Cross cultural adaptation and psychometric validation of the Persian version of a scale measuring perception of workplace gender discrimination among women nurses

Abstract

Workplace gender discrimination against female nurses is a critical issue requiring evidence-based investigation and documentation. This study aimed to validate the Persian version of the Scale to Measure the Perception of Workplace Gender Discrimination for Female Nurses and ensure its psychometric robustness for clinical and research applications. Employing a cross-sectional methodological design, the study recruited 535 female nurses in Iran through convenience sampling. The Persian translation of the scale was developed in accordance with World Health Organization (WHO) guidelines. Validity and reliability were assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and internal consistency measures. The EFA and CFA confirmed a five-factor structure with 29 items, accounting for 51.029% of the total variance. Model fit was excellent, as indicated by CFI, GFI, TLI, RMSEA, and SRMR values. The scale exhibited acceptable internal consistency, with Cronbach’s alpha and McDonald’s ω coefficients of 0.905 and 0.916, respectively. These findings establish the Persian version of the scale as a valid and reliable instrument, addressing a significant gap in the assessment of workplace gender discrimination for female nurses.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-026-56824-8.

Introduction

Despite decades of legislation aimed at promoting workplace equality, gender discrimination remains a pervasive issue across numerous professions worldwide, with women experiencing fewer opportunities for professional advancement compared to men¹. Notably, the nursing profession, a cornerstone of healthcare systems and crucial for enhancing the quality of care^2,3, stands out as one of the occupations grappling with the highest levels of gender inequality^4,5. Since the establishment of modern nursing by Florence Nightingale in 1860, this profession has been predominantly associated with a female workforce⁶, with women currently constituting approximately 90% of the global nursing workforce^7,8. Consequently, investigating the issue of gender discrimination against women within the nursing workplace is of paramount importance.

Discrimination, in general terms, refers to unfair and differential treatment of an individual or a group, leading to the denial of equal opportunities⁹. Gender discrimination in the workplace specifically involves placing women in unfavorable and subordinate positions solely based on their gender, irrespective of their competencies, skills, or job requirements¹⁰. Gender disparities and various forms of discrimination within the nursing profession are on the rise, evolving into a significant challenge. Research evidence suggests that female nurses perceive men as benefiting from advantages such as higher salaries, greater educational and training opportunities, and faster career progression—benefits often provided without regard to their actual experience or qualifications¹. Understanding these discriminatory practices reveals numerous negative consequences, including increased stress and burnout, diminished job satisfaction, and higher turnover rates¹¹. Given the global shortage of nurses, fostering work environments free from gender discrimination is crucial for retaining competent nurses and promoting job satisfaction⁵, a factor that can indirectly enhance the quality of patient care.

A key element in designing effective interventions to promote gender equality in the nursing workplace is a thorough understanding of female nurses’ experiences and perceptions of gender discrimination. The availability of standardized, comprehensive, and specific instruments capable of scientifically measuring female nurses’ perceptions of workplace discrimination can play a vital role in identifying the type and extent of these inequalities, thereby paving the way for remedial actions. However, a review of various databases indicates a scarcity of existing tools in this area. For instance, ZareKhafri et al. (2022) developed a 33-item questionnaire to examine the perceptions of nurses (both male and female) regarding workplace discrimination in Iran¹². While this instrument explores different dimensions of discrimination in the nursing environment, it was not specifically designed to assess gender discrimination from the perspective of female nurses. Similarly, van der Heever and van der Merwe (2021) in South Africa developed a tool to measure discriminatory behaviors, which did not specifically focus on gender or the perceptions of female nurses¹³. Therefore, the absence of a comprehensive, valid, and specific instrument to assess gender discrimination from the viewpoint of female nurses constitutes a significant research gap in this field.

To address this gap, Gauci et al. (2024) developed the "Perception of Workplace Gender Discrimination for Women in Nursing" scale, a 29-item instrument encompassing five dimensions: primary carer responsibilities, glass escalator, gender stereotypes, gender bias from other women, and unequal standards¹⁴. This instrument, due to its comprehensiveness and specific focus on the perceptions of female nurses, holds significant potential for the scientific assessment of this phenomenon.

