Notes on (Men in) Nursing

Cover of "Notes on Nursing"
Cover of Notes on Nursing

In the Preface of Notes on Nursing, Florence Nightingale wrote, “…every woman is a nurse.” That men were—or could be—nurses was not within Nightingale’s Victorian worldview. Men were doctors (husbands) and women were nurses (wives and mothers). A re-read of her book revealed to me one place in which she hints at the fact that men could be useful as nurses. It comes mid-way through her chapter “Noise”:

“A man is now a more handy and far less objectionable being in a sick room than a woman. Compelled by her dress, every woman now either shuffles or waddles—only a man can cross the floor of a sick-room without shaking it!”

She goes on to condemn the wearing of rustling silk and crinoline and the creaking of stays and shoes. Presumably she advocated simple (and quiet) cotton dresses for nurses.

As I wrote in my previous blog post “More than a few more men needed in nursing” (12-15-10), nursing continues to be the least gender balanced of any of the health professions. The traditionally male-dominated medical profession has achieved almost perfect gender balance. The other traditionally female-dominated profession of social work now has at least 20% men, while nursing continues to have a paltry  7% men in the workforce.

Until this week I considered myself an enlightened female nurse on the issue of gender diversity in nursing. But then I started looking at the required readings—especially the ones from nursing textbooks—that I had assigned for my community health course. I realized how un-gender neutral they are. All of the contemporary community/public health nurses who are quoted or included in photographs in the chapters are female. An otherwise well-written chapter on the history of public health nursing in the U.S. only mentions female nurses and uses terms like “our sister nurses” and “our foremothers.” Where are our brother nurses and our forefathers?

Important facts I learned this week from reading up on the topic of men in nursing include:

  • Men in nursing have a long and venerable history that is not acknowledged or taught very well in nursing schools. The history includes monastic orders dating back to the fourth and fifth centuries.
  • In the U.S. beginning after the Civil War men were actively shut out of nursing. For instance, the U.S. Army Nurse Corps banned men until 1955. When men were allowed to be nurses they were mainly confined to psychiatric nursing, which was considered dangerous and undesirable work for female nurses.
  • The commonly held perception (and resentment) among female nurses that men in nursing disproportionately get promoted and hold higher-paying administrative positions over their female counterparts does have merit. Economists call this phenomenon the “glass elevator,” and it applies to men in all female-dominated occupations (pink-collar jobs). However, within nursing this could also be partially explained by the fact that most men enter nursing at an older age and after time in another career versus their female counterparts. (see NYT ” More Men Enter Fields Dominated by Women” by Dewan and Gebeloff/5-20-12 and “More Men Trading Overalls for Nursing Scrubs” by Vigeland/3-21-12).
  • The Institute of Medicine’s Future of Nursing report specifically identifies improvement in gender diversity as a necessity for nursing. Running a profession on only half of the population (gender-wise) is unwise and untenable.

My conclusion: Nursing needs the best and the brightest no matter what their chromosomal make-up happens to be. We need more men in nursing. We need better nursing textbooks….

More than a few good men needed in nursing

Walt Whitman and his male nurse Fritzenger
Image via Wikipedia

“Bearing the bandages, water and sponge, Straight and swift to my wounded I go…” Walt Whitman “The Wound Dresser” The Civil War Poems

Walt Whitman was a nurse. My students, and especially the male students, always seem surprised by this fact. Whitman stumbled into volunteer nursing during the Civil War as he went looking for his brother wounded in the war. It is difficult to find reliable statistics on such things, but it is likely that male nurses involved in the war were not unusual.

We need more men in nursing. They don’t have to be poets as well, but we need more men. Whenever we discuss the need to increase diversity in nursing, it needs to include gender diversity. This fact is addressed in the IOM Future of Nursing Report. They point out that all other health care professions have achieved approximately equal gender parity. Even among the traditionally male dominated physicians: 50% of MD graduates are women.  And looking outside of health care to another (at least more recently) ‘female dominated profession’—teachers in public schools, 25% of the teachers are male.

What’s wrong with us? Current HRSA statistics are that only 7% of our RN workforce is male, and our schools of nursing only admit 13% male students. A quick and highly unscientific analysis of the undergraduate students I have personally taught in the past 12 months (close to 300), are that only 8% are/have been male. The current “Master Plan for Nursing” in Washington State where I reside and teach, completely leaves out gender under discussion of the need to improve diversity within nursing. Apart from all of the societal issues of gender stereotypes related to nursing, I do think that the ‘old girl’s network’ of leaders in nursing education is hindering an improvement in gender equity. I think that many of the nursing leaders have an unacknowledged bias against men in nursing. I have seen this played out and even stated in classroom settings, in meetings, in reports, and ‘in private/behind closed doors.’ What are they afraid of? I don’t think that it is a coincidence that there does seem to be a strong age correlation, and the older cohort of nursing leaders tend to have a stronger anti-male nurse bias. But given the ‘advanced age’ of our nursing educator workforce throughout the US, this translates to a big problem for making nursing education more gender-neutral.

The American Academy of Men in Nursing (aamn.org) takes on these and related issues—and they are open to women members as well as men. Their 2010 winners of the “Best Nursing Schools for Men” include Duke, Louisiana State, and University of Pennsylvania. I plan to check out what they are doing right.