Professional Pathways: Opening Doors for Men in Nursing
From 2002 to 2009 the nursing profession has grown by 62% (Macwilliams, 2013). Bowman (2020) reported that from 1960 to 2020 men in nursing increased from 2% to 13% of all U.S. nurses. The Bureau of Labor and Statistics reports a need for 3.19 million nurses by 2024. Men have historically been underrepresented in nursing, including roles in nursing education. With the increased demand for RNs, health care providers and academia must ensure an inclusive environment for everyone, no matter the gender. This article will explore the data on male nursing school enrollment and strategies to enhance recruitment of men into nursing. Also, this article includes the personal journey of one male nurse leader.
Nursing education
The challenge of recruiting and retaining a diverse popula-tion of men in the nursing profession begins in the nursing academic environment. According to the American Association of Colleges of Nursing (AACN) (2020a), during the period of August 1, 2018, to July 31, 2019, only 47,309 (12.7%) males were enrolled in undergraduate nursing programs. In graduate nursing programs during this time period, there were 17,608 (12%) males enrolled in master’s, 4,993 (13.8%) enrolled in doctor of nursing practice (DNP), and 509 (11.1%) enrolled in a research-focused doctoral degree program. Of the graduates from August 1, 2018, to July 31, 2019, 18,308 males (12.7%) earned an undergraduate baccalaureate degree, 5,894 (11.8%) earned a master’s degree, 1,043 (13.1%) earned a doctorate of nursing practice, and 79 (9.8%) earned a research-focused doctoral degree (AACN, 2020a).
The male nursing enrollment and graduation data may be reflective of the challenges reported by male nursing students. As a minority within the profession, Macwilliams and Bleich (2013) reported that male nursing students experience higher rates of attrition than female nursing students, experience higher levels of role strain, and loneliness and isolation (Macwilliams & Bleich, 2013). Researchers have identified barriers such as frequent references to “she” in lectures and textbooks; lack of male nurses in textbooks; little to no content on male contributions to the history and profession of nursing; gender-related bias in obstetric rotations; anti-male remarks made by nursing faculty and practicing nurses; and lack of male role models and mentors (Macwilliams & Bleich, 2013; O’Lynn, 2004). Male nursing students have expressed fear of “suspect touch” when caring for female nursing students, with little to no nursing content in lectures or textbooks addressing this. Negative influences on gender diversity in nursing are evident when nursing faculty place males under closer scrutiny, do not understand or accept the manner in which males engage in caring behaviors and express emotions or the ways in which men self-reflect on their practice. Men in nursing can be reluctant to seek support and sometimes engage in a less expressive form of self-reflection that may be assumed as non-caring by female colleagues. Men may be reluctant to engage in caring touch due to concerns about the touch being interpreted as inappropriate. In addition, faculty sometimes have the expectation that male nursing students should be assertive, act as leaders and take on the lifting tasks for the female students (Macwilliams & Bleich, 2013).
African American male nursing students experience similar challenges to white male students; however, some challenges are attributable to race. Patterson (2020) reported additional challenges experienced by African American male students such as being the only Black male in the class, clinical group or sometimes in the hospital setting (feelings of alienation, loneliness and social isolation), overcoming financial struggles, being excluded from study groups and social events, experiencing insensitive racial jokes and implicit biases, and lack of black male faculty.
Male academic faculty can experience a “glass ceiling” within the predominately female nursing academic environment. AACN (2020b) reports of the 783 nursing school deans in the country, only 46 (5.9%) are males. The largest number of male deans reported was in 2014, but that number amounted to only 6.2%. Male faculty also are underrepresented in nursing academia. Of the 21,622 faculty reported, 1,528 (7.1%) were male (AACN, 2020b).
Men in nursing academia have similar experiences to male nursing students. Male academic faculty report feeling isolated, desire more male role models in nursing academic administration and need mentors to assist with navigating the unfamiliar environment and culture of academia. Mott and Lee (2018) reported that male nursing faculty enter academia for the same reason as females—the desire to teach, motivated by the ability to shape the future of nursing. Male nursing faculty have a limited peer group and lack of male mentors to understand practices such as promotion, tenure and securing a program of scholarship and research. Male faculty also express concerns with interacting with female patients and female nursing students due to the “hidden thread of sexual conflicts” (Mott & Lee, 2018). Male faculty reported feeling the need to leave the door open when meeting alone with female nursing students. Male faculty experience unconscious and implicit gender bias within academia. Male nursing faculty report that differences in communication and the manner in which men think may not be appreciated for their diversity (Mott & Lee, 2018). Males may engage in a manner of direct communication that is succinct and expressive with minimal wording. This can be interpreted as aggressive communication by some individuals.