The nursing profession in Iran, particularly within a social context characterized by patriarchal features, has also faced numerous challenges related to gender discrimination. Although evidence suggests that Iranian nurses consider discrimination a significant barrier to their inter-professional collaboration¹⁵, and some studies have confirmed the relationship between discrimination and employment status or work experience ¹², no instrument has yet been designed or psychometrically evaluated in Iran to specifically and comprehensively assess female nurses’ perceptions of gender discrimination in the workplace. The lack of such an instrument makes an accurate assessment of this issue difficult and hinders policymakers’ efforts to achieve gender equality in nursing environments. Developing such a tool not only expands existing discussions about women’s leadership in the healthcare workforce but also provides a broader conceptual and linguistic framework for analyzing the phenomenon of gender discrimination in the workplace.

While the "Perception of Workplace Gender Discrimination for Women in Nursing" scale¹⁴ presents a promising option, it was originally developed and validated in Australia—a country with distinct sociocultural norms, healthcare systems, and workplace conditions compared to Iran. As a result, its application in Iran necessitates a rigorous psychometric adaptation process to ensure relevance and accuracy within the Iranian healthcare context. This study, therefore, aimed to translate, culturally adapt, and psychometrically evaluate the "Perception of Workplace Gender Discrimination for Women in Nursing" scale for use in Persian-speaking nursing professionals within Iran’s healthcare system.

Methods

Design

This methodological investigation, conducted from February to May 2025, sought to examine the psychometric properties of the Persian version of the "Perception of Workplace Gender Discrimination for Women in Nursing" scale. The study was executed in two distinct phases. Initially, the original scale underwent translation and cultural adaptation to align with the Persian-speaking context. Subsequently, the psychometric attributes of the adapted instrument.

Study population and setting

The study involved 535-woman nurses working in the clinical setting at university-affiliated teaching hospitals in Kermanshah, Iran. Participants were recruited through convenience sampling, adhering to specific eligibility criteria. For Exploratory Factor Analysis (EFA), sample size recommendations range from 100 to 250 participants or 2 to 20 participants per item¹⁶. Given the scale’s 29 items, a ratio of 11 participants per item was employed, resulting in 330 participants allocated for EFA. For Confirmatory Factor Analysis (CFA), guidelines suggest a sample size of 150 to 500 participants¹⁷, The EFA phase included 330 participants, which then increased to 535 participants for the CFA phase. Too, sample size of 50 to 100 is recommended for test–retest reliability analysis¹⁸.

Eligibility required participants to hold at least a bachelor’s degree, identify as female, and possess a minimum of one year of clinical experience. Informed consent was secured from all participants. Questionnaires exhibiting more than 10% missing data were excluded from analysis¹⁹. Of the 588 distributed questionnaires, 535 valid responses were obtained, yielding a response rate of 90.98%.

Instrument

The perception of workplace gender discrimination was assessed using the "Perception of Workplace Gender Discrimination for Women Nurses" (PWGDWN) scale, originally developed by Gauci et al. (2024) in Australia¹⁴. While the instrument was theoretically conceptualized based on a five-factor framework, Gauci’s final validation identified a four-factor structure due to the empirical convergence of the “Glass Escalator” and “Gender Stereotypes” dimensions. In its validated form, the scale comprises 29 items across four factors: Glass Escalator (12 items), Interpersonal Discrimination (7 items), Primary Carer (6 items), and Gender Bias from Other Women (4 items).

To ensure the structural integrity of the Persian version, we conducted a Confirmatory Factor Analysis (CFA) to compare the original theoretical five-factor model against the statistical four-factor model identified in the source study. Items are scored on a 5-point Likert scale (1 = “strongly disagree” to 5 = “strongly agree”), where higher aggregate scores reflect a more pronounced perception of gender discrimination. The overall scale exhibited a Cronbach’s alpha coefficient of 0.964, with coefficients for the four factors ranging from 0.89 to 0.97, demonstrating robust internal consistency.

Translation procedure

The instrument was translated into Persian following the World Health Organization (WHO) guidelines to ensure conceptual and cultural equivalence²⁰. Initially, two independent translators, both specializing in nursing, translated the original English instrument into Persian. The research team compared these translations with the English original to reconcile discrepancies and create a standardized Persian version. Subsequently, an expert translator, also specializing in nursing but unfamiliar with the original instrument, performed a back-translation of the standardized Persian version into English. The instrument’s developer reviewed the back-translation to confirm that it accurately conveyed the key concepts and terminology. Feedback from this review was incorporated to develop the final Persian version of the instrument. The final version underwent rigorous psychometric evaluation, including validity and reliability testing, using a carefully selected sample of Persian-speaking nurses to ensure its applicability within this population.

