Amid recent reports of nursing errors and neglect, some argue that nurses have become 'too posh to wash'.
They have supposedly forgotten their proper roles as devoted angels, physician helpers, and bedpan engineers.
Instead, they seek more university degrees, respect for their technical skills, and an expanded scope of practice.
The popular dramas House and Grey's Anatomy together have 20 major physician characters, but not a single nurse
Compassion and diligence are of course essential qualities in nursing.
But nursing is far more than that.
Nurses
also save lives by monitoring patient conditions, intervening with
cutting-edge technology, advocating for patients, and teaching them how
to manage their health.
With more education, nurses can do even more.
Research shows that the care of advanced practice nurses is at least as effective as the care of physicians.
But under-staffing, resource shortages, and abuse undermine nursing practice daily.
The global nursing shortage is a public health crisis. Unhealthy attitude
Burned-out nurses have fled the bedside, and many wealthy nations have rushed to recruit foreign nurses.
Nurses
today are asked to do a harder job with fewer resources, and research
shows that low nurse-to-patient ratios are risking lives.
One
big problem is the unhealthy media portrayal of the profession, which
plays a key role in forming and reinforcing popular attitudes. Even
television dramas affect the public's views and decisions about health
care.
In a 2008 study, nursing scholars at the University of
Dundee found that television images of nurses as 'brainless, sex mad
bimbos' were discouraging academically advanced students from pursuing
the profession.
To resolve the nursing shortage, we must all learn what nurses really do
Disrespect from decision-makers means too few nurses on the wards.
Overworked nurses are less able to detect subtle changes in patient
status, catch life-threatening errors, and give vital health advice.
Disrespect encourages patients and physicians to ignore and even abuse
nurses. Drama portrayal
The popular dramas House and Grey's Anatomy together have 20 major physician characters, but not a single nurse.
The
shows' physician characters do many exciting things that nurses do in
real life, from defibrillation to patient teaching to psychosocial care.
The few nurses who appear are meek subordinates who rarely speak.
Sometimes
the smart, attractive physician characters mock nurses. Dr House, the
godlike diagnostician, once joked that he had "created" nurses to clean
up the mess. And Meredith Grey reacted this way to an insult by a male
colleague: "Did you just call me a nurse?!"
Even the news media often ignores nurses' real contributions to modern health care.
Usually,
elite press entities consult only physicians as health experts, even
about topics that nurses know at least as well, such as preventative
health and pain management.
And advertising relies heavily on regressive imagery, presenting nurses as deferential helpers or sex objects.
Earlier
this year, a West Midlands bus company used a large naughty nurse ad,
with the tag line 'Ooooh matron!', to promote its route to the hospital.
To resolve the nursing shortage, we must all learn what nurses really do.
Those who craft public policy and media content should raise awareness of nursing.
And nurses themselves must speak out about their work.
Of
course specific instances of poor care should be addressed promptly.
But in the long term, only an understanding of the true value of nursing
will ensure that qualified, caring nurses are there to save us when we
need them.
MALE NURSES, MEN IN A FEMALE DOMINATED PROFESSION:
THE PERCEIVED NEED FOR MASCULINITY MAINTENANCE
by Christopher Neighbours
Introduction
Nursing is perceived to be a subordinate occupation, both in relation to
medicine, and to the world at large. Whilst men may have greater power
and prestige within the profession, I argue that they too are
subordinate. This subordination demonstrates itself in different ways
than the subordination of women, but it is there nonetheless. This
essay will outline the various ways that male nurses are socially
disadvantaged, and the ways they attempt to maintain their masculine
identity.
Nursing is seen as a feminine occupation and is thus devalued in male
dominated patriarchal society. It is stereotyped as having the traits
of nurturing, caring, dependence and submission. This contrasts with
the perceived male traits of strength, dominance and aggression. Male
nurses separate themselves and the masculine sex role from their female
colleagues.1
When someone forms an identity that is incompatible with society’s
expectations, people become uncomfortable and are unsure how to behave.
