By Jamie Kagihara
With the rise of the women’s movement and publications such as Betty Friedan’s The Feminine Mystique, many channels have been made to support and advance women’s progress into traditionally male dominated fields. As women find growing acceptance in stereotypically masculine roles, television series including
Commander in Chief and Grey’s Anatomy portray successful female politicians and physicians comparable to their male colleagues. Interestingly, however, little attention has been dedicated to the challenges men face in entering predominantly female occupations. In the United States nursing remains one of the most female dominated fields (Meadus, 2000). Fewer than 6% of registered nurses are men and, despite a steady increase in the number of male students enrolled in nursing education programs, 85% of men compared to 35% of women either drop out or fail (Evans, 2003). Furthermore, 12% of approximately 300 baccalaureate programs nationwide report, on average, having no men in their graduating classes. Indeed, nursing continues to be perceived as a passive, weak, and feminine career and society has done little to dispel this impression.
For the past twenty years, the healthcare system has been experiencing a severe and threatening shortage of nurses (Allison, 2004). With baby boomers aging at the same time a majority of the nursing population is retiring, the maintenance of efficient health services is imperative (Windham, 2004). Nurses provide the largest percentage of the medical workforce, and nearly every person’s healthcare experience from birth to death involves the contribution of a registered nurse (O’Leary 2003). Currently, over 120,000 positions are unfilled and by 2020 the national deficit is projected to triple to 400,000 (O’Leary, 2003). In fact, due to this deficit, 30 states have already reported a significant lack of medical care, and the inability to provide an adequate nursing force poses a pressing controversy (Allison, 2004). Surprisingly, hospitals and healthcare professionals have only recently begun to turn to males as a labor source that could alleviate this shortage. Compromising a mere 5.4% of the approximate 2 million registered nurses in the U.S., strategies must be developed to reduce sexist barriers which contribute to male attrition rates (Allison, 2004). Ultimately, the obstacles that male students face stem from the belief that nursing is an extension of a woman’s nurturing and caring role in domesticity. While a number of explanations have been proposed to account for this acute under-representation, the most convincing theories cite the lack of male icons in nursing academia, the homosexual stereotype portrayed in the media, and their low socio-economic status (Meadus, 2000; Hereford, 2005). Still, regardless of the numerous factors at blame, the problem is not expected to abate unaided, and society must address the obstacles men face in this arena immediately. If nursing is to provide quality care to serve an increasingly diverse and gender-balanced population, healthcare must expel the image of nursing as a single-sex occupation.
A history of female-governed literature along with the scarcity of male role models in nursing curricula have been repeatedly identified as major contributors to the absence of men. The dramatic decline in the prestige of male nurses began in the 19th century with the Victorian efforts of Florence Nightingale who established schools that did not integrate male and female students (Meadus, 2000). Men were banned from these schools, a tradition which continued into the 20th century, inventing the image of the male nurse as an anomaly (O’Lynn, 2004). As women gradually dominated the field, “she” was constantly used to address the generic nurse, male contributions to the field were completely disregarded, and nursing academia developed in a fashion that was geared completely toward the feminine eye (Meadus, 2000).
The sexist literature employed in most texts and educational settings restricts career choice and furthers the exclusion of male students. Various research concentrated on the experiences and perceptions of nursing students support this by revealing that the most outstanding barriers were the lack of male documentation, insufficient male faculty, and the constant use of the pronoun “she” (Smith, 2006). A study of 111 male students, from 90 nursing schools across the nation, indicated that men did not feel welcome in such clinical settings and were often discouraged by anti-male remarks frequently made by teachers in the classroom (O’Lynn, 2004). Participants reported that they felt concerned with the lack of career advice and counseling, while often sensing that they should ideally pursue occupations that were more socially acceptable and recognized as masculine. Indeed, the mere language in nursing itself advances the presence of men as a deviation from the norm. Women who nurse are simply nurses while men require the title “male nurse” (Meadus, 2000). Egeland and Brown (1988) suggest that the qualifier “male” indicates that they are different, leading to their isolation and compliance to leave the field. Historically, nursing has been documented as an overwhelmingly feminine profession and with the critical lack of male mentors to provide motivation or insight into the actual practices defining nursing, promising male students opt to find careers which are more male-friendly.