Psychometric evaluation

Face validity

To evaluate the face validity, interviews were conducted with fourteen nurses representing diverse clinical backgrounds and levels of experience. This sample size meets Mikkonen et al.'s (2022) recommendation of 10–20 participants for assessing face validity²¹. The nurses reviewed each item for its clarity and level of difficulty, providing suggestions for alternative phrasing where necessary. These recommendations were carefully considered, and appropriate changes were incorporated. The research team subsequently reviewed the feedback and reached a consensus on the final version of the instrument.

Content validity

Content validity was examined through a mixed-methods approach, combining qualitative and quantitative evaluations.

Qualitative assessment

A panel of fourteen experts, comprising nursing educators, managers, and clinical nurses, assessed the scale for grammatical correctness, suitability of terminology, item arrangement, clarity, scoring methods, and cultural appropriateness within the Iranian context.

Quantitative assessment

Quantitatively, the Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated. For the CVR, experts rated each item’s necessity on a three-point Likert scale ranging from “not necessary” to “necessary”^22,23. Results were compared to Lawshe’s table, which specifies a minimum acceptable CVR of 0.51 for a panel of 14 experts (Lawshe, 1975)²³. For the CVI, experts evaluated item relevance on a four-point Likert scale from “not relevant” to “very relevant.” The Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI/Ave) were computed, with acceptable thresholds set at 0.78 and 0.90, respectively^24,25.

Construct validity

The construct validity of the Persian version of the instrument was assessed using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Prior to factor analysis, the Kaiser–Meyer–Olkin (KMO) measure and Bartlett’s test of sphericity were conducted to determine data suitability. A KMO value exceeding 0.7 and a significant Bartlett’s test (p < 0.05) indicate that the data are appropriate for factor analysis (KMO Test)^26,27.

Exploratory factor analysis

EFA was performed using the Maximum Likelihood method with Promax rotation to explore the underlying relationships among items²⁸. Acceptable criteria included a total variance explained exceeding 40%, eigenvalues greater than 1^29,30, factor loadings above 0.5, and communalities of at least 0.30 ³¹.

Confirmatory factor analysis

CFA was employed to validate the factor structure identified through EFA. Model fit was assessed using multiple indices: a chi-square to degrees of freedom ratio (χ²/df) less than 3, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Incremental Fit Index (IFI) all greater than 0.9, and Root Mean Square Error of Approximation (RMSEA) less than 0.08^32,33. Factor loadings greater than 0.3 and T-values exceeding 1.96 were considered acceptable and statistically significant³⁴.

Reliability assessment

Reliability was evaluated using the test–retest method, where the questionnaire was administered twice to a subsample of 52 participants with a 10- to 14-day interval³⁵. The reliability coefficients were categorized as follows: below 0.5 (poor), 0.5–0.75 (moderate), 0.75–0.9 (good), and above 0.9 (excellent)³⁶. Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega coefficients, with values exceeding 0.70 indicating acceptable consistency³⁶.

Data analysis

Data were analyzed using SPSS version 27 and LISREL version 8. Descriptive statistics were used to summarize participant demographics. The Waltz & Bausell index was employed to assess quantitative content validity. Construct validity was evaluated through EFA and CFA, with statistical significance set at p < 0.05. Reliability was determined using Cronbach’s alpha, McDonald’s omega, and test–retest methods to assess stability over time.

Data collection

Following approval from hospital authorities, participants were recruited via convenience sampling based on the study’s inclusion criteria. Informed consent was obtained, and questionnaires were distributed in sealed envelopes at nursing stations across various shifts. Participants completed the questionnaires independently to ensure accurate self-reporting and minimize bias. Participation was voluntary, with 535 completed questionnaires included in the final analysis.

Results

Descriptive results

For the EFA phase, 330 nurses participated, with a mean age of 30.43 years (SD = 5.65, range 24–51). Of these, 46.4% were married, with an average experience of 6.14 years (SD = 5.32), and 89.7% held a bachelor’s degree (Table 1). For the CFA phase, 535 nurses were included, with a mean age of 30.71 years (SD = 5.31, range 24–51). Of these, 53.6% were single, with an average experience of 6.41 years (SD = 4.99), and 88.4% held a bachelor’s degree (Table 1).