In a society where nurses are seen as female, it is difficult for
people to know how to relate to a male nurse. They find it hard to
understand why anyone would choose a job dominated by the lower status
sex, and make a choice that is likely to involve negative sanctions.2
Men are deterred from the profession by believing that other people will
see them as unmanly. They may also believe that nurses only take
orders from doctors, have limited career opportunities,
and are poorly paid.3 Children are often particularly puzzled by male
nurses. To a child it is simple, this cannot be a
nurse, because he is a man.4
Tokens
Men are a small minority in nursing. About 3.1% of nurses in the United
States and Canada are male, and 8.77% in the United Kingdom. Women who
work in male dominated occupations are usually met with hostility. But
men who work in female dominated occupations may not be disadvantaged.5
New Zealand statistics show similar trends to the United Kingdom. 7.76%
of New Zealand nurses are male. Meanwhile, 72.48% of doctors in New
Zealand are male.6
“Kanter (1977) suggests that tokens are people who differ from the
majority of the group members in ascribed characteristics such as sex or
race, which carry with them a set of assumptions about culture, status,
and behaviour.”7
The high visibility of tokens puts an increased pressure upon them to
perform well. The characteristics of the token group are given
abnormally high importance by the dominant group. The stereotypes
surrounding tokenism are so strong that it is often much easier for the
tokens to conform, and accept their role entrapment, than it is to
create dissention within the group.8
‘Appropriate’ fields for Male Nurses
Men in nursing are a privileged minority. In patriarchal culture, men
have greater status and power than women. Men are disproportionately
represented in the specialties and in administration.9
Men are ‘tracked’ into what are seen as more appropriate fields for them
to practice in. Uniquely, this means their pay and prestige are
enhanced. However, it is independent of men’s individual desires.10
Tokenism is relevant again here. Their role entrapment means they may
not be able to do tasks they would like to do as it does not fit in with
their role.11
Kanter did not foresee that differentiation between dominants and tokens
may be originated by the tokens themselves. If the tokens have a
higher position in society as a whole than the dominants, the tokens
will try to enhance their position. For example, a male nurse might say
‘I am a psychiatric nurse’, hoping that his listeners will focus on
‘psychiatric’ rather than nurse.12
'Tracking’ however, is sometimes very blatant. During the 1980s, the
American Courts ruled that hospitals could refuse to employ men in
maternity wards. In 1994, a California hospital’s ban on male nurses in
labour and delivery rooms was upheld by that state’s Fair Employment
and Housing Commission. The rationale was that having male nurses
performing vaginal exams would add to the patient’s distress and
anxiety. This gives the message that male nurses are somehow less
professional than male doctors.13
Also in 1994, a male nurse filed a complaint with the Equal Employment
Opportunity Commission against two Florida hospitals who had barred him
from their maternity wards because of his gender. The Commission
accepted the hospital’s argument that the patients would be
uncomfortable if a male nurse looked after them. The hospital paid a
settlement and offered the nurse a job in another ward as a compromise
measure. The Commission felt that this was enough, but if male nurses
in the United States want to work in maternity wards, formal action in
the Courts is the only option open to them.14
The perception that it is unsuitable for men to work in maternity wards
is widespread. Even male student nurses are restricted in how much
practical experience they may have in women’s health. However, this may
change as more men enrol in nursing programmes. There is an unconscious
expectation that men are not supposed to be nurses.15
People single out men in nursing as they are the minority. But men want
to be seen as a nurse -not as a ‘male nurse’. They want to be part of
the whole, not a highly visible minority.16
Nursing: The Female Profession
Nursing combines professional values as well as feminine values of
caring and support. This combines with the patriarchal construct that
men are valuable and that women nurses support their
male colleagues, consciously or unconsciously.17
This is due to Oppressed Group Behaviour. Women are oppressed by their
subordinate status in society as a whole, and are also oppressed in the
health care system, as it is controlled by male
doctors. Oppressed groups assimilate to the norms and values of their
oppressors, seeing them as achievers and wishing to be like them.
Oppression is most complete when it is not even recognised.18
Indeed, women’s oppression could be made worse by their subordination to
male colleagues. This could result in nursing becoming divided between
male management and female ward workers.19
Florence Nightingale felt women were intrinsically nurses, so much so
that they did not require an education prior to nursing training. They
were taught by doctors under an apprentice system. The long history of
men in nursing has been ignored, which may have contributed to nursing’s
feminine image. Believing that nursing is an extension of the domestic
role further devalued the profession
in relation to male occupations, particularly medicine.20
Even today, men are sometimes excluded within nursing. Nursing texts
and articles frequently refer to nurses only as women, and the history
of men in nursing is often ignored too.21
The Male Advantage
The major rationale for attracting men into nursing is to raise the
prestige of the profession as a whole. Whether this will actually work
or not is debatable. Some authors have argued that this puts more
pressure on men to ‘rescue’ nursing, yet others suggest that men
entering the profession only elevates the status of men.22
Men also have an advantage due to the stereotype that men are in the
breadwinner role. Women generally take primary responsibility for
housework and childcare, giving men a distinct advantage. They can stay
at work, while their wives interrupt their careers. There is an
overwhelming perception in the United States (and the Anglo-Saxon world
in general) that men are more dedicated to their work than women. This
is due to the unequal division of labour within the
household. Thus, even in a ‘female’ profession, men have an unfair
advantage over women.23
The top roles in nursing emphasize leadership, technical knowledge, and
dedication to work, all seen as being masculine traits. Attention to
detail and showing emotion - which are seen as female
traits - are not seen as good leadership skills. Male nurses socialise
more with doctors than their female colleagues do. The men felt they
did not have much in common with their women colleagues and preferred to
talk about sports and vehicles with men, particularly male doctors.