In addition to the impediment of a gender biased curriculum, the inaccurate and effeminate stereotype of nursing portrayed in the media is an irrefutable barrier that hinders male attraction to patient care. Since the 1950s, melodramas, sitcoms, and motion pictures have misinterpreted and negatively portrayed the role of the nurse (Hereford, 2005). Nurses were the victims of societal stereotypes, shown to be subservient, obtuse, and often transformed into sexual objects existing solely to satisfy the erotic desires of male physicians (Hereford, 2005). Overall, mere image of a male nurse proved to be an oddity. A study comparing the depiction of nurse character traits to physician traits on fourteen prime time television series from 1950 to 1980, found that physicians were portrayed to harbor higher levels of ambition, intelligence, self-confidence, and sophistication (Hereford, 2005, qtd. in Kalisch & Kalisch, 1986). Further, an investigation comparing 670 nurse and 466 physician qualities in entertainment media (novels, motion pictures, etc.), concluded that the media nurse was predominantly female (99%), Caucasian (95.6%), single (71%) and childless (89.4%) while media physicians were found to be predominantly male (92.5%), more often parents, and presented to be more central to the plot (Hereford, 2005, qtd. in Kalisch & Kalisch, 1987).
Today, nurses are depicted as a blend of these appearances, rarely exposed as competent professionals or respected authorities (Hereford, 2005). In the hit 2000 film Meet the Parents, Ben Stiller’s lead character, a male nurse, is a target of the homosexual stereotype who is conveniently named Gaylord Focker and ostracized as a failed physician. Also, the gay personality Jack (Sean Hayes) in an episode of the popular sitcom Will & Grace finds his “vocation” after hooking up with a male nurse and persuades Karen & Will to fund his training in the profession. Indeed, these flawed and discouraging representations in the media prevent the majority of men from pursing such a career. Current research efforts have found that negative publicity and damaging self-images undermine the self-confidence, beliefs, and values impacting the work of baccalaureate nursing students (Hereford, 2005). When a profession is devalued and ridiculed in entertainment, male nursing students are less likely to consider it as a desirable career choice (Hereford, 2005). Consequently, the success of nursing into the 21st century depends on an accurate portrayal of what nursing entails and why it is indispensable to health care.
The third prevalent factor contributing to male attrition is the low economic status, pay, and value attributed to nursing when compared to conventionally “masculine” work (Meadus, 2000). Nursing has historically been an undervalued and underpaid profession, considering the high level of education, skills and responsibility required (Department for Professional Employees; ALF-CIO, 2006). Trudeau (1996) claims that the financial and economic incentives for women who enter male-dominated occupations are lacking for men who contemplate a career in female identified sectors. Because in this patriarchal society, the average income of men is higher than women, nursing has been perceived as a low-valued profession (Meadus, 2000). Porter-O’Grady (1995) contends the low economic ranking of nurses erroneously reinforces a limited value to the role of nurse. In fact, career questionnaires administered to 126 male high school students and found that most rejected nursing as a prospective career because of their assessments of the poor economic status of nurses (Meadus, 2000, qtd. in Barkely & Kohler, 1992). Sixty-two percent of the students did not think that nurses made high salaries or had an income close to traditionally male occupations. Similarly, Williams (1992) examined the barriers to “male” emergence into three female-dominated occupations: social work, nursing, and teaching. Subjects reported that they felt underpaid relative to male professions and, additionally, suggested that the institution of a “comparable-worthy” policy may aid in attracting more men to these fields (Meadus, 2000). Clearly, the female role has acquired a low value in society and the true impact of a nurse in the medical sphere is not reflected through financial rewards.
