The current role of men is ambiguous in a female-dominated nursing profession (Abushaikha et al., 2014; Smallheer et al., 2020) due to preconceptions of nursing care as an authentic role for women. Although male nurses may provide varied and unique contributions, their numbers remain scarce in nursing practice (Mott & Lee, 2018; World Health Organization, 2020). A great deal of literature focuses on core issues of diversity in an attempt to include more male nurses in the nursing sphere. To date, few texts have been published that explore the position of men in the caring discipline. Hence, the current Commentary aims to provide an exposition on the birth, nature, trends, and trajectories of men in nursing. It is hoped that this critical theory-driven piece will shed light on the burgeoning yet interesting field of gender neutrality, intersectionality, philosophy, and trajectories for the male nurse.
Male Domination in Early Nursing
The historical position of men in nursing can be traced back to the pre-Nightingale era. The dominance of power and religion in history has also asserted the position of men in nursing. Males are usually portrayed as healers and providers of the sick. For instance, the Christian holy scriptures' parable of a Good Samaritan underscores a story of a male person caring for his ailing fellow (Johnson et al., 2015). With these classical influences, there is no doubt that the first school for male nurses was established in India during 250 B.C. (Lim & Sanchez-Vera, 2013). Likewise, in ancient tribes, caring for the sick was a role designated to male shamans (Roux & Halstead, 2009). In early Greek civilization, public health care was provided by men (Anderson & Zinsser, 2000). During the religious wars and age of the crusades, male military knights (e.g., Knights Hospitaller, Knights of St. Lazarus, Nosocomi) established institutions for the sick while offering aid and medical care for pilgrims and soldiers off-site (Cartwright, 2018; O'Lynn & Tranbarger, 2007; Schrader, 2020). The story of the Alexian Brothers of Nursing, a Catholic religious order, interestingly provided concretized status for a masculine figure in nursing (Wall, 2009).
It was not until the time of modern nursing that the gender shift in nursing started to favor feminist perspectives. Florence Nightingale, along with her colleagues in nursing education and sanitary reform, believed that (formerly) “unskilled” men were not fit to caring roles and had no place in nursing except for duties requiring physical strength (Summers, 1988). Nightingale's era coincides with periods of recovery and expansion during which women were homebound in a patriarchal society (Garbaye, 2015), and men were provided with more privilege, political rights, and position in the community. Although men occupied top hierarchies, they became subaltern (i.e., of lower status) and othered (Kirkham & Anderson, 2010) in the field of nursing. The successful development of “sisterhood”' generated wide discrepancies in gender association in nursing.
There is a stream of thought about whether male individuals want to dis-associate themselves in health caring roles or whether there is a brewing perception that responsibilities linked to nursing care are inappropriate for the male cohort. Nursing connotes a nurturing role similar to the role of a mother caring for her young. During the time of Nightingale and “White nursing women” (Baker et al., 2012), the emphasis was more on positivistic inquiry and hard sciences, which are both linked to concepts of masculinity. Concurrent with the relevant and rousing works of Florence Nightingale, the position of a male in nursing is gradually dissipating. The gender imbalance in nursing favoring women has cultural and long-standing origins.
Conflicts and Oppression from Emancipatory Lens
Men's re-entry into nursing since modern nursing has provided several challenges and misconceptions on issues related to oppression and disregard. Gender differences in occupations are universally evident across geographic boundaries and cultures, more so in formal health care professions (Tay et al., 2019) that offer the basic need for wellness. Males are thought to have a greater tendency to seek jobs as channels to enhance their social status, gain high-impact outputs, and attain leadership positions, whereas females tend to sociolocate themselves (Burton, 2016) and emphasize communal behaviors in search of affiliation and affinity in workplaces (Adams et al., 2015). Due to these concepts, few males in caring roles remains a static scenario (Whitford et al., 2020).
The contemporary rationale for a male persona to enter nursing has evolved from its novice beginnings. Men, although relatively few, choose nursing at present because of its associated income security and stable employment; however, they are not spared from negative preconceptions. In current times, male individuals inherit complications related to gender identities and binary gender classifications (Riches & Salih, 2011), while experiencing oppression, gender discrimination, and marginalization. In historical times and now, male nurses have been labeled as He-Man, incompetent, and/or troublemakers (Budu et al., 2019; McKinlay et al., 2010), and appear to be deficient and lacking in not assuming or achieving the roles of a physician or a health care manager (Ku, 2011). There is sufficient literature suggesting that gender discrimination exists in nursing against men (Kovner et al., 2018). Little is known whether male nurses will assume the “outsider-within” status and self-definition similar to Black feminist thought (Collins, 1986); that is, whether men in nursing will be in an advantageous position to shape nursing in the future. Knowing the advantages given to men in today's society, there is potential for men to be equally successful in the health care nursing field.
The tenets of emancipatory knowledge are sufficient to also acknowledge the demise of the status of men in contemporary nursing literature. This scenario seems to replicate itself in the mainstream knowledge development and philosophy building earlier in the field. Significant paradigms and theories grounded in Heideggerian phenomenology in modern nursing science, as summarized in an article by Earle (2010), are legacies of female scholars. By and large, there are few male nurses who noticeably dominated the universal science literature of caring in the past centuries. Although the number of publishing male scholars is increasing, their research topics focus more on the hard science and nursing integration with other hard science disciplines (e.g., informatics) and STEM-based courses of inquiry.
