Men in the female dominated nursing profession

The existing literature in nursing reviewed, and is mostly based on the reason for the shortage of men in nursing, and their experiences in a female dominated profession. Most of the articles obtained in this literature review were from the databases of Pub-Med, MEDLINE, Elsevier, Bio Med Central, SAGE pub, and Google Scholar.

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The key search words were “caring,” “gender,” “men,” “nurses”, “nursing”, “stereotypes”, “non-traditional jobs”, and “advantages”. The data obtained for this literature review span from 1964 to 2010.

Little is it known about the experiences of men in nursing in Malta. However, Mr. Joseph Camilleri (1964) wrote about History of nursing in Malta stating that the knights themselves performed the nursing care “exclusively,” to the same gender.

The literature review presented is aimed to explore the advantages and disadvantages that male nurses experience while performing their caring roles in nursing.

2.2 Difficulties male nurses encounter in a traditionally female profession

2.2.1 Introduction

Nursing became predominately a female profession in the late 19th century. Though Florence Nightingale made major contributions in the nursing profession, she was greatly involved in excluding men from this profession by affirming that nursing was a discipline for female. She did work hard in establishing nursing as a laudable profession for ‘respectable women’, ignoring the past indispensable contributions made by men (Black and Germaine-Warner, 1995). Nightingale saw the males’ task restricted to physical jobs like moving or lifting patients and never appreciated their caring task. Besides, the Industrial Revolution largely influenced the way out of men from caring professions, such as nursing. During this period, the widely acknowledged professions for men were business, technology and science. Men pursued medicine and women pursued nursing (Black and Germaine-Warner, 1995).

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Men entering the nursing profession cross the conventional lines of gender. As a result, their masculinity becomes an issue. Over time, masculinity has been defined by the roles men perform (Connell, 1995). The concept, notion or idea of masculinity deters men from entering women-dominated professions, such as nursing, but men are silent on the entry of women in the men’s traditional professions, such as medicine and technology. Williams (1995), Table 2.1 conducted in-depth interviews with 76 men and 23 female who work in predominantly female professions as social workers, elementary school teachers, nurses, and librarians. Through deft interpretation of her interviewees’ words, it was found that male nurses and those in other female-conquered fields frequently emphasize their masculinity and try as much as possible to avoid socializing with their women colleagues. This is argued by Williams as the only way of legitimising their working in the women’s conventional professions.

An exploratory study, conducted by Heike’s (1991),Table 2.1 based on in-depth interviews with fifteen male nurses, showed that male nurses saw themselves in the abnormal position of belonging to two very dissimilar groups. For instance, in the nursing profession, men are taken as a minority group tagged as ‘male nurse’, whilst in a broader society, men fit in the dominant social group where they are expected to be successful and excelling in their profession. Male nurses are therefore a unique type of minority group in the sense that they are either a minority of the principal social faction or minority of majority. This disparity in grouping (minority-majority) stresses and discriminates men in nursing more than other tokens. “Furthermore, the study indicates that many of the disadvantages male nurses experience (e.g., homosexual stigma, gender stereotypes) originate from outside of the nursing profession (Heikes, 1991, p.398).”

According to theoretical research of the literature, carried out by Evans (2004), Table 2.1, a man associated with the nursing profession compromises his reputation plus social status in patriarchal culture. Also, male nurses experience the stigma of working in a female-dominated profession, and they are seen by society as challenging the conventional roles of men (Lammi and Kauppinen-Toropainen, 1993). Evans argues (1997,p.228), citing Mangan (1994), that ‘stigmatising labels imply that men who do nursing are different from other men, isolating them as ‘deviants’ who are ‘odd’ or ‘homosexual’.

Furthermore, while analysing the data from semi-structured interviews with eight men nurses on their experiences in nursing, Evans (2002) noted that the male nurses are exposed to rejection and suspicion as nurturers and caregivers due to the perception that men and women caring styles were not the same. Touch was one expression of caring that all participants identified as central, to their practice as nurses, and potentially dangerous because it can be misinterpret, which makes them” vulnerable caregivers”.