This also provided advantages for career prospects as doctors see male
nurses as being more competent. But male nurses may identify too
closely with doctors and become disenchanted with the low status and pay
of nursing. Thus the female world is devalued and barriers are put up
against women gaining leadership roles.24
Men choose nursing due to job availability and security, and some are
attracted by nursing’s emphasis on biological science, and the desire to
work in a humanistic field. Some enter the profession with the aim of
gaining a job in administration. A few do become nurses as they can not
become doctors due to financial constraints and competition for places
for medical school. However, many male nurses interviewed stated that
they could have become doctors had they
wished to do so. They assigned the values of the higher status
profession to the lower status profession.25
Nursing’s image is also changing, from bed-pan scrubber to doctor’s
assistant. The recruiters inside the profession need men to become
nurses so that they can fight for equal pay for female nurses. It would
be impossible to fight for equality if there were no men to measure
women’s pay against.26
However, this the percentage of men in Administration does vary between
countries. In the United Kingdom, less than 10% of nurses are men, yet
they hold over 50% of the top nursing positions. In contrast, men
occupied about 6% of nursing administrative positions in the United
States in 1996.27
Role Traps and Stereotypes Of Male Nurses
Male nurses are usually locked within four role traps. These are:
The Ladderclimber
The Troublemaker
The He-Man
The Homosexual
All except the last category reinforce accepted male behaviour.28
Labelling male nurses as odd is a social control network. This implies
that men who are nurses are different to other men. Male nurses also
have to cope with the stigmatising label of homosexual. To avoid this,
many specialise in fields compatible with the masculine image. For
example, anaethesiology, intensive care, or the Emergency Department.
This dispels the labels of ‘deviant’ that isolates them from other men.
These specialties also have more prestige and better pay. This also
protects men from having to touch their patients, or giving intimate
bedside care.29
But all this is secondary, for male nurses are trying to fit into the
group of masculine men in general, rather than fitting into the dominant
workgroup of female nurses.30
These judgments are based on patriarchal ideas of what are appropriate
masculine and feminine traits. However, nursing’s stand on not
permitting men in maternity wards could be seen as gender
discrimination.31
On the other hand, sometimes men are preferred as nurses. For example,
some men prefer a male nurse to do their perineal cares, as they would
be too uncomfortable if a woman did this intimate and potentially
embarrassing task.32
The ladderclimber stereotype arose because men are expected to be
successful in whatever they do, so male nurses are viewed as ambitious.
This is enhanced by a higher proportion of men in
administration positions compared to nursing as a whole.33
The troublemaker label was acquired because men do not put up with
degrading comments and treatment from male doctors, and are socialised
to be more assertive.34
The He-man label arose as men are perceived to have greater physical
strength. This translates into men being expected to do all the heavy
lifting. In reality however, male nurses use lifting aids
as often as female nurses.35
The stereotype that male nurses are gay is based more on ideas of what
is masculine and what is not than any objective assessment of sexual
life styles. If a man has ‘feminine’ traits, such as empathy and
caring, they are assumed to be gay. This is a deterrent to men becoming
nurses, but few male nurses find this a day to day problem. It could
be sidestepped by mentioning a girlfriend or wearing a ring on the
appropriate finger.36
Yet, men have nursed since ancient times. For example, a military order
of male nurses staffed a hospital for men who were ill on the voyage to
the Holy Land during the Crusades (1096-1291). In the United States,
men nursed during the Civil War, but began to withdraw shortly
afterwards due to the influence of Florence Nightingale. Ms Nightingale
believed ‘every woman is a nurse’ but ignored men completely. 19th
century society deemed nursing qualities of caring, compassion, and
subservience to be feminine, and many nursing schools stopped admitting
male students. By 1941, only 68 out of 1303 schools of nursing in the
United States admitted male students.37
Male nurses have to have a strong sense of self identity, or they will cave in to the pressures from outside the profession.38
The stereotypes of Ladderclimber, Troublemaker and He-man are imposed on
the tokens by the dominant group. The homosexual stereotype is imposed
from outside the workplace and by men rather than women. This
stigmatising attribution is given to all men who deviate from accepted
masculine behaviours, not just to male nurses.39 As a result,
socio-cultural factors should be examined whilst one is trying to
explain group interaction patterns.40
It is difficult however, to see men as a disadvantaged group requiring
preferential treatment, as they have higher status and power than do
women, or minority groups.41
Male nurses often get on well with female doctors, due to their shared
‘outsider’ status. Hospital society is very sexist, but male doctors
are the only group who do not see this.42 Female doctors,
and both male and female nurses are very aware of it, although from very
different viewpoints.
