Introduction
Although the progression of men into nursing has increased over the past decade, men still constitute a small minority of the nursing population in Canada and the United States. Nursing remains one of the most female-dominated occupations. In 1996, there were 2,588,873 registered nurses in the United States; 4.9% of these were men. Nowadays men comprise only 5.4per cent of the 2,694,540 licensed registered nurses (RNs) in The United States (Anthony, 2004). To most Americans, this figure is not surprising. Many would even say it is appropriate, because women are more “naturally suited” to the profession. Indeed, one-third of male and female nursing students in one study agreed that women were superior to men in their natural aptitude for nursing (Anthony, 2004). Yet a review of the historical evidence shows that the first nurses were, in fact, male.
It is worth noting that women have been moving into previously male-dominated professions, particularly medicine, dentistry, law, business, and pharmacy. The movement of men into nursing, however, has been slow (MacPhail, 1996). Women have been given support to make inroads into male-dominated professions, but little attention and support have been given to men to break into professions dominated by women. Nursing programs have given little consideration to attracting and retaining men in nursing.
Forefathers
Historically, and even today, nursing is considered a single-sex occupation, identified as a role that is inherently natural to the female gender. Thus, it has become identified as a profession deeply embedded in the gender-based power relations of society. Nursing is an occupation established by women; it supports the stereotypical “feminine” image with traits of nurturing, caring, and gentleness in contrast to masculine characteristics of strength, aggression, and dominance (Evans, 2002). For this reason, occupations requiring these qualities have been considered exclusively suited to women, and labeled “women’s work.”
However, the art and science of nursing has not always been a predominantly female profession (Evans, 2004). Men have played a dominant role in organied nursing dating back to 330 A.D. in the Byzantine Empire. During this era, hospitals were one of the major institutions where nursing emerged as a separate occupation, primarily for men. Moreover, military, religious, and lay orders of men known as nurses have a long history of caring for the sick and injured during the Crusades in the llth century (MacPhail, 1996). In the United States, men served as nurses during the Civil War. John Simon, the lesser-known rival of Florence Nightingale, was the founder of an experimental field hospital in Germany during the Franco-Prussian War (1870-1871). Male nurses were hired to staff the hospital, and mortality rates among the troops were kept abnormally low (Evans, 2004). Unfortunately, men were not accepted readily in nursing schools for many years. Interestingly, in 1888, Darius Odgen Mills established the first male nursing school in America, based at Bellevue Hospital in New York City. This school of nursing provided education and training for nurses to care for psychiatric patients. However, it appears that this men’s contribution to nursing has been forgotten. This nonrecognition has likewise perpetuated the feminine image of nursing in society and the perception of the male nurse as an anomaly
Generally, nursing as we know it today came to be regarded as a woman’s profession through the efforts initiated and developed by Florence Nightingale during the 19th century. She saw nursing as suitable for women because it was an extension of their domestic role. It was assumed that it was natural for women to become nurses because of their innate caregiving and healing traits; nursing was not a place for men. At that time, more and more women entered the profession of nursing. Nightingale’s image of the nurse as subordinate, nurturing, domestic, humble, and self-sacrificing, as well as not too educated, became prevalent in society. The ostracization of men in nursing was established.
Public Perception
According to several authors, one major barrier that may deter men from entering the profession is nursing’s traditional image. Nursing’s image perpetuates cultural understandings and societal attitudes about occupations appropriate for men and women. As such, nursing remains stereotyped as a female occupation. After all, gender-role socialization patterns in society provide examples of ways in which boys and girls are exposed to different role models and different me sages about what is appropriate to each gender. Society has presented men with strong stereotypical boundaries concerning masculine or feminine behavior. Men who choose nursing as a career risk challenging traditional gender-defined roles and stereotypes (Evans, 2002; Nelson & Belcher, 2006).
These stereotypes-enhanced by social, political, and economic systems-often lead to discrimination for men choosing careers outside their gender. Males appear to encounter more negative criticism from the public on entering female-identified occupations. For example, they are “held suspect” and penalized for role violation. Furthermore, these traditionally female jobs are perceived by society as a step down in status (Williams, 1992). Accordingly, these beliefs deter men from pursuing nontraditional careers.
It is troublesome for some to accept the image of men as caring, compassionate, and gentle. Men wanting to enter the female-identified occupation challenge society’s stereotypical image of nursing. Some scholars have argued that caring and nurturing traits are not exclusive to women.