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Similarly, men in nursing are likely to be labelled gay. Pringle (1993) asserted that any ‘feminised’ profession is believed to attract homosexual men, be it fashion, hairdressing, or even nursing. A study link appears to be drawn between sexual preferences and gender. Savage (1987) suggested that a male nurse is always tagged with a predominant image of being homosexual. He further supported this suggestion by asserting that men entering the nursing profession have purportedly failed in other ‘manhood’ professions and that the only opening for them remains in the women’s world. Harding, (2007), Table, 2.1 in the social constructionist study conducted among 18 New Zealand men employed in general nursing found that majority of men in nursing are heterosexual. However, public perception is still that most male nurses are gay. This stereotype persists only in general nursing because it was” constructed as feminine and abnormal for men, whereas psychiatric nursing was constructed as normal for men” (Harding, 2007, p.641)

Male nurses are believed to be further weakened, emasculated or ineffectual by resorting on women’s traditional jobs in which they are anticipated to exhibit feminine qualities, such as being gentle, caring and subordinate to women. Thus, labelling of men in the nursing profession as homosexuals makes them feel remorseful, outcast and discouraged. Pringle (2002) asserted that in most cultures, male homosexuality is seen as an infringement of masculinity and a denigration of men’s mythical power. He further asserted that as homosexuality nibbles at masculinity, it deteriorates the gender order.

As earlier mentioned, up to this very moment nursing is extremely dominated by women and this translates to a number of personal and professional challenges to men entering the field. For example, several male nurses have reported about physicians and head nurses placing less trust in them. Besides, male nursing students encounter discrimination from physicians, practicing nurses and the general public (Kelly et al., 1996). Female nurses frequently request male colleagues for assistance in turning and lifting patients, thereby emphasising physical strength and not professional expertise. It is all very frequent for male nurses or students to find themselves unwanted in delivery rooms, prenatal clinics and other related settings that male physicians have liberated access (Black and Germaine-Warner, 1995).

Another difficult issue male nurses or students encounter is a mistrust emanating from their patients. Literature has it that a considerable number of patients become so violent or hostile in the presence of a male nurse and will be uncomfortable submitting to intimate medical procedures. This is a difficult position to encounter, and several male nurses usually become frustrated when patients are not willing to confide in them because of fear or underserved disrespect (Fisher, 1999). Also, mounting study indicates that men in female-dominated careers, such as catering, nursing and fashion, encounter gender bias, elevated rates of job linked to stress as well as job discrimination (Amour, 2003).

Table 2.1

The distribution of studies regarding the difficulties male nurses encounter in traditionally female profession

Author/s and setting

Sample and sampling method

Research design/Instrument

Significant findings

Evans, J.

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(2004),

Canada

•Theoretical research of literature review on men nurses in Canada, Britain & U.S.A. between 1900 and 2003.

•Statistics, CINHAL, Pub Med, and Sociological Abstract databases

•Failure to recognize men’s participation in nursing leaves male nurses without historical background, almost invisible;

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•Gender boundaries are negotiable during wars and acute nursing shortage,

•Men in nursing tend to choose areas of specialization that are more masculine,

•Men’s career path takes on traditional masculine role that seeks power and influence

Evans,J

.(2002),

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Canada

•8 male nurses from community health nursing, medical-surgical, and general duty nursing,

•6 married, 1 with partner, and 1 ‘gay’;

•Age from late 20s to mid 50s

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•Two rounds of semi-structured interviews

•The stereotype of men as sexual aggressors is compounded by the stereotype that men nurses are gay,

•These stereotypes sexualise men nurses’ touch,

•Men nurses are subject of accusation of inappropriate behaviour

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Harding,T.

(2007),

Norway

•Discourse analysis of data from existing texts, and 2 films on men, nursing and masculinity, and interviews conducted in 2003-2004,

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•18 participants, 11 self-identified as gay, 6 heterosexual, and 1 no information on sexuality,

•The workplace included clinical nursing, education, administration, midwifery, mental health and armed forces

•Purposive and snow ball sampling

•Loosely structured interviews with broad, open-ended questions

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•Three themes emerged which characterized the participant’s experiences:

•Persistence of the stereotype of the gay male nurse,

•Meeting homophobia in the work place,

•Strategies to protect one’s homosexuality like working as psychiatric nurses.