Table 1.

Demographic characteristics of participants in the study.

Variables	N (%)
	EFA (330)	CFA (535)
Age (years)	30.43 ± 5.65	30.71 ± 5.31
Working history (years)	6.14 ± 5.32	6.41 ± 4.99
Marital Status
Single	177 (53.6)	287 (53.6)
Married	153 (46.4)	248 (46.4)
Educational level
BSc	296 (89.7)	473 (88.4)
MSc	34 (10.3)	62 (11.6)
Employment Statue
Official employment	212(64.2)	336 (62.8)
Contract employment	118 (35.8)	199 (37.2)
Working unit
Medical-Surgical ward	115 (34.8)	184 (34.4)
Critical care	88 (26.7)	153 (28.6)
Emergency	67 (50.3)	105 (19.6)
Pediatric	60 (18.2)	93 (17.4)

Face validity

Feedback from fourteen clinical nurses suggested minor revisions to enhance the clarity and relevance of certain items. After careful review, all items were retained, as they were deemed essential for assessing the target population.

Content validity

Qualitative analysis identified the need for minor revisions to items 9 and 17 to improve clarity and comprehensibility. Following these revisions, an expert review confirmed the suitability of all items. Quantitatively, the CVR was 0.88, within the acceptable range of 0.71 to 1. All I-CVIs exceeded 0.86, and the S-CVI was 0.95, indicating strong content validity for all 29 items.

Construct validity

The KMO value was 0.92, and Bartlett’s test of sphericity was significant (χ² = 4496.044, p < 0.001), confirming data suitability for factor analysis. EFA revealed a five-factor solution, with all items loading above 0.50 on their respective factors, communalities exceeding 0.459, eigenvalues greater than 1, and a total variance explained of 59.275% (Table 2). The scree plot supported this five-factor structure (Figs. 1, 2).

Table 2.

Item factor loadings from exploratory factor analysis of the measure the perception of workplace gender discrimination for women in nursing scale.

Factors	Items	Mean (sd)*	Factors					Communality
			1	2	3	4	5
Factor 2 Primary carrier responsibilities	Q1	3.68(0.94)	0.053	0.573	0.256	0.194	0.344	0.344
	Q2	3.22(1.07)	0.139	0.739	0.285	0.377	0.561	0.561
	Q3	3.20(1.12)	− 0.010	0.727	0.202	0.275	0.556	0.556
	Q4	3.23(1.12)	0.232	0.704	0.311	0.293	0.507	0.507
	Q5	3.43(1.16)	0.282	0.653	0.252	0.226	0.457	0.457
	Q6	3.19(1.14)	0.230	0.683	0.232	0.369	0.493	0.493
	Q7	3.22(1.14)	0.177	0.658	0.281	0.338	0.444	0.444
Factor3 Glass Escalator	Q8	3.35(1.17)	0.304	0.362	0.667	0.381	0.487	0.487
	Q9	3.52(1.13)	0.221	0.407	0.741	0.384	0.593	0.593
	Q10	3.45(1.14)	0.299	0.244	0.767	0.343	0.594	0.594
	Q11	3.36(1.14)	0.401	0.244	0.765	0.274	0.596	0.596
	Q12	3.36(1.16)	0.400	0.189	0.772	0.300	0.609	0.609
	Q13	3.41(1.13)	0.451	0.292	0.725	0.238	0.558	0.558
Factor1 Gender stereotype	Q14	3.42(1.15)	0.634	0.238	0.501	0.280	0.479	0.479
	Q15	3.35(1.11)	0.702	0.253	0.517	0.399	0.587	0.587
	Q16	3.36(1.11)	0.643	0.353	0.452	0.325	0.492	0.492
	Q17	3.23(1.09)	0.570	0.383	0.448	0.433	0.475	0.475
	Q18	3.28(1.12)	0.605	0.313	0.443	0.371	0.453	0.453
Factor5 Gender bias from women	Q19	3.32(1.14)	0.342	0.350	0.381	0.396	0.396	0.396
	Q20	3.39(1.11)	0.357	0.323	0.324	0.298	0.381	0.381
	Q21	3.42(1.16)	0.207	0.366	0.367	0.420	0.579	0.579
	Q22	3.39(1.15)	0.341	0.295	0.324	0.313	0.691	0.691
	Q23	3.28(1.14)	0.109	0.389	0.332	0.474	0.580	0.580
Factor4 Unequal standards	Q24	3.33(1.12)	0.257	0.328	0.291	0.594	0.404	0.404
	Q25	3.26(1.10)	0.083	0.417	0.346	0.716	0.557	0.557
	Q26	3.22(1.22)	0.184	0.337	0.402	0.801	0.668	0.668
	Q27	3.26(1.12)	0.324	0.225	0.370	0.634	0.442	0.442
	Q28	3.13(1.08)	0.144	0.275	0.201	0.606	0.371	0.371
	Q29	3.27(1.26)	0.204	0.258	0.269	0.664	0.445	0.445
Eigenvalue			9.121	2.155	1.522	1.143	1.08
Percentage of the Variance (%)			31.451	7.430	5.248	3.942	2.958