These traits, however, are not inherent in the biological and social nature of the sexes, but are cultural constructs reinforced by the social activities associated with being male or female. Evans (2004) maintains that gender and politics have influenced how the responsibility for caring activities has been settled exclusively on women. Actually, this appropriation has influenced how the division of labor is postulated along gender lines, meaning that occupations are socially or culturally defined through constructions of gender.
Thus, because one’s identity is linked to the sex/gender system in society, it is difficult to rethink the concept of masculinity. As such, men in or aspiring to female-dominated professions are evaluated less positively by society than their female colleagues in male-dominated occupations (Williams, 1992). These views restrict career choice and sustain societal stereotypes, inhibiting men from entering the nursing profession.
Nursing Images
The traditional image of the nurse has been supported through the use of symbols such as the angel, battle-ax, sex symbol, or doctor’s handmaiden, and, most notably, nurses as women. These images, based on female attributes and values, have been used by interpersonal and mass communication, reinforcing the stereotypes of nurses as women. These behaviors and attitudes are further strengthened by the exclusion of men in any recruitment and promotional materials depicting the profession of nursing.
Evans (2004) argues for a shift away from the womanly traits associated with the “old” Nightingale image of the nurse, the basis for the feminine stereotype of nursing that is still evident today. When the nurse is a man, societal images of the caregiver role are not associated with the gender. For example, Williams (1995) conducted in-depth interviews with 32 men employed in nursing. One nurse reported that a teacher at a day-care center told his daughter that her father could not be a nurse, and insisted that he must be a doctor. Thus, nursing has been socially constructed as an occupation requiring gender traits that are associated with “feminine,” regardless of the sex of its individual members.
In a study of 126 male high school students using a career questionnaire, Barkley and Kohler (1992) investigated opinions about nursing. The teenagers surveyed held a positive view of men in nursing. Seventy-three percent rejected the idea that only women should be nurses, and 77% thought that male nurses are not wimps. Evans (2002) surveyed 25 male nurses to investigate the perceptions of being a male nurse. The most prevalent negative factor identified was sex stereotyping resulting from the general perception that nursing is a female profession. According to Kleinman (2004), language and images are dominant forces, which may have the effect of marginalizing any group. Subsequently, for centuries men in nursing have been excluded from the language and image of nursing, therefore from its history. As such, he believes nursing practice has been sexualized. It could be argued that the label of nursing as women’s work is a significant deterrent that inhibits recruitment of men into the profession and aids promotion of the sex imbalance in the nursing workforce. Because of their gender, male nurses have been prohibited from working in specific clinical areas, such as maternal/infant child care. These beliefs have been supported by court decisions; however, there are no restrictions on the practice of female nurses with male patients. These attitudes tend to succor sexism in the profession, affecting the recruitment of men.
Williams (1992) claims that cultural barriers are more pronounced in the media’s representation of men’s occupations. She contends that women in traditionally male professions have achieved acceptance on popular television programs. Today, women are portrayed as doctors, lawyers, and architects, but where are the male nurses, teachers, and secretaries? These beliefs are reinforced by language used in nursing. Women in nursing are simply nurses, not “female nurses”; however, men in nursing are frequently identified as “male nurses.” These images, perceptions, and language influence societal views of the nurse. This, too, leads to the marginalization of men nurses and fortification of negative stereotypes.
Kleinman (2004) stated that the work belongs to neither sex. By excluding males, such messages constitute a critical barrier to men considering nursing as a career. This fact is reflected in the invisibility of men in the profession. This is demonstrated in the example of a 1997 photo feature called ‘Nurses at the Bedside” in the American Journal of Nursing. Of the 15 pictures of the nurse caring and working with clients, none shows a man. This assessment substantiates the invisibility of men’s contributions and visibility in the profession. Moreover, such findings nourish society’s stereotypical image of nursing as a feminine occupation, negatively affecting recruitment of men into the profession. According to Evans (2002), “The hope for change lies in challenging and transforming hegemonic notions of masculinity and femininity” (p. 230).
Sex-Related Stereotypes
Another commonly held stereotype concerning men who choose nursing as a career is that they are effeminate or gay (Williams, 1995). According to Williams, it is assumed by society that in order to be a nurse, female attributes such as a capacity to serve, empathize, and nurture are required. Hence, men who nurse must be “feminine” and are regarded as gay. Although there are a number of gay men in the profession, this stereotype forms a major obstacle to many heterosexual men who might otherwise consider pursuing a career in nursing (Nelson & Belcher, 2006; Trossman, 2003).