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Heikes, J.

(1991),

U.S.A.

• 15 male RN’s from nine different hospitals in Austin, Texas;

•Age range 26-43 years;

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•Working experience ranged from 1-14 years

•In-dept interviews based on interview questions about the concrete work experiences, and non-work interactions

•Four role stereotypes emerged from the data: Ladder-climber, Troublemaker, and He-man, traditionally masculine traits, and homosexual, which is imposed on male nurses from the outside;

•Male tokens are expected to excel in the occupational or public sphere;

•Respondents reported social isolation in order to maintain higher status and to reduce the possibility of them being labelled “un masculine” or homosexual.

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Williams,C. (1995),

U.S.A.

•76 men and 23 women in four occupations: nursing, librarian, elementary school teacher, and social worker;

•From 1985-1991

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•Snowball sampling

•Age range from 20-66

•In-dept interview, with the interview questionnaire consisted of several open ended four broad questions on “motivation to enter

the profession, experience in training, career progression, and general about men’s status”. (p.229)

•Face to face interview

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•Cultural and social stereotypes about masculinity pressure men to raise in a “glass escalator” to

the highest paid and most prestigious nursing specialities;

• Men encouraged to advance by an ‘invisible’ pressure;

•Men develop strategies to present themselves as masculine, and superior to female colleagues

2.3 Advantages and disadvantages perceived in male’s nursing career

2.2.1 Introduction

Male nurses belong to a minority group. Approximately 3.1 percent of nurses in Canada and the United States are male, about 8.77 percent in the United Kingdom, (Rott, et.al (2008), and in Malta 28 percent (Council for nurses and midwifes, 2010). According to Evans (1997), Table 2.2, women working in men’s traditional professions normally encounter hostile working environment. However, men working in female-dominated professions may never encounter such disadvantages. That said, the focal rationale for drawing men to nursing is to enhance the status and the prestige of the profession as a whole. It remains debatable whether this will really work or not. Several researchers and scholars have argued that the rationale puts a noteworthy pressure on men to ‘salvage’ the nursing profession, whereas others believe that allowing men in the profession merely raises the position of masculine gender in the society (Evans, 1997).

Male as well encompass an advantage in the nursing profession due to traditional stereotype that men are always the breadwinners of the families. In most societies, women usually take primary tasks for childcare and housework, giving men a distinct benefit. For instance, there is a devastating perception in the United States and most Anglo-Saxon world that women are less devoted to their work than men. This is largely due to the unfair division of labour inside the household. As such, even in ‘female’ professions, men remain with this unequal advantage over women (Williams, 1995).

In addition to, Abrahamsen (2004), Table 2.2, argues ” when men obtain leading positions more often than women, this can be result of favourism of men” (p.35). A quantitative, non-experimental descriptive study ,conducted over twenty years, in order to identify constructions of masculinity, and career development, showed that twenty years after graduation, ,70% of male nurses were in the leadership position, and away from somatic wards. They moved to a sector which offered better income , which suggests that salary is important when male nurses move within different parts of the healthcare sector ( Abrahamsen, 2004).

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Additionally, the major functions in nursing accentuate technical knowledge, leadership and devotion to work, all these are perceived as being masculine traits. Consideration to detail and showing of emotions that are usually characteristics of females are not credited as good skills of leadership. What is more, male nurses are more social with doctors than their female counterparts. Since men feel they lack much in common with their female counterparts, they prefer talking about vehicles and sports with other men, especially male doctors. This in itself provides advantages for career projections, as doctors begin to appreciate male nurses as being competent just like their women colleagues (Bush, 1976).

The transversal study of Dassen, T., Nijhuis,J.N. & Philipsen, H. (1990), Table 2.2 which was based on a National Survey among intensive-care (IC) nurses in The Netherlands, showed that male IC-unit nurses consider IC-nursing to be a medical rather than a nursing activity in order to upgrade their own profession into a kind of medical profession. Due to an over-representation of men in technical wards, distribution of labour among male and female nurses is taking place according to traditional sex -specific patterns where male nurses stand a better chance of being promoted to higher positions. In addition, the study revealed that 50% of male nurses wish to become head of a nursing ward which proves that male nurses are more oriented towards profesionalization than female nurses.