Sex stereotypes have become so entrenched in the public eye that practicing male nurses themselves ironically and naively reinforce the stigma they try to escape (Evans, 2003). As male nurses may often feel that their masculinity is threatened, they engage in patronizing practices to heighten the status differential between their female colleagues (Evans, 2003). Men compensate for the belief that they are performing “less valued” work by distancing themselves and creating an exclusive physical space where they can share similarities and affirm one another’s masculine identity. Rather than associate with women nurses, men establish cliques and feel the need to flash their wedding rings or mention their families (Meadus, 2000). Such socialization patterns illustrate the gravity and complexity of the problems facing men. By asserting a hegemonic masculinity, male nurses foster their own isolation and perpetuate their digression (Evans, 2003). The call to end this vicious cycle must happen now. The change is not to disadvantage women, nor to deny the gentle aspects of patient care, but to address and correct the differential treatment of men (Evans, 2003).
Campaigns to increase the documentation of male accomplishments and reduce female specific literature will render nursing as a viable occupation for men. Active efforts require that schools maintain gender neutral classroom and choose textbooks, journals, and exam questions that do not favor the female sex (Brady, 2003). Monitoring the sexist language and connotations toward femininity can help men to feel welcome and accepted in health care settings. Similarly, like many minorities, male students will benefit from the knowledge and experience from successful male role models (Brady, 2003). Nursing programs and baccalaureate schools should employ a higher proportion of male faculty so men can maintain a sense of masculinity while having a mentor to discuss problems that emerge during their educational experience (Evans, 2003). If professional male instructors are not available, nursing schools could implement a mentorship program where men shadow male nurses in local hospitals or invite male professionals to speak at nursing conferences (Brady, 2003). One strategy that is currently being implemented for male students is a complimentary membership to the American Assembly for Men in Nursing through which they can establish relations with clinical mentors (Brady, 2003).
Faculty should also note that male students have different learning styles and ways of coping with problems in the classroom. Consistent with masculine values of autonomy, power, and efficiency, male students often prefer to be independent and self-directed in their learning (Brady, 2003, qtd. in Paterson et. al, 1995). Many men are used to being the “expert” and focused on increasing a status differential, while women are conditioned to counsel and learn from others (Brady, 2003). Instructors must be aware that male students may be reluctant to seek help despite struggling in clinical environments and, thus, appear to be increasingly focused or withdrawn (Brady, 2003).
Additionally, as public perceptions associate nurses with the negative and inaccurate portrayals in the media, nursing organizations and health care officials must become proactive to correct these deceptions. During a critical nursing shortage, the fallacious portrayal of the nurse as a subservient female leads men to decide that nursing is a less respected occupation than medicine (Hereford, 2005). Students are only exposed to the woman nurse who is subordinate to the male physician such that the converse becomes illogical. Consequently, nurses must engage in public campaigns to increase male visibility and convey accurate information about their work’s value. Healthcare programs and medical schools need to depict men as successful nurses in their publicity materials while promotional brochures and advertisement posters should avoid portraying only the female nurse (Meadus, 2000). Promising evidence of a recent study indicates that nurses can have a positive impact by presenting young students with instructive counseling of the real challenges and exciting facets of nursing. In high school, students are looking at their interests and skills, already making decisions about prospective careers based on their perception of what is acceptable (Hoke, 2006). Hoke (2006) presented over 150 students with a discussion of what nurses do, where they work, and how anyone interested in nursing could start an education. The findings provided support that male students’ attitudes could be favorably changed through a simple classroom presentation, steering their interest towards nursing as a career. Also, research conducted by Allison & Beggan (2004) identified that although people showed unfavorable impression of male nurses and favorable impression of female nurses, the source of negativity could be moderated by publicizing nursing’s masculine aspects. After surveying over 250 individuals, their data revealed that the bias against male nurses could be resolved by actively portraying male nurses as (1) average men set at home with wives and an interest in football and (2) men at work who are accepted and admired by their colleagues while receiving public recognition for their accomplishments. Such evidence is both encouraging and demonstrative in that the disdain toward men can be removed by increasing the representation of male nurses as common men tending to masculine duties (e.g., lifting patients onto stretchers and making lifesaving decisions). By embodying male nurses as intelligent professionals with lives comparable to those of fire fighters, physicians, and CEOs, the homosexual and derogatory stereotypes may dissipate.