The marginalization of men in nursing schools is somewhat extant and discouraging. Literature suggests several contributing factors for nursing entry among males, such as the refusal of school admission entry (Evans, 2004), inconsistent policies, and legal restraints (Mackintosh, 1997). Male students are bound to encounter social stereotypes, the challenge of intimate care to patients of the opposite sex (Stokowski, 2012), the bias in teaching pedagogy, bias in exemplars from learning resources, and lack of dominant male reference (Barrett-Landau & Henle, 2014). Many men are noticeably experiencing challenges in navigating and staying in undergraduate nursing education and academia (Mott & Lee, 2018).
Gender Neutrality and the Way Forward
Current trends and issues in health care demand an increased health care workforce. The current shifts in nursing and increasing heterogeneity of clients in health care also require more diverse and gender-neutral nurses. The quality and quantity of health care may help break existing health disparities. After all, health is a basic need. In addition, our industry transition to the fourth industrial age requires a synergy of skills and behavior sets from male and female nurses to sustain nursing while keeping it “grounded” in patient care.
Much has to be done to make nursing appealing and welcoming to men. The potential solution to a more gender-neutral profession might rest on the cautious modern application of the Marxist philosophical concept of conscientization (i.e., use of critical thinking and consciousness to understand root cause of inequality) (Cloke et al., 2020). To achieve such equality, redefining nursing in contemporary practice based on the dynamics of the current community and societal requirements must be embedded in our core. Diversity must be considered similar to female individuals being accepted in workspaces traditionally dominated by men. There is a need to explore uncharted philosophies on social justice—redistribution, recognition, and parity of participation (Bickford, 2014) as applied to the male cohort. Breaking barriers in delimiting opportunities for men is also necessary.
There is no doubt that recreating space for men in nursing will open opportunities for nursing and health care. Studies using a positivist approach and more emphasis on hermeneutics may uncover several uncharted philosophies and areas of concern for men venturing into nursing that will eventually help sociologists and philosophers understand their unique roles. Although men have experienced changing roles throughout the course of development of nursing from novice to what it is today, they offer unquestionable impact to contemporary nursing as a male-being-in-the-world and as a caring person.
Michael Joseph S. Diño, PhD, MAN, RN, LPT
Director, Research Development and
Our Lady of Fatima University
School of Nursing, Johns Hopkins University
- Abushaikha, L., Mahadeen, A., AbdelKader, R. & Nabolsi, M. (2014). Academic challenges and positive aspects: Perceptions of male nursing students. International Nursing Review, 61(2), 263–269 doi:10.1111/inr.12098 [CrossRef] PMID:24666351
- Adams, R. B. Jr.. , Hess, U. & Kleck, R. E. (2015). The intersection of gender-related facial appearance and facial displays of emotion. Emotion Review, 7(1), 5–13 doi:10.1177/1754073914544407 [CrossRef]
- Anderson, B. S. & Zinsser, J. P. (2000). A history of their own: Women in Europe from prehistory to the present (rev. ed). Oxford University Press.
- Barrett-Landau, S. & Henle, S. (2014). Men in nursing: Their influence in a female dominated career. Journal for Leadership and Instruction, 13(2), 10–13.
- Bickford, D. (2014). Postcolonial theory, nursing knowledge, and the development of emancipatory knowing. Advances in Nursing Science, 37(3), 213–223 doi:10.1097/ANS.0000000000000033 [CrossRef] PMID:25102212
- Budu, H. I., Abalo, E. M., Bam, V. B., Agyemang, D. O., Noi, S., Budu, F. A. & Peprah, P. (2019). “I prefer a male nurse to a female nurse”: Patients' preference for, and satisfaction with nursing care provided by male nurses at the Komfo Anokye teaching hospital. BMC Nursing, 18(1), 47 doi:10.1186/s12912-019-0369-4 [CrossRef] PMID:31641337
- Burton, C. W. (2016). The health needs of young women: Applying a feminist philosophical lens to nursing science and practice. Advances in Nursing Science, 39(2), 108–118 doi:10.1097/ANS.0000000000000119 [CrossRef] PMID:27149225
- Cartwright, M. (2018, August24). Knights hospitaller. Ancient History Encyclopedia.