A Journey to Nursing Leadership
My 14-year journey as a male RN will help shed light on the barriers faced by men in nursing; some are easily recognized, but need a robust collective effort to dramatically change. Growing up in the 1980s and 1990s in rural North Carolina, I did not see any men in nursing. In fact, my only interactions with nursing—the female school nurse and the female nurses who cared for my great-grandmother when she had a massive stroke—reinforced this image. At that time, momentum for equal rights for women was in focus. All-male military schools had to admit women in order to receive public funding; women were delaying marriage and children, pursuing higher education, joining the workforce, and assuming independence and identities outside of the home. This increased women’s economic power and entry into male-dominated professions. By 1995, women reported earning half or more of the household income. The decades were rife with female pioneers: Sally Ride, Geraldine Ferraro, Janet Reno, Carly Fiorina and Madonna were trailblazing pathways for women (Yarrow, 2018). However, I did not see a corresponding movement for men to move into typically female-dominated careers. TV shows such as M*A*S*H, which had an all-male doctor and all-female nurse portrayal, gave way to shows like ER which had male and female doctors, but the nurses portrayed remained largely female.
Discovering nursing
Divine intervention led me to nursing. During my first career as an electrical journeyman, I found myself a single father of two children. I needed to stop traveling out of town to work, which led me back to college to be a teacher. First semester in Spanish 101, I met a male nursing student who opened my eyes to men in nursing. Despite strange looks from other men who heard I was going to be a nurse, I pushed forward because I knew I had found my purpose. I was fortunate to have three other men in my nursing class that made it to graduation. I was pleasantly surprised to find other males from similar backgrounds who had chosen nursing as a second career. Our books, the instructor’s education style and projects were geared to a female audience as evidenced by references to the nurse as “she” or “her.” In addition, only female references were made when discussing nurse engagement in provision of care. All the core faculty were female. Within our small group of male classmates, we felt no one else could truly understand our perspective on being a nurse.
Entering the nursing workforce as a male was exciting and intimidating. The experience created an empathy and support for those that deal with being a minority in other situations. My organization and work family were particularly supportive of my success. I tried every day to bring a strong work ethic, positive attitude and willingness to take on the most challenging assignments to rapidly improve my clinical skills. I transitioned the same mindset into leadership when given the chance, which led to my current director level position.
Challenges on the path
All along the way, my remarkable female colleagues helped open doors and push me to be the best I could be. I’ve had some great friendships with female colleagues that I would never replace. However, there were some that made me feel unwelcome to the field. When I pushed for challenging work, some of my supervisors placed me in assignments meant to sharpen and grow my clinical skills, while others placed me in assignments to take patients few female nurses wanted to care for. These assignments typically are behavioral health and/or patients with the greatest BMI. Male nurses I’ve met across multiple venues agree we want to take on more than our share of these patients, feeling a need to shield our female colleagues from the physical and mental burdens this type of patient can present. However, a constant stream of these patients can be draining. Professional relationships with female nursing colleagues also can be a challenge for male nurses. Rumors of romantic relationships can have traumatic effects on a male and female nurse who are a great work team.
As a supervisor I was concerned about being in a room with a woman alone. I had been warned early on to always keep the door open. When a female team member came to tears, my natural reaction was to place an arm on her shoulder. Early on, I spent a great deal of time just trying to figure out how to best console a female team member. It was very challenging. After much trial and error, I learned the best path forward was to be genuine, be mindful of personal space, and know your team members and their preferences.
Looking toward the future to meet nursing workforce demands, nursing must advocate for additional research in an effort to target, attract and retain male nurses. Local efforts are likely to influence young men to consider nursing as a career.
To my female nursing colleagues, thank you for all you have done to support men in nursing. You certainly are the pillars that gave nursing its foundation. Continue to push for nursing to be an inclusive profession. Be aware of what it feels like to be the only person of a different gender in the room. Seek to engage men in nursing in the improvement efforts in your units, facilities and organizations. We stand ready to help.
To my male nursing colleagues, thank you for having the courage to enter a female-dominated profession. Realize you are continuing to pave a path forward for the future of nursing. You are pioneers and can make a difference. Be a role model to other male nurses. Join a local nursing organization, partner with local schools and talk with students about what being a nurse means to you. Partner with schools of nursing to develop research and create changes in academia to support gender diversity in the art and science of patient care. Together we are stronger.
David Beasley, MHA, RN, NE-BC, FACHE
Recruiting men
Recommendations for recruitment of men in nursing:
About the Authors
Demetrius J. Porche, DNS, PhD, FNP, FAAN, is dean and professor, Louisiana State University Health – New Orleans, School of Nursing.
David Beasley, MHA, RN, NE-BC, FACHE, is director of nursing at Novant Health Kernersville Medical Center in North Carolina.