On the other hand, Kanter’s (1977) notion of tokenism supposed that the numerical underrepresentation of individuals in an occupation, particularly those classified by gender, ethnicity or race, will lead to discriminatory treatment. Therefore, for all minority groups, a given profession will always experience negative job impacts. According to Kanter, members of minority group are likely to achieve less in the working environment than members of the majority group. However, Williams (1995) contravened that when men are seen as minority group in the nursing profession, they normally use their dominant gender privilege to rapidly rise to the topmost hierarchy (Saville-Smith and James, 1994).

Conversely, nursing is seen by several people as a feminine profession and is therefore devalued in male-conquered patriarchal society. This profession is always stereotyped as having the characteristics of caring, nurturing, submission and dependence. These traits accredited to nursing contrast with the alleged male characteristics of dominance, aggression and strength and thus male nurses usually isolate themselves from their female nurses as a way of expressing the notion of masculinity (Heikes, 1991). Moreover, when an individual forms an identity which is incompatible with the expectations of the society, people usually become uncomfortable and uncertain on how to behave. In most societies all over the world, nurses are perceived as women, and thus it is quite difficult for individuals to know how to interrelate with male nurses. They find it too unusual why a man would decide on a career dominated by a recessive sex. This is a major disadvantage to men in nursing and most of them are indeed deterred from the profession by assuming that other individuals will see them as unmanly (Bagilhole and Cross, 2002).

Table 2.2

The distribution of studies regarding the advantages and disadvantages perceived in male’s nursing career

Author/s and setting

Sample and sampling method

Research design/ Instrument

Significant findings

Abrahamsen, D.

(2004)

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Norway

•1450 male and female nurses who completed training in 1977

•Norwegian survey of nurses undertaken at the end of 1998

•After a year from graduating, 10% of male and female, both were in leadership position,

•After twenty years later, 70% of men were in leading position away from somatic wards and bed-ridden patients,

• Better income was moved male nurses within different parts of the healthcare system.

Dassen,T.W.N.et.al.,

(1990)

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The Netherlands

•1960 male and female nurses, data borrowed from the Intensive Care Association,

• 960 returned the forms by post,

•R.R.49%

•Survey, questionnaire sent by post;

•There is an over-presentation of men in technical wards,

•10% of the male nurses reported having chosen to work in an IC-unit,

•50% of the male nurses wish to become head of a nursing ward compared to only 15% of female nurses.

Evans,J.

(1997)

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Canada

•Theoretical literature review

•Not stated

•Even in the female dominated profession , patriarchal society enables men to obtain dominant position,

• Marital status for men has significant career advantage,

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• Men nurses have more university degrees compared to women nurses,

2.4 Why men choose nursing as a career

2.4.1 Introduction

Most men choose nursing for the similar reasons women choose nursing. They are goaded by the desire to care for patients (Boughn, 2001). Besides, men have numerous practical reasons that include career opportunity, job security, job flexibility and stable income. Conventionally, men tend to prefer active and challenging fields of nursing, such as cardiac care units, trauma units, emergency departments, cardiac care units, intensive care units, anaesthesiology or flight nursing, among others. Men are often attracted to the technical aspects of acute care specialties and always motivated by the challenges created by the medical instruments utilised in those units.

However, a pilot study investigating the motivations and experiences of 42 males in the nursing profession conducted by Whittock M. & Leonard L. (2003), Table 2.3 showed that a major factor that attracted men in nursing was influence of parents, specially mothers, employed in nursing or other healthcare professions. On the other hand, this finding was not true for all interviewees.

A similar, qualitative, study exploring what motivates Israeli men to choose nursing as their profession was conducted by Romem, P.& Anson, O. ( 2005), Table 2.3. Self- administered questionnaires which included 52-items were drawn up, in order to determine the social characteristics of male nurses, and their motives in choosing the profession. These questionnaires were distributed to all registered nurses, 137 female and 123 male, in three general and three psychiatric hospitals. The results of the study show that an early exposure to the profession, as well as the ethnic background are prominent factors that motivate men to choose nursing. Job security, career opportunities and salary, also play an important role (Romem, & Anson,2005). On the other hand, men in nursing are not taking leading positions in the health care system due to their social origins.

