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:

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

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