- Cloke, P., May, J. & Williams, A. (2020). Post-secularities of care: In-common ethics and politics of “the meantime(s).”Cities (London, England), 100, 102667 doi:10.1016/j.cities.2020.102667 [CrossRef]
- Collins, P. H. (1986). Learning from the outsider within: The sociological significance of black feminist thought. Social Problems, 33(6), S14–S32 doi:10.2307/800672 [CrossRef]
- Earle, V. (2010). Phenomenology as research method or substantive metaphysics? An overview of phenomenology's uses in nursing. Nursing Philosophy, 11(4), 286–296 doi:10.1111/j.1466-769X.2010.00458.x [CrossRef] PMID:20840140
- Evans, J. (2004). Men nurses: A historical and feminist perspective. Journal of Advanced Nursing, 47(3), 321–328 doi:10.1111/j.1365-2648.2004.03096.x [CrossRef] PMID:15238127
- Garbaye, L. (2015). Female and male activism for women's rights in eighteenth-century America and France. XVII-XVIII, 72, 213–230 doi:10.4000/1718.371 [CrossRef]
- Johnson, K. A., Memon, R., Alladin, A., Cohen, A. B. & Okun, M. A. (2015). Who helps the Samaritan? The influence of religious vs. secular primes on spontaneous helping of members of religious outgroups. Journal of Cognition and Culture, 15(1–2), 217–231 doi:10.1163/15685373-12342147 [CrossRef]
- Kirkham, S. R. & Anderson, J. M. (2010). The advocate-analyst dialectic in critical and postcolonial feminist research: Reconciling tensions around scientific integrity. Advances in Nursing Science, 33(3), 196–205 doi:10.1097/ANS.0b013e3181e4a7d3 [CrossRef] PMID:20693830
- Kovner, C. T., Djukic, M., Jun, J., Fletcher, J., Fatehi, F. K. & Brewer, C. S. (2018). Diversity and education of the nursing workforce 2006–2016. Nursing Outlook, 66(2), 160–167 doi:10.1016/j.outlook.2017.09.002 [CrossRef] PMID:29037502
- Ku, M. C. (2011). When does gender matter? Gender differences in specialty choice among physicians. Work and Occupations, 38(2), 221–262 doi:10.1177/0730888410392319 [CrossRef]
- Lim, F. A. & Sanchez-Vera, L. (2013). The nurse in the man: Lifting up nursing or lifting himself?Nursing Management (Springhouse), 44(6), 12–14 doi:10.1097/01.NUMA.0000430409.96077.e6 [CrossRef] PMID:23698331
- Mackintosh, C. (1997). A historical study of men in nursing. Journal of Advanced Nursing, 26(2), 232–236 doi:10.1046/j.1365-2648.1997.1997026232.x [CrossRef] PMID:9292355
- McKinlay, A., Cowan, S., McVittie, C. & Ion, R. (2010). StartStudent nurses' gender-based accounts of men in nursing. Procedia: Social and Behavioral Sciences, 5, 345–349 doi:10.1016/j.sbspro.2010.07.102 [CrossRef]
- Mott, J. & Lee, O. D. (2018). Navigating unfamiliar waters: Men in nursing academia. Journal of Professional Nursing, 34(1), 42–46 doi:10.1016/j.profnurs.2017.07.005 [CrossRef] PMID:29406137
- O'Lynn, C. E. & Tranbarger, R. E. (2007). Men in nursing: History, challenges, and opportunities. Springer.
- Riches, S. & Salih, S (Eds.). (2011). Gender and holiness: Men, women, and saints in late medieval Europe. Taylor & Francis.
- Roux, G. M. & Halstead, J. A. (Eds.). (2009). Issues and trends in nursing: Essential knowledge for today and tomorrow. Jones and Bartlett Publishers.
- Schrader, H. (2020). The forgotten military order: The Knights of St. Lazarus. https://www.defenderofjerusalem.com/knights-of-st.-lazarus.html
- Smallheer, B., Morgan, B. & Stern, R. (2020). A historical look at men's involvement in nursing and leadership in GAPNA. Geriatric Nursing, 41(1), 52–53 doi:10.1016/j.gerinurse.2020.01.003 [CrossRef] PMID:32044147
- Stokowski, L. (2012, August16). Just call us nurses: Men in nursing. https://www.medscape.com/viewarticle/768914_1
- Summers, A. (1988). Angels and citizens: British women as military nurses, 1854–1914. Routledge & Kegan Paul.
- Tay, P. K. C., Ting, Y. Y. & Tan, K. Y. (2019). Sex and care: The evolutionary psychological explanations for sex differences in formal care occupations. Frontiers in Psychology, 10, 867 doi:10.3389/fpsyg.2019.00867 [CrossRef] PMID:31057471
- Wall, B. M. (2009). Religion and gender in a men's hospital and school of nursing, 1866–1969. Nursing Research, 58(3), 158–165 doi:10.1097/NNR.0b013e3181a308fe [CrossRef] PMID:19448519
- Whitford, H. M., Marland, G. R., Carson, M. N., Bain, H., Eccles, J., Lee, J. & Taylor, J. (2020). An exploration of the influences on under-representation of male pre-registration nursing students. Nurse Education Today, 84, 104234 doi:10.1016/j.nedt.2019.104234 [CrossRef] PMID:31707252
- World Health Organization. (2020). State of the world's nursing 2020: Investing in education, jobs, and leadership. https://apps.who.int/iris/handle/10665/331677
- Zhang, W. & Liu, Y.-L. (2016). Demonstration of caring by males in clinical practice: A literature review. International Journal of Nursing Sciences, 3(3), 323–327 doi:10.1016/j.ijnss.2016.07.006 [CrossRef]