Nevertheless, there has been worry that several men may just look at the nursing profession as a facilitator to other masculine professions such as medicine and that they may not take nursing as their long lasting career. This is because of low pay and perceived low status of nursing as it is always associated with a lesser sex in the society (Williams, 1989). This anxiety was borne out in 2002 by a study conducted in the University of Pennsylvania. The study was based on the Analysis of the 1992-2000 the National Survey of Registered Nurses, ” the nation’s most extensive and comprehensive statistics on registered nurses with current licenses to practice in US.” In this study it was found that about 7.5% of new-fangled male nurses left this female-dominated profession within four years after graduating from nursing school. This was a higher percent compared to the 4.1% of female nurses who deserted the nursing profession in the same period (Solchalski, 2002).

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While Sochalski (2002), Table 2.3, in her research ‘underscored the need to determine the reasons for the exodus’ of nurses, a study of Rajapaksa & Rothstein (2009), Table 2.3, showed that men and women nurses who left nursing had some similar and some different reasons for their actions. The sample consisted of 1,589 registered nurses who were employed in other occupations at the time of the National Sample Survey of Registered Nurses 2000. Gender was the primary independent variable, although the vast majority of respondents in this study were female ( 93,5%). At the time of the survey , 63.2% of the respondents were working full time at their new jobs, and 36.8% were working part time. The survey consisted of a self-administered forced-choice questionnaire that included gender, participants age, working age, income, marital status, educational level and race. The results revealed that both men and women left nursing for better working hours and more rewarding positions elsewhere, and while”men nurses do not leave nursing for other occupations because of dissatisfaction with their roles as nurses, but rather because of their perceptions of the low financial rewards associated with nursing” (Rajapaksa, et al 2009, p.206).

A number of issues face majority of men who do decide to remain in nursing. These men frequently feel an emotional reaction, a role strain that might be felt by any individual in a profession which has a social formation conquered by members of the opposite sex. For those men raised in the culture of American andocentricism, not used to anti-male gender inequity, this may create discontent and anxiety. Increasingly, though, men today fill majority of leadership tasks in the nursing profession.

2.3 Table

The distribution of the studies exploring why men choose nursing as a career

Author/s and setting

Sample and sampling method

Research design/Instrument

Significant findings

Rajapaksa,S.&

Rothstein,W.

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(2009)

U.S.A

•Secondary Analysis of the National Sample Survey of Registered Nurses 2000,

•Sample 1.589 RNS who were employed in other occupations

•90% white,

•Age of the respondents 48.49

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• Average number of years worked as an RN was 8.73 years

•The data used were the General Public Use Files,

• Self-administered forced choice questionnaire

•Three main reasons for leaving nursing:

•46% respondents stated that the working hours where more convenient in the new job,

• 47,2% found current job more rewarding,

•35% stated that they left for better salaries

Romem,P.&Anson,O.

(2005)

Israel

•260 participants, 123 male and 137 registered nurses in 3 general and 3 psychiatric hospitals during 1997-1998.

•RR 74%

•Mean age was 37

•Majority of the respondents were married

• 52-item questionnaire based on in-dept interviews with 5 male and 5 female RN

•Nursing appeals to groups out-of the stream (immigrants and ethnic minorities);

• Israeli men in nursing do not occupy leading positions in health care;

•Men are absent from the nursing

Administration.

•78% of the male in this study belong to immigrants or ethnic minority.

Sochalski,J.

(2002)

U.S.A.

•Data Analysis of 1992-2000 National Sample Survey of Registered Nurses;

•The number of respondents in 2000 questionnaire was 35,579.

•R.R.71.7%

•Data from National Survey of Registered Nurses;

•Questionnaire

• New nurses at the beginning of their career show job satisfaction,

75% of women among new nurses were satisfied with their job, and only 67% men,

•7.5% of new male nurses left their job within four years,

• Male nurses are leaving profession twice the rate of women

•136,000 nurses are working in other professions.