Masculinity Maintenance
Male nurses base their masculine role on the separation of masculine and
male from nursing, a profession that embodies feminine values and the
subordinate female role in patriarchal society.43
Male nurses emphasise their work as task oriented rather than people
oriented to further masculinise it. They distance themselves from a
care orientation, which is perceived to be a female trait. Even when
male nurses work at the bedside, they emphasise different caring styles
and lift patients more often than their female colleagues. It is the
job title and associated images, not the practice of nursing that deters
men from the profession. The uniform is another deterrent. Many male
nurses select specialties where they do not have to wear uniforms - so
that they do not appear to be nurses. In particular, those who work in
the Operating Theatre wear theatre greens, and are thus
indistinguishable from doctors.44
The role strain is reduced by choosing specialties that do not require
personal care to be given, and where non-traditional clothing may be
worn.45
So men have created ‘islands of masculinity’ within the profession. The
profession itself supports the view that some fields are more suitable
for men than others. As I mentioned above, several American hospitals
have been permitted to ban male nurses from its obstetric and
gynaecology wards.46 Neonatal intensive care is an exception however,
as it is seen as more masculine due to its task
related orientation.47
However, some male doctors have a very hard time with male nurses. They
believe only gay or incompetent men would be nurses, and that if they
were competent they would go to medical school and become doctors. And
then, they would be doing a ‘man’s job.’ Also, as male nurses have a
high status in a low status profession, many doctors try to push male
nurses into positions in administration, which are more prestigious, or
even leave nursing altogether, in order to resolve this contradiction.48
Some patients share this view; that male health care workers are doctors
or medical students, and that a male nurse must be too lazy or not
clever enough to go to medical school.49
If they are strongly suspected to be homosexual, men will be
disadvantaged and discriminated against. It could be that opportunities
for men in nursing only extend to those who show
traditional masculine characteristics. This includes a heterosexual
orientation.50
Relationships with Female Nurses
Female nurses generally respond favourably to male nurses, but feel some
jealousy and resentment that men take the better paying jobs. Men are
accepted more easily when they are on the wards rather than when they
are in administration. In general, female nurses do not marginalise or
reject male nurses.51
But sometimes men are asked to lift patients for the female nurses, or
to catheterise the male patients. Whilst this often annoys them, male
nurses gain admiration for their ‘special’ abilities - which is another
advance. Male nurses are often invited to socialise with female nurses,
which they often do, although it often means attending a Tupperware
party. The problem here comes from outside, the husbands and boyfriends
of the female nurses would become jealous of male nurses, who see more
of their wives and girlfriends than they do.52
This does not always occur however, and often men are excluded from
these female events. The female nurses may be able to use bridal
showers, etcetera as good networking opportunities. This isolation may
be furthered as male nurses are uncommon, and there may only be one male
nurse on the ward.53
Conclusion
Male nurses attempt to maintain their masculine role by distancing
themselves from traditional bedside care, and going into specialties.
This means that they will not appear to be a nurse, and
will thus avoid the stigma associated with men who work in female
dominated professions. Some work in anaethesiology, where they wear
theatre greens and are indistinguishable from doctors. Others work in
specialties such as psychiatry where traditional male attributes such as
physical strength are used, and where again, nursing uniforms are not
worn. Many more go into administration, which requires the attributes
traditionally assigned to males; such as leadership,
and dedication to work.
Male nurses face role traps and sex typing daily. Several American
hospitals have been permitted to ban men from their maternity wards, on
the grounds of the patients possibly being uncomfortable with the idea
of a man looking after them. Many doctors, and people in general
believe male nurses are either homosexual, or incompetent, or both.
The label of homosexuality is assigned to all men who work in jobs
emphasising attributes traditionally assigned to females, such as
empathy and caring. Men who work in a ‘woman’s job’ are seen to be
incompetent, because women’s work is ‘easier’. If they were true men,
they would go and be doctors, and do a ‘Man’s Job’.
