amp; Lee (2019) posit that patriarchal norms within healthcare institutions expect women to be submissive and silenced.\u003c/p\u003e\u003cp\u003eIn the Pakistani context, nursing is often viewed as an extension of domestic labor, particularly for women from rural or lower-middle-class backgrounds. As a result, this perception perpetuates a cycle of occupational segregation, poor professional image, and constrained upward mobility for nurses in healthcare management system. Chang and Yeh (2016) say that this economic way of thinking makes nursing a \"second choice\" profession, especially for women who could not pay for or get into medical school. Actually, gender socialization in healthcare management issues is compounded by structural inequalities and a lack of gender-sensitive training (Khan et al., 2025).\u003c/p\u003e\u003cp\u003eThis study explores the gender role socialization of student nurses in Lahore's public hospitals. Specifically, it aims to reveal how gendered expectations influence their daily clinical interactions, self-perceptions, and long-term career aspirations. This research aims to offer insights into the power dynamics, cultural stigmas, and identity negotiations that influence the making of a nurse in Pakistan by documenting the lived experiences of nursing students. The present study contributes to this emerging discourse by foregrounding the voices of student nurses and tracing how gendered socialization operates through institutional practices.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cp\u003eThis study employed qualitative research methods and conducted 30 in-depth interviews with female student nurses from the public health sector in Pakistan. Braun and Clarke's (2006) thematic analysis and NVIVO-14 were used to uncover student nurses internalized gendered roles during their professional socialization.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Facilitator\u003c/h2\u003e\u003cp\u003e The facilitator secured the consent of all participants to ensure ethical concerns were addressed. The authorization process ensured that the nursing students shared their knowledge and experiences with gender role socialization freely and consciously, encouraging them to engage in the discussion and share their thoughts on the subject.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Participants\u003c/h2\u003e\u003cp\u003eTo ensure confident and open communication about gender role socialization in the healthcare management system. Participants were interviewed. The interviews were conducted in their native languages. Urdu, English, and Punjabi. The interviews lasted 60 minutes. They aimed for depth while maintaining focus. Researchers later translated the verbatim transcriptions in English, Urdu and Punjabi into English for analysis and wider dissemination. NVIVO-14 software was used to facilitate a structured examination of the translated interview data. The demographics of the respondents are provided in Table\u0026nbsp;1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable No: 1 Demographics of Participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterviewee\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic Hospital\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNurses Student Year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQualification\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDepartment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYears of Experience\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCoronary care unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAccident and emergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2nd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePediatric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 year\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOphthalmology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIntensive care unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePsychiatry ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3rd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2nd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 year\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGynecology unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGynecology unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3rd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNeurosurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2nd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNeurology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 year\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNephrology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2nd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 year\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedical unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSurgical unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNursing office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMaternal ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBSN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUrology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe demographic profile in Table\u0026nbsp;1 showcases a varied selection of female nursing students from the public health sector in Pakistan. The participants offered a wide range of viewpoints. These viewpoints were on applications for GRS. Their level of education ranged from first year to final year, and some had completed their professional training. The respondents ranged in age from 22 to 35 and had one to five years of work experience.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data Collection\u003c/h2\u003e\u003cp\u003eThe data collection process involved diversity in accessible population to made sure that the investigation of GRS was thorough, covering different roles and levels of expertise within the healthcare system. The interview questions were based on the following:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do student nurses perceive gender norms in nursing during their clinical placements and training?