* The mean and deviation of each item’s score.

Fig. 1.

Scree plot of the extracted components of the persian version of the measure the perception of workplace gender discrimination for women in nursing scale.

Fig. 2.

Final measurement model of the persian version of the measure the perception of workplace gender discrimination for women in nursing scale.

The CFA results confirmed the five -factor structure identified through EFA, with fit indices indicating an acceptable fit: χ² = 1073, p = 0.0001, RMSEA = 0.06, NNFI/TLI = 0.97, CFI = 0.97, GFI = 0.96, SRMR = 0.049, df = 367, χ²/df = 2.94. Pearson’s correlation analysis demonstrated significant and positive relationships between the subscales and the overall scale score (Table 3). All first and second-order factor loadings were statistically significant at the 95% confidence level (|Tvalue|> 1.96). Table 4 presents the Lambda coefficient, which represents the standardized factor loadings for each factor. All standardized factor loads exceed the recommended critical value of 0.30 (range = 0.41 ~ 0.77), indicating a good fit between the model and the data.

Table 3.

The Correlations between the Measure the Perception of Workplace Gender Discrimination for Women in Nursing Scale and sub-scales.

Factor	1	2	3	4	5	Total Scale
F1. Gender stereotype	1
F. 2 Primary carer responsibilities	0.432**	1
F. 3 Glass Escalator	0.477**	0.469**	1
F. 4 Unequal standards	0.514**	0.504**	0.562**	1
F5. Gender bias from women	0.589**	0.422**	0.469**	0.529**	1
Total Scale	0.784**	0.753**	0.775**	0.793**	0.756**	1

**P < 0.01.

Correlations represent latent factor correlation estimates derived from the CFA model. All correlations were statistically significant at p < 0.01.

Table 4.

T-value, pearson correlation coefficient, factor loadings, mcdonald’s ω, and cronbach’s alpha of the persian version of the educational leadership scale for nursing students. (N = 535)

Factor	No	valuea t	b(λ)	R c	Test-retest (N = 87)	Cronbach Alpha	Macdonald Omega
Factor 2 Primary carer responsibilities	Q1	13.38	0.57***	0.47**	0.761	0.759	0.819
	Q2	11.89	0.52***	0.44**
	Q3	18.68	0.74***	0.57**
	Q4	18.02	0.72***	0.60**
	Q5	17.18	0.70***	0.58**
	Q6	16.88	0.69***	0.58**
	Q7	9.62	0.43***	0.40**
F. 3 Glass Escalator	Q8	11.48	0.50***	0.49**	0.823	0.789	0.832
	Q9	16.15	0.66***	0.60**
	Q10	18.62	0.73***	0.61**
	Q11	18.51	0.73***	0.58**
	Q12	19.69	0.76***	0.62**
	Q13	17.89	0.71***	0.60**
Factor1 Gender stereotype	Q14	15.29	0.65***	0.54**	0.808	0.711	0.733
	Q15	18.93	0.76***	0.67**
	Q16	11.00	0.49***	0.44**
	Q17	12.09	0.53***	0.50**
	Q18	13.84	0.60***	0.53**
Factor5 Gender bias from women	Q19	15.65	0.65***	0.61**	0.738	0.785	0.803
	Q20	14.02	0.59***	0.54**
	Q21	18.34	0.73***	0.63**
	Q22	17.67	0.71***	0.60**
	Q23	16.60	0.68***	0.59**
F. 4 Unequal standards	Q24	14.99	0.63***	0.58**	0.755	0.758	0.785
	Q25	12.00	0.52***	0.47**
	Q26	19.64	0.77***	0.65**
	Q27	16.62	0.68***	0.60**
	Q28	9.22	0.41***	0.36**
	Q29	15.21	0.64***	0.55**
The Measure the Perception of Workplace Gender Discrimination for Women in Nursing Scale.					0.824	0.905	0.916