Williams (1992) also suggests that the stigma associated with homosexuality leads some men to enhance or magnify their “masculine” qualities. Using focus groups, Williams (1995) investigated the experience of being a male student nurse. All participants reported that nursing is viewed as a women’s profession, and several stated a fear of being perceived as unmanly by their peers or by clients. These beliefs fostered among the men a view that the profession is a threat to their masculinity. Subsequently, these men felt a need to show their wedding ring or to mention their wife and children in order to acknowledge their heterosexuality. In addition, the labeling of male nurses as effeminate or homosexual can be interpreted as a social control mechanism that redefines nursing as woman’s work. This signifies that male nurses are different from other men. Consequently, as a result of these attitudes and perceptions, one can understand why nursing remains an occupation low on career choice for males.
Economic Factors
Another factor suggested as contributing to men’s underrepresentation in nursing is the low economic status, pay, and value given to nursing in comparison to male occupations (Kleinman, 2004). Overall, social and economic inducements for women to enter male-dominated professions are lacking for men who may contemplate careers in female-dominated areas. Moreover, he believes that current cutbacks in healthcare funding may deter some men who might otherwise have considered a nursing career.
Historically, nursing is considered to be a natural extension of a woman’s role in society. As a result of this notion, it is considered a low-value occupation (Williams, 1992). It is well known that the average income of men is well above that of women. Accordingly, these findings support the view that jobs customarily held by women are devalued. Williams (1995) argues that the economic value of other major disciplines and that of nurses reinforces the limited value attached to the role of the nurse. Consequently, the separation, isolation, and labeling of certain roles as women’s or men’s roles in both traditional and modern society reflect the patriarchal social structure.
Barkley and Kohler (1992) administered a career questionnaire to 126 male high school students, grades 9 to 12. Findings indicated that most rejected nursing as a future career because of their beliefs about nurs& economic status. Sixty-two percent of the subjects surveyed did not think that nurses made high salaries, and 46% believed that nurses do not get paid well. These researchers concluded that in order for nursing to compete financially with other male-dominated professions, salary discrepancies need to be changed. In spite of changes in nursing education today, in practice, social attitudes valuing men’s work over women’s work are still apparent (Kleinman, 2004). Traditionally, the female role has a lower value in society, thus the importance of a nurses value is not reflected by economic rewards. These resilient attitudes have been reinforced through gender socialization, leading to less status and power for nurses within society.
In a similar study, using in-depth interviews, Williams (1992) examined the barriers to men’s entry into three female-dominated professions: social work, nursing, and teaching. Participants felt they were all underpaid relative to comparable “male” occupations. Moreover, several of the respondents suggested that instituting a comparable-worth policy might attract more men to these professions. Even so, nursing is still recognized as a female profession, and, in general, women’s roles in society continue to be less valued as reflected in social status and financial compensation.
Future directions
How would nursing look today if it had remained a male-dominated profession? Would nursing enjoy greater prestige, power and status than it receives today? How would nursing practice and education differ? Would there have been a revolution in the profession as more and more females entered nursing, as they have in other traditionally male-dominated professions?
Strategies to Recruit More Men to the Profession Currently, the realities of healthcare cutbacks have had a negative impact on the nursing profession. As a result, nursing education programs are attracting fewer students. Admission levels are now lower than they have been in decades (Trossman, 2003). These facts may provide an opportunity to recruit an available source of male applicants into the profession. Such recruitment efforts may lead to increasing support and enrollment of men in the profession. Undertaking these endeavors might help eliminate the societal barriers and perceptions of nursing as a sex-typed occupation.
Presently, several people in Canada and the United States are predicting that a nursing shortage is looming. Both countries could face a registered nursing shortage by the year 2011. Since the profession is still largely female dominated, it is recruiting almost exclusively from one half of the population. Likewise, because of falling birthrates, aging workforce, and shrinking recruitment pools, the nursing pool is not renewing itself at a sufficient rate. Furthermore, enrollment in baccalaureate programs has been declining for several years. It is suggested that this may be due to students’ reluctance to enroll because of hospital right-sizing and healthcare cutbacks.