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do clinical instructors, peers, and patients contribute to reinforcing or challenging gendered expectations?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do student nurses come to terms with and navigate conflicting expectations regarding gender roles in healthcare settings?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow are their developing professional identities and anticipated future roles influenced by these gendered internalizations?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Data Analysis\u003c/h2\u003e\u003cp\u003eThe following paragraph describes the six steps of thematic analysis of Braun and Clarke (2006) which is about thematic analysis, a type of qualitative research. It\u0026rsquo;s a formal framework. This is useful for those who need a structured approach to their work for thematic analysis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Step 1: acquired yourself with the data\u003c/h2\u003e\u003cp\u003eThe first step in thematic analysis is for the dataset to be immersed in. This involves carefully examining the qualitative data gathered. This data can be interview transcripts or texts. (Maguire \u0026amp; Delahunt, 2017).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Step 2: generate preliminary codes\u003c/h2\u003e\u003cp\u003eIn the early data analysis phase, data is systematically coded into manageable segments. The coding method is tailored to the study objectives, ensuring accurate and efficient data collection and organization. It involves carefully reviewing transcripts. It also involves the application of codes. The NVIVO tool is used for this. The transcript is read many times before an extensive coding process, which helps to extract important information. Examples of code application to a short data set are illustrated in Table\u0026nbsp;2, which shows the coding process.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Step 3: searching for themes\u003c/h2\u003e\u003cp\u003eBraun and Clarke's (2006) list of codes was compiled based on data collection and served as the starting point for the thematic analysis phase. According to Dawadi (2021), the main objective is to identify patterns and connections across the entire data set. Braun and Clarke (2006) defined themes as significant elements of data that are related to the topic under investigation and have clear patterns. It shown in Fig.\u0026nbsp;1, the codes created in Step 2 were grouped into three overarching themes and underwent further refinement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable No: 2 Main Themes, sub themes and frequency about GRS\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubthemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency of coding\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePersonal Concerns about Professional GRS\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBecoming an ideal nurse-mother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBalancing care services at work and at home.\u003c/p\u003e\u003cp\u003eFamily approval for job\u003c/p\u003e\u003cp\u003eEmotional labor of dual roles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivation of spirituality belief\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eServing as a sacred duty\u003c/p\u003e\u003cp\u003eFaith is resilience\u003c/p\u003e\u003cp\u003eReligious rewards for caregiving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCareer advancement perceptions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAspiration to lead and manage\u003c/p\u003e\u003cp\u003eClass mobility through nursing\u003c/p\u003e\u003cp\u003eGendered barriers to promotion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eExperiencing Societal Challenges about GRS\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthos of good girl modesty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExpectations of dress and behavior\u003c/p\u003e\u003cp\u003eSelf-policing for reputation\u003c/p\u003e\u003cp\u003eRespect through silence |\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacing cultural taboos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStigmas and stereotypes,\u003c/p\u003e\u003cp\u003eAvoiding night shifts and hospitals\u003c/p\u003e\u003cp\u003eFear of working with male staff\u003c/p\u003e\u003cp\u003eMarriage risks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic mockery for nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse as immoral woman\u003c/p\u003e\u003cp\u003eStereotype\u003c/p\u003e\u003cp\u003eBlame in patient interactions\u003c/p\u003e\u003cp\u003eRidicule by community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eInstitutional Management Problems during GRS\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation training on femininity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGendered language in instruction\u003c/p\u003e\u003cp\u003eEmphasis on obedience/softness\u003c/p\u003e\u003cp\u003eIdeal nurse image\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCarry serving lady femininity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExpected to smile, serve, endure\u003c/p\u003e\u003cp\u003eGendered patient interactions\u003c/p\u003e\u003cp\u003eReduced autonomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomy compensated clinicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderpaid care work\u003c/p\u003e\u003cp\u003eGender pays gap in nursing\u003c/p\u003e\u003cp\u003eLimited financial independence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSilence to patriarchal roar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnduring harassment silently\u003c/p\u003e\u003cp\u003eDiscouraged from reporting abuse\u003c/p\u003e\u003cp\u003eNormalization of inequality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.8 Step 4: reviewing step 3\u003c/h2\u003e\u003cp\u003eIn Step 3, the themes were reviewed in depth. This included careful consolidation, development, and deletion. The goal was to identify the main general topics and subtopics. These had to represent the data collection accurately. The three implementation stages created in stage 3 were thoroughly evaluated and updated.