***P < 0.001; **P < 0.01; * P < 0.05.

^aThe calculated values of all factor loadings, both first-order and second-order, exceed 1.96, indicating statistical significance at the 95% confidence level . ^bThe specific value, represented by the Lambda coefficient (λ), is calculated as the sum of the factor loadings for all variables associated with that factor. ^c Pearson Correlation Coefficient.

Reliability

The scale demonstrated strong internal consistency, with a Cronbach’s alpha of 0.905 and McDonald’s omega of 0.916 (Table 4). Test–retest reliability was 0.824, indicating good stability over time.

Discussion

In the present study, the tool developed by Gauci et al. (2024) underwent a process of translation and cultural psychometric evaluation into Persian within the context of Iran. Through this process, the instrument was ultimately psychometrically validated, yielding a structure comprising 5 factors and 29 items from a cultural perspective. These factors were identified as Gender Stereotype (5 items), Primary Carer Responsibilities (7 items), Glass Escalator (6 items), Unequal Standards (6 items), and Gender Bias from Women (5 items). The Content Validity Ratio (CVR) and Scale-Level Content Validity Index (S-CVI) were calculated as 0.88 and 0.95, respectively. These values substantiate the content validity of the tool and demonstrate that the "Perception of Workplace Gender Discrimination for Women in Nursing—PWGDWN" scale is distinctly capable of assessing perceptions of workplace gender discrimination among women in nursing.

The variance explained by these five factors amounted to 51.03%, with model fit indices indicating satisfactory conditions. In the study by Gauci et al. (2024), the determination of dimensions and generation of items for the PWGDWN tool relied on two comprehensive and in-depth literature reviews^1,4 and a qualitative study³⁷. Additionally, both inductive and deductive reasoning methods were employed to develop the tool’s items. This process identified five dimensions: Primary Carer Responsibilities, Glass Escalator, Gender Stereotypes, Gender Bias from Other Women, and Unequal Standards. However, during the exploratory factor analysis (EFA) phase, the dimensions Glass Escalator and Gender Stereotypes were merged into a single factor labeled Glass Escalator. Furthermore, all items pertaining to Unequal Standards and one item (item 23) from Gender Bias from Other Women were reclassified under a factor termed Interpersonal Discrimination. The variance explained by these four factors reached 71.27%¹⁴. It is noteworthy that the Persian version of the "Perception of Workplace Gender Discrimination for Women in Nursing—PWGDWN" aligns with the dimensions derived from the conceptualization of the original tool¹⁴.

In addition to exploratory factor analysis, the present study conducted confirmatory factor analysis, the results of which confirmed the five-factor structure within the studied sample. During this process, each item loaded onto its presumed component. Fit indices for the tool were computed, and their values indicated a good model fit, suggesting a coherent relationship between the items and dimensions³⁸.

Given that each country possesses its own unique cultural and social contexts, these factors can influence how individuals perceive and experience concepts related to gender and discrimination. For instance, gender discrimination may be more overt in one culture, whereas it might be less perceptible in another. Moreover, gender roles and social expectations vary across nations, potentially affecting how individuals respond to the tool. In Gauci’s Australian study ¹⁴, the “Glass Escalator” and “Gender Stereotypes” dimensions merged into a single factor. This suggests that in some Western professional contexts, the psychological perception of stereotypes is inextricably linked to the structural phenomenon of rapid male promotion. However, our findings in Iran suggest these remains distinct constructs. This may be attributed to cultural nuances in the Iranian healthcare system, where gender-based societal expectations (stereotypes) are perceived as a separate barrier from the organizational mechanisms that facilitate the “glass escalator” for male nurses. Generally, the differences in extracted factors between the Persian and English versions of the tool arise from a combination of cultural and social influences. These disparities can enhance the understanding of gender discrimination in both contexts and enable researchers to optimize the tool to meet the specific needs of each culture.