Equally, however, healthcare programs must acknowledge that gay nurses exist within the profession and should not be alienated in efforts to overemphasize masculinity though projections of heterosexual men. Gay nurses are presumably less susceptible to the gender barriers that affect heterosexual men, yet overwhelming publicity denouncing the stigma of homosexuality may cause them to feel detrimental to the profession and, in effect, a dynamic contributing to the problem. Indeed, homosexual employees and professionals appear amongst many stereotypically masculine vocations and nursing is no exception. Accordingly, professionals and educators should recognize that the removal of the effeminate and homosexual stereotypes does not entail denying the presence of gays. Rather, healthcare programs must illustrate that men who are capable of exhibiting gentle and nurturing characteristics required by nursing can simultaneously be powerful and respected. In this visual culture, when men can be depicted as emotional and caring individuals without denying an innate masculinity, public understanding will follow.
Finally, learning from the success of prior resolutions, a rapid increase in nursing wages and economic status will assist in luring men to the nursing profession. From 2002 to 2004, increased starting wages for registered nurses was followed by a rise of 185,000 in employment (Kirby, 2005). The results of a corresponding national survey from 2002 to 2004 also indicated that job satisfaction and content with career choice showed a marked increase (Kirby, 2005). Further, more nurses suggested that they would definitely recommend nursing as an occupation to qualified high school students (Kirby, 2005). As of 2005, nurse’s wages regained some ground increasing 4.5% while earnings of the labor force as a whole actually fell by 0.3% (Department for Professional Employees; ALF-CIO, 2006). The Health Resources and Services Administration (HRSA) under the U.S. Department of Health and Human Services, recognizing that the nation’s goal of high-quality health care is experiencing a severe deficiency, has utilized the Nursing Supply Model (NSM) to calculate the changes in wages that would attract new entrants. The NSM adds the estimated number of newly licensed registered nurses, subtracts the estimated number of separations, and tracks cross-state migration patterns to calculate an end-of-year estimate of nurses by state (Health Resources and Services Administration, 2004). Assuming each 1% increase in wages increases the number of new nursing graduates by 0.8%, the HRSA states that a continuous 3% annual increase in salary would prevent the shortage from reaching a critical level (FIGURE 1). However, nursing salaries are gradually becoming stagnant and these projected numbers have not led to any immediate action. These small gains are merely short-term solutions and must continue in order to combat future loses. Fortunately, individuals can take matters into their own hands through the growth and establishment of unions. Unions are also very successful strategies to raise and significantly impact wages. Nurses covered by a union contract in 2005 earned 16% more per week than non-covered nurses and, in cities with a strong union presence, salaries are noticeably higher (Department for Professional Employees; ALF-CIO, 2006).
Diversifying and maintaining an efficient workforce is a desirable goal as the growth lag of a predominantly female workforce delivering care to an aging, gender-neutral population is troubling (TABLE 1, TABLE 2). Women are finding success in increasingly more fields, and society can not depend on an unlimited supply of young female students or imported professionals to fill future vacancies. Conclusively, the appeal to and retention of men is essential. Although male students are coerced to believe that nurses cannot be financially successful nor a member of an important profession, health service organizations can and must combat this by assembling several definitive strategies. All social outlets which affect popular perception, especially educational literature and the media, should eliminate the use of exclusively female entities, while government policies must focus on providing economic rewards which echo the magnitude of nursing in quality patient care. Once society recognizes the male nurse as a successful, intelligent man with the capacity to excel in traditionally feminized roles, men will thrive in nursing schools and the threatening shortage expected to afflict the nation will subside.
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