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.9 Step 5: defining themes\u003c/h2\u003e\u003cp\u003eThe themes are created and improved in Step 4. Then, the researcher creates a narrative that clearly conveys the results of the thematic analysis. This narrative forms the core of the research paper or report. At this stage, researchers organize the concepts methodically and logically. They usually do so in the order that best fits the study questions or goals. See Table\u0026nbsp;3 for Step 5 and the refined and defined themes that emerged from the thematic analysis. The themes are created and improved in Step 4.Then, the researcher creates a narrative. This narrative clearly conveys the results of the thematic analysis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.10 Step 6: report writing\u003c/h2\u003e\u003cp\u003eThe sixth step in Braun and Clark's (2006) thematic analysis is report writing. This step involves creating a comprehensive manuscript. The manuscript should demonstrate a clear connection between chosen themes, their relevance, and research findings. The final stage provides a detailed analysis of in-depth interviews, exploring each step of the GRS process in healthcare. The analysis was carried out using NVIVO-14 software after completing all six steps of the thematic analysis recommended by Braun and Clarke (2006) on the transcript of the interview with the 30 participants. A more thorough analysis of the outcomes was enabled by the subsequent creation of a graphical representation, or hierarchy chart.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Findings","content":"\u003cp\u003eThe study finds the themes that arose from the interviews to provide a nuanced understanding of the challenges that student nurses face in navigating gender role socialization in healthcare management. The findings, summarized in Table\u0026nbsp;2, categorize the main themes and subthemes across personal concerns, societal challenges, and healthcare management issues.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable No: 3 Defining Themes\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS/No\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRank Theme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDefinition of theme\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePersonal Concerns about Professional GRS\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBecoming an ideal nurse-mother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThis concept refers to the internalized belief that a \"good nurse\" must also be a nurturing, family-oriented woman who can balance caregiving both at home and in clinical settings. It reflects the dual burden of professional and domestic responsibilities, which are shaped by gender norms.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMotivation of spirituality belief\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe text describes how student nurses use their religious or spiritual beliefs to justify and provide emotional support for their nursing role. People often see nursing as a type of religious service or moral duty, which supports the idea that it's okay to make sacrifices for others.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCareer advancement perceptions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThis text explores how gender norms shape student nurses' aspirations for leadership or career progression. It includes concerns about acceptability, feasibility, and societal judgment regarding female authority in healthcare management.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eExperiencing Societal Challenges about GRS\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthos of good girl modesty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe term \"modesty, obedience, and humility\" refers to the expectation that female nurses embody these qualities. This ethos affects their dressing, speech, interactions with men, and perceived respectability in society.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFacing cultural taboos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial and familial disapproval of nursing work is a result of cultural beliefs surrounding night shifts, working with male doctors, and being present in mixed-gender settings. These taboos often threaten marriage prospects and family honor.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic mockery for nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIt highlights the negative stereotypes and ridicule nurses encounter in public discourse, media portrayals, and casual conversations. Nurses are often subject to shaming, which can take various forms, including verbal harassment, online criticism, and even physical assault. They are also subjected to sexual innuendos. They may even be labeled as \"immoral.\" This is due to the nature of their work.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eInstitutional Management Problems during GRS\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducational training on femininity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIt refers to how formal and informal education reinforces feminine ideals such as patience, subservience, and emotional labor. Students are often taught to prioritize obedience, gentleness, and caregiving, but this approach may not always be effective. They are taught to prioritize these things over assertiveness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEconomy compensated clinicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe text delves into the economic marginalization of nurses, with a focus on student nurses who are expected to put in long hours but receive minimal compensation. This reflects gendered undervaluation of care work and contributes to financial dependency.