Thus, male nurses have a strong pressure on them to conform to society’s
norm at all times, and need a strong sense of self if they are to
resist this, and continue to work in an occupation they wish to work in.
Whilst men have a high status in nursing due to patriarchal values
infiltrating even a female dominated profession, the benefits gained
come at a heavy cost. Men deal with guarded acceptance from the female
staff, and often outright bigotry from male doctors. However, the most
stigmatising stereotype - homosexuality - comes from outside the nursing
profession, and is imposed on male nurses by other men, who feel
threatened by men who step outside the traditional masculine role.
My own opinion is that of Michelle Davidson, RN.:
“It is not a person’s gender that makes him or her a
good nurse; it is what is in their hearts and what they give to their
patients.”54
FOOTNOTES
1. Evans, J., Men In Nursing - Issues Of Gender Segregation and Hidden Advantage, Journal Of Advanced Nursing 1997, Aug. p226
2. Bush, P., The Male Nurse: A Challenge to Traditional Role Identities, Nursing Forum Vol.XV, No.4, 1976 p390
3. Poliafico, J., Nursing’s Gender Gap, (Handout from Dr. Kirkman) p2
4. Williams, C., Hidden Advantages For Men In Nursing, Nursing Administration Quarterly, Vol19,No2, 1995 p68
5. Evans, J., op.cit., pp226-227
6. Sociology 307 handout: Selected Occupations, New Zealand, Census ‘96
7. Evans, J., op.cit., p227
8. Heikes, E., When Men Are In The Minority, The Sociological Quarterly Vol.32, No.3, 1991, p390
9. Evans, J., op.cit., p227
10. Williams C., op.cit., p64
11. Heikes, E., op.cit., p390
12. Ibid., p393
13. Poliafico J., op.cit., p3
14. Burtt, K., Male Nurses Still Face Bias,American Journal Of Nursing, Vol.98, No.9, 1998 p64
15. Ibid., p64
16. Davidson, M., Not A Male Nurse, A Real Nurse, Nursing Forum, Vol.31, No.4, 1996 p28
17. Evans J., op.cit., p227
18. Ibid., p227
19. Ibid., p227
20. Ibid., p228
21. Poliafico J., op.cit., p3
22. Evans, J., op.cit., p227
23. Williams C., op.cit., p65
24. Evans, J., op.cit., p229
25. Bush, P., op.cit., pp395-396
26. Ibid., p399
27. Poliafico, J., op.cit., p5
28. Heikes, E., op.cit., p394
29. Evans, J., op.cit., p228
30. Heikes, E., op.cit., p397
31. Evans, J., op.cit., p228
32. Williams C., op.cit., p69
33. Heikes., E, op.cit., p394
34. Ibid., p395
35. Ibid., p396
36. Williams C., op.cit., p69
37. Poliafico, J., op.cit., p2
38. Bush, P., op.cit., p402
39. Heikes., E., p397
40. Ibid., p397
41. Ibid., p397
42. Williams C., op.cit., p67
43. Evans, J., op.cit., p227
44. Ibid., p229
45. Bush, P., op.cit., p403
46. Evans, J., op.cit., p228
47. Williams C., op.cit., p64
48. Ibid., op.cit., p66
49. Poliafico, J., op.cit., p3
50. Williams, C., op.cit., p65
51. Ibid., p67
52. Ibid., p68
53. Heikes, E., p392
54. Davidson, M., p28
BIBLIOGRAPHY
Evans, J., Men In Nursing: Issues Of Gender Segregation And Hidden
Advantage, Journal Of Advanced Nursing. v26, n2: pp226-231, August 1997.
Heikes, E., When Men Are The Minority: The Case Of Men In Nursing, The Sociological Quarterly, v32, n3: pp 389-402, Fall 1991.
Williams, C., Hidden Advantages For Men In Nursing, Nursing Administration Quarterly, v19, n2: pp63-70, Winter 1995
Bush, P., The Male Nurse: A Challenge To The Traditional Role Identities, Nursing Forum, vXV, n4: pp390-405, 1976
Poliafico, J., Nursing’s Gender Gap(NB: This article was given to me as a
handout by Dr. Kirkman. However, the original text was found in RN,
v61, n10: pp39-43, October 1998)
Burtt, K., Male Nurses Still Face Bias, American Journal Of Nursing, v98, n9: pp64-66, September 1998
Davidson, M., Not A Male Nurse, A Real Nurse, Nursing Forum, v31, n4: p28, October-December 1996