Among the components examined in this study, the Gender Stereotype factor accounted for the largest proportion of variance explained by the entire tool, contributing 31.45% to the total variance. This substantial share underscores the critical importance of gender stereotypes in shaping perceptions of workplace gender discrimination among female nurses. Comprising 5 items, this factor addresses a phenomenon tied to traditional gender role expectations and stereotypical perceptions of men and women. These stereotypes are typically fixed and encompass generalizations about the traits and capabilities of women and men. Within nursing, a common assumption prevails that male nurses are better suited for leadership positions and advanced activities than their female counterparts^39,40. This viewpoint stems from misconceptions regarding women’s abilities and can lead to disparities in job opportunities. Supervisors and leaders may assume that male nurses exhibit greater interest in leadership, potentially overlooking the inclinations and competencies of female nurses³⁷. Additionally, male nurses are often regarded as possessing superior skills and greater technological proficiency^40,41.Such beliefs can foster a discriminatory environment, adversely impacting women’s career opportunities. Addressing these challenges requires raising awareness about gender stereotypes and fostering a collaborative culture among all employees, irrespective of gender.

The second factor, Primary Carer Responsibilities, accounted for 7.43% of the total variance, securing its position as the second most significant factor in assessing perceived workplace gender discrimination among female nurses. This factor, consisting of 7 items, focuses on responsibilities related to pregnancy, family caregiving, and reduced working hours due to these duties. Female nurses face constraints in accessing training programs, personal skill development, and new job opportunities as a result of these caregiving responsibilities. Supervisors may assume that female nurses, upon returning from maternity leave, lack interest in career progression due to familial caregiving obligations and reduced work hours^42,43. Male nurses, who are less likely to experience career interruptions from caregiving, are often preferred for managerial and supervisory roles^37,43.This preference can result in the neglect of female nurses’ abilities, skills, and aspirations, leading them to feel that they have lost career opportunities. Overall, caregiving responsibilities not only negatively affect the professional lives of female nurses but can also contribute to deeper workplace inequalities. To establish a more equitable work environment, shifts in attitudes and organizational policies are essential to fully harness the talents and capabilities of female nurses.

The third factor, Glass Escalator, describes a phenomenon wherein men in predominantly female professions ascend to managerial and leadership positions more rapidly than women. This factor focuses on several items, including men receiving promotions despite less experience and competence, mutual support among men, the belief in men’s suitability for leadership roles, men’s perceived superiority in clinical and technological skills, and a greater inclination toward leadership among men compared to women. Male nurses receive significantly more opportunities for professional development than female nurses, with greater incentives provided for them to assume leadership positions and advanced nursing activities^6,40. These selections clearly expose biases embedded in hiring and promotion processes. Male nurses in managerial and leadership roles may offer each other greater support⁴¹, which can reinforce their leadership positions within nursing and facilitate their advancement to higher ranks. The Glass Escalator phenomenon vividly illustrates the significant challenges faced by female nurses. Addressing these challenges necessitates structural and cultural changes in the workplace to ensure equal opportunities for all employees.

The fourth factor, Unequal Standards, encompasses items that examine workplace structures, practices, and interaction patterns that favor men. These inequalities exert adverse effects on female nurses. Studies indicate that male nurses are less likely to be reprimanded for mistakes compared to female nurses^6,37, potentially leading to an unequal work environment where men feel more secure and their errors are readily overlooked. Furthermore, the contributions of female nurses to patient care are not valued by multidisciplinary teams to the same extent as those of male nurses, which can diminish female nurses’ confidence and motivation while reinforcing feelings of being disregarded⁴⁴. Interactions in the workplace with male nurses are conducted with greater respect than those with female nurses, a behavior that can perpetuate gender discrimination and feelings of injustice^37,44.Additionally, male nurses are afforded more opportunities to perform complex procedures compared to female nurses⁴⁰, which can result in disparities in skill development and career advancement for women. Ultimately, unequal standards in the workplace can profoundly impact female nurses and contribute to gender discrimination. To foster a fair and equitable work environment, organizations must review and revise these standards, creating a space where all employees, regardless of gender, are equally recognized and respected.