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSilence to patriarchal roar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIt refers to the normalization of gendered oppression within clinical settings, such as harassment, exploitation, or discrimination, where student nurses are expected to remain silent and tolerate patriarchal dominance to preserve their jobs or reputation.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe table underscores the crucial role of personal concerns about professional GRS by highlighting subtheme frequencies. These concerns encompass three major themes, and specialized subthemes emphasize their importance for organizational readiness.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Personal Concerns about Professional GRS\u003c/h2\u003e\u003cp\u003eThe nursing students personal concerns about professional gender role socialization emerged as deeply interwoven with their career ambitions, spiritual values and familial responsibilities. Besides, the pressure of becoming an \u0026ldquo;ideal nurse-mother,\u0026rdquo; where their nurturing role at home was expected to align with their professional identity, often creates emotional tension with institutional demands. In nursing, women should be in nurturing positions relate to their career expectations and confidence in attaining their desired job. A first year nursing student from accident and emergency department shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eWhen I enrolled in nursing school, many relatives discouraged me, saying that this profession is not \u0026ldquo;respectable\u0026rdquo; for women because of the night shifts and interactions with male doctors. This constant judgment makes me question whether society will ever accept nursing as a professional identity for women instead of viewing it through gendered stereotypes (Participant, 4).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.1.1 Becoming an Ideal Nurse-Mother\u003c/h2\u003e\u003cp\u003eStudent nurses often reflected on the expectation to balance their caregiving responsibilities at home with their professional healthcare duties. They internalized the notion of becoming an \u0026ldquo;ideal nurse-mother,\u0026rdquo; who is patient, self-sacrificing, and nurturing in both the family and workplace settings. This dual responsibility often generated emotional strain because institutional expectations, such as long shifts or night duties, conflicted with cultural ideals about women's domestic availability. A nursing student who was doing her internship in neurosurgery department shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eDuring my first clinical rotation, one of my teacher said, \u0026ldquo;A ideal nurse is like a good mother who is caring, patient, and selfless.\u0026rdquo; I was wondered: Was I getting training to become a nursing professional or to be a mother on the basis of society expectations?(Participant, 15).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.1.2 Motivation of Spirituality Belief\u003c/h2\u003e\u003cp\u003eSpirituality emerged as a strong motivational anchor in the students professional journeys, guiding them as they navigated the complexities of their chosen careers. In addition, nursing was not only a career but also a moral and religious calling, where caring for patients was seen as an act of ibaadah (worship) and service to humanity. This belief system gave them the resilience to counteract the social stereotypes that demean nursing as \"low status\" or \"women's work.\" A nursing student who was doing her internship in medical unit shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eDuring my bad time, my spiritual beliefs made me strong. I found motivation in the idea that caring for the patient was a form of service to God. I thought of it as both a professional duty and an act of worship. My spiritual faith gave me resilience when the emotional demands of nursing work began to weigh heavily on me (Participant, 24).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.1.3 Career Advancement Perceptions\u003c/h2\u003e\u003cp\u003eDespite societal expectations that women should prioritize family roles, many student nurses expressed aspirations for career progression, such as specialization, leadership roles, and higher education. Nursing students often negotiate their ambitions by envisioning \"acceptable\" career paths that align with family approval. A 2nd year nursing student who was doing her internship in neurology ward shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eNursing school has became negotiation of gender socialisation. Each and everyone I cared for in clinical though I was becoming: a nurse who believed nursing is compassion as worship, but who also questioned why society expected me to always be the nurturing mother, not a leader (Participant, 19).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Experiencing Societal Challenges about GRS\u003c/h2\u003e\u003cp\u003eSocietal challenges has emerged as a critical dimension of nurses\u0026rsquo; gender role socialization within healthcare management as student nurses made their way through their study program. Entering nursing often conflicts with prevailing cultural norms in which caregiving professions are devalued. Nursing is perceived as \"helpers\" rather than professionals, which resulted in a diminished sense of recognition from family and community members. Female nursing students showed restrictions on mobility, night duties, and interactions with male colleagues, reflecting broader patriarchal expectations that restrict women\u0026rsquo;s participation in the public sphere.