Whittock,M.&

Leonard,L.

(2003)

U.K.

•1.Literature review on males in nursing from historical and present day perspective,

•2. Pilot study on what prevents from considering a nursing career

•30 pre registration male nurses,

30 post registration male nurses,

10 ex-nurses males.

•The sample to date 42 male nurse of different ethnicities

Mean age 33,64 years

•In dept semi-structured interview limited to 1 hour duration;

• Face to face interview

• Interviewees have expressed the view that males can be caring as females,

•They have experienced some form of caring situation, usually in family,

•School’s services are doing nothing or little to portray nursing as a possible career for young men,

•Only 14% of male are enrolling into nursing

2.5 Views of male nurses in the nursing profession

2.5.1 Introduction

Several male nurses have over time expressed their views concerning the nursing profession and in most instances they have reported undergoing a role strain. This has greatly implicated their career ambition and put a question as to whether caring is destined for them (Simpson, 2005). A qualitative study conducted by Simpson (2005), Table 2.4,in order to explore the experience of men in non-traditional occupations ,underscored from 40 in- depth interviews, that majority of men feel ” discomfort, embarrassment and shame”.

Many have reported masculinity challenges, including low pay and loss of status. Moreover, in the nursing profession, a good nurse is usually acknowledged by having attributes such as caring, subservience, compassion and kindness (Hicks, 1999). All these attributes are similar to those naturally depicted in females and thus the profession requires an individual with ‘feminine’ traits. Loughrey,M.(2007), Table 2.4 performed a quantitative, non-experimental descriptive design in order to find out the gender role perception of male nurses, for the first time, in Ireland. Following the analysis of this research, out of 104 male nurses, 78 respondents identified themselves as affectionate, sympathetic and understanding, which corresponds more to female gender roles, and that adoption of the characteristics of the female gender role may not be unusual to male nurses.

Hart, K. (2005), Table 2.4, reports on Men in Nursing Survey, that the reality that nursing is traditionally female profession is the main reason why more men aren’t attracted to the profession, according to 38% of respondents. Other key reasons cited were the stereotype that all men in nursing are gay (29 %), poor pay (15 %), and lack of role models (15%). One respondent said that many people think “a man who chooses to spend his career as a staff nurse is a failure or lacks direction”. Many others said that male nurses are perceived as men who ‘flunked’ out of medical school. (Hart, p.48). With these hard-hitting facts, men in nursing view themselves as unsuited for caring task (Wingfield, 2009).

Even more, male nurses have reported not once of being victims of homophobic abuse, some of them state that they have been called dreadful names, such as ‘you faggot this’ while providing nursing care to patients. There are even views of male nurses who feel disadvantaged in life because they decided on a female-dominated profession, which confers a lesser status upon them (McDougall, 1997).

The effect of nurse gender on nurse and patient perceptions of nurse caring were explored by Ekstrom, (1999),Table 2.4, using two matched, Likert-like, and 61 items questionnaires. The results collected from the two groups of 145 nurse-patient gender combination, indicated that caring is not particularly female quality, and that nurse caring can be performed by both genders male and female, from the nurse or the patient perspective. However, men find it difficult to demonstrate caring behaviours suggesting avoidance of self-identification with a feminine stereotype.

According to these views, it is as if humans are perpetually susceptible, incapable of handling their affairs. Undoubtedly, the preoccupation with the harms and hurts of being a male nurse appears at odds with the evidence of men’s masculinity and brisk technological advancement (Furedi, 2003).

2.4 Table

The distribution of the studies regarding the views of the male nurses in the nursing profession

Author/s and setting

Sample and sampling method

Research design/Instrument

Significant findings

Ekstrom,D.N.

(1990)

U.S.A.

•Sample of two 145 nurse-patients combinations, from 5 adult acute care medical centers;

• Random sampling of the patients,

• Mean age of female nurses 35.5

• Mean age of male nurse 36.3,

•Patients had a mean age of 46.4 with a range of 19-82 years.

• Two 61 items-matched Likert like questionnaires:

1. The nurse caring questionnaire,

2.The patient caring questionnaire