The fifth factor, Gender Bias from Women, examines discriminatory behaviors against women in the workplace perpetrated by other women. Research reveals that female leaders are more inclined to allocate job promotions to male nurses rather than female nurses, indicating the presence of erroneous biases and gender inequalities even among women^37,45.This behavior can lead to feelings of inadequacy and job dissatisfaction among female nurses, limiting their career advancement opportunities. Additionally, female leaders typically offer less criticism of male nurses compared to female nurses and establish friendlier relationships with them⁶. These disparities can intensify feelings of injustice and being overlooked among female nurses. Moreover, female nurses often fail to provide adequate support to one another, particularly in situations requiring flexible scheduling, and this lack of support can foster a competitive and unequal culture among women^37,46. To create a fair and supportive work environment, it is imperative that women assist each other and prioritize collaboration and support over competition.

The reliability of the tool in this study was evaluated using Cronbach’s alpha, McDonald’s omega coefficient, and test–retest reliability, yielding values of 0.905, 0.916, and 0.824, respectively, which were deemed acceptable. Consistent with these findings, Gauci et al. (2024) reported a Cronbach’s alpha of 0.964 for the entire tool. Collectively, these results affirm that the Persian version of the "Perception of Workplace Gender Discrimination for Women in Nursing—PWGDWN" is a reliable instrument for assessing perceptions of workplace gender discrimination among female nurses.

Limitations of the study

This study employed a cross-sectional design and convenience sampling to examine the psychometric properties of the "Perception of Workplace Gender Discrimination for Women in Nursing—PWGDWN" among nurses working in western Iran. Consequently, the findings are generalizable only to the studied population and may not extend to other settings or nursing populations due to differences in cultural, organizational, and professional contexts. Furthermore, it should be noted that the PWGDWN is a self-report tool, with assessments based on participants’ own perceptions and interpretations. Differing work and cultural conditions may influence responses to the questions, potentially altering the validity and reliability of the results. The tool’s validity was assessed through content validity and construct validity; however, criterion validity, including concurrent and predictive validity, was not examined. It is recommended that future research evaluate the applicability of the PWGDWN in diverse cultural contexts and countries to further validate and adapt the tool for measuring perceptions of workplace gender discrimination across a broader range of nurses.

Conclusion

In this study, a valid and reliable tool, tailored to the cultural context of Iran, was psychometrically evaluated for assessing perceptions of workplace gender discrimination in nursing. By focusing on identifying the dimensions of perceived gender discrimination in the workplace for female nurses, this tool offers a comprehensive perspective on its various facets. Examining female nurses’ perceptions of gender discrimination within a predominantly female profession is essential for promoting interventions aimed at enhancing workplace gender equality. The PWGDWN can serve as a comprehensive instrument for evaluating the dimensions of perceived workplace gender discrimination among female nurses and for developing and designing cultural and organizational programs based on its indicators. Additionally, researchers and research managers can utilize this tool to advance studies related to gender discrimination in nursing and enhance its various aspects in accordance with their specific contexts.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

CVI

Content validity index

CVR

Content validity ratio

KMO

Kaiser Meyer Olkin

EFA

Exploratory factor analysis

CFA

Confirmatory factor analysis

TLI

Tucker-Lewis index

NFI

Normed fit index

GFI

Goodness of fit index

RMSEA

Root mean square error of approximation

PC

Principal components

SRMR

Standardized root mean square residual

KUMS

Kermanshah University of Medical Sciences

Author contributions

All authors participated and approved the study design. KH, M; A, SH and A, J contributed to designing the study. K, M; K, B; J, K; L, M and B, S collected the data, and data analyses were done by A, J. The final report and article were written by A, J; KH, M; K, M; K, B; J, K; L, M and B, S and all authors read and approved the final manuscript.

Funding

This study was funded by the Kermanshah University of Medical Sciences in Iran.

Data availability

The data analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study received ethical approval from the Ethics Committee of Kermanshah University of Medical Sciences (Ethics Code: IR.KUMS.REC. 1403.545). Written permission was obtained from the scale’s developer, and all participants provided written informed consent. The research adhered to the ethical principles outlined in the Declaration of Helsinki and complied with all relevant guidelines.

Consent for publication

Not applicable.

Clinical trial number

Not applicable.