\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Ethos of Good Girl Modesty\u003c/h2\u003e\u003cp\u003eFemale nurses embody the image of a good girl which is characterized by soft-spoken behavior and restrained interactions with male colleagues. In case of deviations from this ethos were often judged harshly, leaving them anxious about balancing professionalism with cultural ideals of femininity. They also said that their families play a role in guiding them toward this career path. A 3rd year nursing student who was doing her internship in psychiatry ward shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eDuring her way back to home, some women in the street questioned why a \u0026ldquo;good girl\u0026rdquo; would work night shifts, while a group of young men laughed, mocking her as if modesty and nursing could not belong together (Participant, 10).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Facing Cultural Taboos\u003c/h2\u003e\u003cp\u003eNursing profession was linked with cultural taboos especially related to working in mixed-gender environments and performing night shifts. Such responsibilities are an essential part of their training, but they often conflict with conservative family and community expectations. This creates a sense of inner conflict and social pressure. A BSN nursing student who was doing her internship in coronary care unit shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eCultural taboos wrapped around her like invisible chains and I wondered why my passion has ridiculed in society. I have to learn every day for balancing professional identity against societal judgment (Participant, 3).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Public Mockery for Nurses\u003c/h2\u003e\u003cp\u003eNursing students experienced moments of embarrassment and hurt when subjected to derogatory remarks in public spaces, such as being called \u0026ldquo;male doctors\u0026rsquo; assistants\u0026rdquo; or questioned about their moral integrity. This public mockery not only reinforced gender stereotypes but also undermined their confidence in pursuing nursing as a respected career. A 3rd year nursing student who was doing her duty in nursing office shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eA young nurse come back home in her uniform, a group mocking her profession, calling it \u0026ldquo;just serving doctors (Participant, 16).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Institutional Management Problems during GRS\u003c/h2\u003e\u003cp\u003eNursing students shows their ability to adjust the expectations imposed by institutional hierarchies and gendered norms. For balancing the traditional perception of nursing as a \"female caring role\" with the professional demands of healthcare management, it require assertiveness, and leadership, that are often discouraged in women within Pakistan's patriarchal context. These personal concerns were further exacerbated by management issues within the institution during GRS, including the absence of gender-sensitive policies, the unequal distribution of responsibilities. A 2nd year nursing student who was doing her duty in operation theater pharmacy shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eA second-year nursing student, often felt invisible in faculty meetings. When she suggested adding leadership modules for nurses, the committee dismissed her, saying, \u0026ldquo;Your job is patient care, not management (Participant, 23).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e3.3.1 Educational Training in Femininity\u003c/h2\u003e\u003cp\u003eEducational journey of nursing students was strongly shaped by gendered ideals of femininity that emphasized traits such as care, obedience, patience, and emotional sensitivity. These qualities are socially constructed as feminine and expected of women in Pakistani culture. While these attributes helped develop a caring professional identity, students also said this emphasis limited their exposure to leadership, authority, and decision-making skills. This reinforced their role as \"supporters\" rather than leaders in healthcare management. A 4th year nursing student who was doing her duty in ophthalmology ward shared her story that\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eNursing students must have gentle smile during bedside training. Nursing instructors often reminded her, \u0026ldquo;A nurse should nurture a patient, not too bold (Participant, 8).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e3.3.2 Economy Compensated Clinicians\u003c/h2\u003e\u003cp\u003eNurses experienced economic marginalization despite their heavy clinical responsibilities because they perceived themselves as underpaid compared to male doctors. However, perception of nursing as women's work in Pakistan's healthcare sector, is considered undervalued and economically devalued. These structural inequality impacted their financial security and shaped their professional sense of worth, making they question whether their contributions were recognized. A 4th year nursing student who was doing her duty in intensive care unit shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eAfter completing long night and morning shifts, a nurse receive less wage disparity. Despite being clinically skilled, nurses realized that the economy valued her care less, not because of her ability, but because nursing was still seen as \u0026ldquo;women\u0026rsquo;s work (Participant, 9).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003e3.3.3 Silence to Patriarchal Roar\u003c/h2\u003e\u003cp\u003eNormalization of silence in the face of patriarchal dominance, which is a form of social control that perpetuates the status quo and silences those who would challenge it. Nursing student described situations where speaking against male doctors, administrators, or even senior staff was discouraged and seen as \"unfeminine\" or disrespectful. This silence led to feelings of frustration and powerlessness for many, yet it was seen as a necessary adaptation to navigate professional spaces. A 4th year nursing student who was doing her duty in medical ward shared her story that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eNursing student mostly felt invisible in official meetings as it your job is patient care, not management.