Meanwhile, many women are not considering nursing as a career, opting to pursue nontraditional careers. Other professions such as medicine, dentistry, and pharmacy have seen a steady growth in gender equality; nursing has not been so fortunate. The tendency to consider nursing as a single-sex occupation has to end.
Active recruitment of young males in high schools and colleges may be a new means of addressing nursing shortages. They provide an untapped pool of nursing school applicants (Trossman, 2003). Because nurses enter a profession, which naturally maintains and reflects society’s sex stereotypes, it is important that strategies attack both the myths and barriers (Kleinman, 2004). Accordingly, general acceptance of nursing as a viable career for men requires input and promotion by nurse educators, administrators, professionals associations, unions, and government.
Marketing nursing to men requires a concentrated effort by all interested stakeholders to break down the socially constructed, stereotypical myths and barriers to help change the perception of nursing as a sex-typed occupation. Thus, nursing schools, professional associations, and governments must reach out to the schools in the community. Here they have an excellent opportunity to educate all students about nursing as a career choice. One endeavor to correct the public image is the development and promotion of career education materials that promote sex equity. This information can be supplied to children and adolescents in schools, providing them an opportunity to acquire a realistic understanding of the nursing profession.
School counsellors influence career choice; however, information provided by counselors to students about nursing is limited and often inaccurate. Research has found that counselors experience misconceptions about nursing (Barkley & Kohler, 1992). Thus, they are not likely to advise academically capable male and female students to pursue a career in nursing. For this reason, a re-education of high school counselors about the nursing profession is important in aiding recruitment of future nurses of both genders. Nursing associations could target school counselors individually, give presentations, and emphasize the positive aspects of the profession for both male and female students. Such attempts will produce a population of wellinformed high school counselors to aid recruitment of future nurses (Nelson & Belcher, 2006).
Studies have shown that nursing schools have shunned men by paying little attention to targeting and retaining men as a source of nursing school applicants (MacPhail, 1996). Consequently, campaigns to recruit male high school and college students into nursing programs must become a priority. Schools of nursing should employ higher numbers of male nursing faculty to be role models for male nursing students.
Nurses and nursing organizations must wage an effective public media campaign to correct the image and the public’s perception of the nurse. Furthermore, hospitals, nursing schools, and other health agencies need to portray men in the role of nurse in their publicity materials. Recruitment, promotional advertisement posters, and brochures should not portray only the female image of the nurse.
Another endeavor is the monitoring of the media for sexist images of the nurse, eliminating sexist language from nursing journals, texts, nursing conferences, and other personal communications (MacPhail, 1996; Kleinman, 2004). Elimination of sexist language and images of nurses might help change the deeply entrenched societal stereotypes about nursing.
Recruiters should emphasize the positive aspects of nursing in all media communications to the public. Most important, involving male nursing students in recruitment efforts and making them visible in recruitment materials and publications may increase men’s representation in the profession. However, the active recruitment of men into nursing should not be viewed as a panacea. Other recruiting strategies would be to encourage professional journals and other literature to portray men nurses in their advertising. Finally, an improvement of pay scales might help make nursing a more attractive occupation for both genders. This would involve the cooperation of nurses, government, and nursing unions through collective bargaining.
Although the literature has identified a long history of men in nursing, their contribution has not been recognized. Nursing is still seen as a role that is inherently natural to females. Many factors have deterred men from entering the profession, and one of the main barriers keeping them away is the well–entrenched societal stereotypes associated with nursing. Even though women and men are socialized differently, both genders have the caring and nurturing characteristics required for nursing. Societal attitudes have aligned these traits exclusively to the female gender. With the changes currently taking place in the healthcare system, nursing needs to recruit the best candidates, regardless of gender, who have the potential to develop their knowledge and skill in caring for individuals. To attract and retain more men will require a concentrated effort not only for those within nursing, but by other stakeholders as well. Nursing must be the forerunner in breaking and correcting the barriers that impede the entry of men into the profession. As these barriers are broken, career options and choices in nontraditional careers may increase for both sexes (Trossman, 2003).
Conclusion
Altogether one might believe that nursing is one of the most important jobs in the medical field based on the reputable history it has, its diversity, and its growing demand. One might also believe that nursing is a very important job due to the fact that people will always need health care. No matter whether it is female or male nursing is more than just caring for the sick, it is not only giving care to the patient but also caring about the patient and his or her well-being.
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