\u0026rdquo; She realized her institution reinforced gendered hierarchies and female nursing students were subtly socialized to obey (Participant, 24).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003e In present study, we undertook thorough exploration of GRS of student nurses that revealed deep personal concerns regarding professional gender role socialization that shaped self-concept and future career expectations of nursing students. They have expressed their anxiety over the stereotypical framing of nursing as an extension of feminine caregiving rather than a recognized professional skill. This association often caused them to internalize doubt about their competence and question their career longevity.\u003c/p\u003e\u003cp\u003eIn Pakistan, nursing students navigate a dual pressure: aspiring for professional recognition while carrying the weight of gendered expectations tied to their personal identities. The pressure to embody femininity through expected softness, compliance, and emotional labor sometimes conflicted with their desire to assert leadership in healthcare spaces. These findings resonate with earlier research that highlights about gender norms infiltrate professional identities, where women in caregiving professions internalize socially constructed ideals of patience and sacrifice. It involves ignoring one's capacities of intellect or acknowledging an improper person just because of gender identity and devalued professional identity. Foucault (1990) argued that biological differences create cultural influences and operate power relations based on gender identity for a woman within the society and organization.\u003c/p\u003e\u003cp\u003eFrom feministic perspective, these approaches appeal to women as mothers, which reinforces the stereotypical view to maintain the essence of nursing women. Butler (1988) and Le Blanc (2017) referred to gender as a constructed identity that is wholly gained through the performativity of roles. Redefining gender roles in caregiving from motherhood to an innovative profession would improve the quality of healthcare and eliminate disparities in its public image (Stattkus et al., 2025). Besides, gender bias plays a role in these female-dominated fields, which are still dominated by patriarchy, perhaps because typical organizational structures are rooted in patriarchy (Hancock \u0026amp; Hums, 2016).\u003c/p\u003e\u003cp\u003eBeyond personal struggles, student nurses reported frequent societal challenges that reinforced gender role stereotypes. Families, relatives, and community members often undervalued nursing, describing it as a \u0026ldquo;female duty\u0026rdquo; rather than a legitimate profession. Stereotypes and bias can hinder the achievement of diverse results in academic nursing and at all nursing levels (Masibo et al., 2025). Some participants shared experiences of stigma attached to working night shifts, interacting with male colleagues, or handling intimate patient care, all of which were framed as morally questionable in conservative social settings. This not only undermined their confidence but also added emotional stress, as they constantly negotiated between professional obligations and societal judgments. The study results affirms that societal perceptions of nursing reinforce structural inequalities, constraining female nurses\u0026rsquo; agency and professional mobility. Foucault (1970) idea of the microphysics of power described that the knowledge-power complex turn human bodies into objects. These challenges highlight how broader patriarchal discourses shape the social standing of nurses in Pakistan, marginalizing their contribution to healthcare management.\u003c/p\u003e\u003cp\u003eIn clinical management, student nurses encountered systemic management problems that further complicated their gender role socialization. Rotational duties and workload distribution were perceived as unfair, with female nurses more likely to be assigned emotionally intensive care tasks rather than technical responsibilities. Feminism has limelight the gender norms in \"patriarchal\" societies that disempower to women as socially subservient human which proceeded gradually with notions of objectification.\u003c/p\u003e\u003cp\u003eIn educational setting, the lack of formal mentorship and insufficient-sensitive training created barriers in their professional growth. Institutional cultures often normalized gender hierarchies, discouraging nurses from voicing concerns about harassment, workload imbalance, or career advancement. These institutional dynamics not only perpetuated gender marginalization but also hindered the development of confident, skilled nursing professionals (Toreid et al., 2025).\u003c/p\u003e\u003cp\u003eIn Pakistan, government policies often underinvest in nursing leadership and development, thereby institutionalizing a compensated yet subordinate identity for nurses. Nurses are often socialized to be silent in hierarchical systems. The result is a cohort of nursing students trained not only in clinical care but in emotional suppression, conflict avoidance, and deference to authority (Afsin 2025).\u003c/p\u003e\u003cp\u003eThe study demonstrates that student nurses journey through gender role socialization is multi-layered, involving the interplay of personal insecurities, societal stigma, and institutional inequalities. Together, these forces construct a gendered professional identity that both limits and motivates student nurses to challenge stereotypes in healthcare management. The findings align with feminist organizational perspectives that emphasize how management structures reproduce social inequalities, embedding gender hierarchies within healthcare governance.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003e5.1 Theoretical Implication\u003c/h2\u003e\u003cp\u003eFrom the view point of theoretical implication, student nurses added deep concerns about gendered expectations shape their learning, practice, and identity. While many internalized femininities as part of nursing, they also struggled with limited recognition as competent professionals in a healthcare environment dominated by hierarchical and gendered norms. Their narratives highlighted both pride in care-oriented roles and frustration at being undervalued, particularly when their work was framed through cultural stereotypes of women as naturally \u0026ldquo;caring\u0026rdquo; rather than skilled professionals. Nurses consistently encountered societal biases rooted in patriarchy and traditional views of women\u0026rsquo;s roles. They reported stigmatization, limited mobility, and lack of respect, which influenced their confidence and career progression. Gendered socialization often reinforced silence and obedience, restricting their ability to negotiate authority within healthcare teams. These challenges underscored how broader social structures marginalize nursing as \u0026ldquo;women\u0026rsquo;s work,\u0026rdquo; further reinforcing inequalities within healthcare management.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003e5.2 Practical Implication\u003c/h2\u003e\u003cp\u003eIn terms of practical implications, at the institutional level, student nurses faced management practices that perpetuated gender disparities. Issues such as unequal task distribution, lack of supportive mentorship, rigid hierarchies, and absence of gender-sensitive policies reflected systemic gaps. Institutions often reinforced traditional gender roles rather than challenging them, leaving student nurses to navigate professional growth within constraining frameworks. The absence of formal platforms for student voices further deepened feelings of marginalization. Overall, the study concludes that student nurses\u0026rsquo; gender role socialization is not merely an individual experience, but a process shaped by entrenched cultural norms, societal stereotypes, and institutional limitations. Their journeys highlight the urgent need for reforms that integrate gender-sensitive training, equitable management practices, and societal awareness campaigns to uplift the professional identity of nurses in Pakistan. Recognizing nurses as skilled professionals rather than gendered caregivers is essential for building an inclusive healthcare system where their contributions are valued, respected, and empowered.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical Considerations\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eEthics approval was sought from the internal board of review studies, University of the Punjab, Quaid-A-Azam Campus, Lahore. Participants were informed that they could withdraw at any time without penalty. To ensure confidentiality, participant names were replaced by codes throughout the analysis and presentation of the results. Each participant gave written informed consent before data collection, as obtained by the first author.\u0026nbsp;\u003c/p\u003e\u003ch2\u003eConflict of Interest\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no actual or potential conflicts of interest.\u003c/p\u003e\u003ch2\u003eFunding statement\u003c/h2\u003e\u003cp\u003eThis research received no supporting funds from any funding agency in the public, commercial, or not-for-profit sector.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe interviews were part of the PhD thesis conducted by SA. SA conducted data collection and RN worked on data analysis in NVIVO. All authors reviewed the final version of the manuscript. The author(s) read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e\u003cp\u003eThe interviews were part of the PhD thesis conducted by SA. SA conducted data collection and RN worked on data analysis in NVIVO. All authors reviewed the final version of the manuscript. The author(s) read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAca Z, Kırcal-Şahin A, \u0026Ouml;zdemir A, Kaymakcı YS. Gender stereotypes and professional experiences of female nurses in T\u0026uuml;rkiye. Front Public Health. 2025;13:1538517.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAfsin SB. Narratives of good care at hospitals in Turkey: occupational experiences of retired nurses. New Perspectives on Turkey; 2025. pp. 1\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed N, Hafeez A. Nursing and midwifery education in Pakistan: Challenges and the way forward. J Pak Med Assoc. 2019;69(6):867\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli R. Socio-cultural barriers faced by nurses in Pakistan: A qualitative study. Int J Nurs Educ. 2020;12(2):15\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnnandale E. Gender theory and health. Medical Sociology on the Move: Revised Edition including New Directions in Theory. Cham: Springer Nature Switzerland; 2025. pp. 83\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraida N, Cannito M, Camoletto RF. (2025). Masculinities and Caring Occupations: The Gendered Dimension in Nursing Education. Feminismo/s, (46), 119\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhimire A, Qiu Y. Navigating masculinity in nursing: Unpacking the'critical care only'career aspirations of male undergraduate nursing students. Nurse Educ Pract. 2025;84:104332.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraells-Sans A, Galbany‐Estragu\u0026eacute;s P, Rodr\u0026iacute;guez‐Mart\u0026iacute;n D, Gasch‐Gall\u0026eacute;n \u0026Agrave;. Nursing at the Intersection of Power and Practice: A Grounded Theory Analysis of the Profession's Social Position. Journal of Advanced Nursing; 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHellman R. My Professional Journey. Mo Med. 2025;122(3):179\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhan S, Shah BA, Anwar M. Publics Perceptions Regarding the Image and Status of the Nursing Profession in Pakistan. Rev J Neurol Med Sci Rev. 2025;3(1):266\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahmood Q, Shabbir S, Imran A. Power dynamics and hidden curriculum in nursing education in Pakistan: A critical reflection. BMC Nurs. 2022;21(1):141.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasibo RM, Masika GM, Kibusi SM. Gender Stereotypes and Bias in Nursing: A Qualitative Study in Tanzania. Nurs Rep. 2025;15(1):14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMayor-Silva LI, Moreno G, Meneses-Monroy A, Mart\u0026iacute;n-Casas P, Hern\u0026aacute;ndez-Mart\u0026iacute;n MM, Moreno-Pimentel AG, Rodr\u0026iacute;guez-Leal L. (2025, February). Influence of Gender Role on Resilience and Positive Affect in Female Nursing Students: A Cross-Sectional Study. In \u003cem\u003eHealthcare\u003c/em\u003e (Vol. 13, No. 3, p. 336). MDPI.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcDonald T, Brown C, Reedy P. Internalized classism and the professional identity of nurses. J Adv Nurs. 2012;68(3):592\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRattani S, Johns M, Ali S. Postcolonial legacy and class in nursing identity formation: Perspectives from Pakistani nurses. Global Health Action. 2021;14(1):1918923.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRehman T, Naseer M, Asghar Z. Clinical learning environment and power dynamics in nursing education: A qualitative exploration. Nurse Educ Pract. 2023;68:103580.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShahbaz S, Fatima N. Language, appearance, and institutional biases in nursing education: A study of student narratives. Pakistan J Gend Stud. 2020;19(1):71\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSheikh K, Naqvi R. Class and cultural capital in Pakistani nursing schools: A study of private and public sector differences. Asian J Social Sci. 2022;50(2):243\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eToreid HE, Sj\u0026oslash;lie BHM, Bj\u0026oslash;rb\u0026aelig;k SA, K\u0026ouml;hler M. (2025). Digital peer mentoring in higher education: Results from a qualitative study involving digital part-time nursing students. Heliyon, 11(4).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"gender roles, socialization, identity, healthcare management","lastPublishedDoi":"10.21203/rs.3.rs-7796539/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7796539/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn the culturally complex healthcare context of Pakistan, gender role expectations significantly shape the experiences and self-perceptions of nursing students.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis qualitative study analyses how young student nurses internalize gendered roles during their professional socialization in health care system.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eThrough a phenomenological lens, this research employs in-depth interviews with 25 nursing students from 5 major public hospitals of Lahore. This study utilizes NVivo-14 software for inductive thematic analysis to comprehensively analyze the nursing perceptions about their gender role socialization. Theoretical insights from Judith Butler\u0026rsquo;s gender performativity, Foucault\u0026rsquo;s knowledge-power dynamics, and feminist objectification theory frame the findings\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe findings reveal central themes from various perspectives on nursing students\u0026rsquo; journey. Gender role socialization happens from the point of view of personal concerns, societal challenges and institutional management exposure that they experience in public health sector of Lahore. The diversified themes are (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the personal negotiation of \u0026ldquo;becoming an ideal nurse-mother\u0026rdquo; as aspiration following gendered norms (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the social normalization on \u0026ldquo;ethos of good-modest girl\u0026rdquo; provides emotional labor due to societal expectations (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) the education offers scripted \u0026ldquo;femininity of serving lady\u0026rdquo; who avoids confrontation under cover lack of encouragement, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) the health care management demands as \u0026ldquo;economy compensated caregivers\u0026rdquo; placement of nurses as under weak leadership and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) the clinical setting appreciate \u0026ldquo;silence to patriarchal voices\u0026rdquo; under organizational hierarchies, reinforcing a submissive identity.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis research highlights how socialization processes in nursing reinforce gender hierarchies, thus impacting care quality and student retention. The study recommends gender-sensitive reforms in nursing pedagogy and leadership to promote equity, empowerment, and professional dignity in healthcare settings. To the best of authors\u0026rsquo; knowledge, this groundbreaking research describes sole perspective of nursing students from being just a student to qualified nurse.\u003c/p\u003e","manuscriptTitle":"Student Nurses Journey through Gender Role Socialization in Healthcare Management: A Qualitative Exploration in Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 04:38:45","doi":"10.21203/rs.3.rs-7796539/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"07c587a4-906b-4240-b70e-ee2158cc6e11","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-05T10:39:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 04:38:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7796539","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7796539","identity":"rs-7796539","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}