Men in Modern Nursing

Men are currently approximately 50% of the American workforce but average less than 10% of all practicing nurses (McMurry, 2011). In response to the perceived current and upcoming nursing shortage, numerous leaders in healthcare have developed a variety of strategies for recruiting, training, and retaining all minorities, including men in the profession. Despite numerous barriers, the literature demonstrates a growing interest by men in this pursuit, describes potential benefits of increasing the male presence in the profession, and provides insights into successful strategies to accomplishing the goals. This training looks at nursing from the American male perspective and describes how to create an environment conducive to increasing the number of men in the profession.

The Bernard Hodes Group's Study

Although slightly dated, the benchmark study of men in nursing that continues to serve as the cornerstone for research on men in nursing was accomplished by the Bernard Hodes Group (2005). This relatively large study was conducted in conjunction with several nursing organizations including the American Assembly for Men in Nursing (AAMN). The mixed method research study was conducted on men who were staff nurses, clinical managers, and educators. The survey was made available to male RN membership of several organizations as well as being promoted on industry websites such as Nursing Spectrum and Nurse Week. A total of 498 respondents completed the 34-question Men In Nursing survey between October 17 and December 15, 2004. Most research accomplished since the report was published references the study, uses it as a launching point, and tends to validate the findings. Due to its level of validity and reliability, this training relies heavily on the Bernard Hodes study.

The Term Male Nurse

Many feel that the term male nurse keeps men away from the profession.

The men surveyed by Bernard Hodes Group (2005) made numerous comments about the term "male nurse" and concerns that using the term adds to the problem. Respondents felt using "men in nursing" is appropriate. Many felt the terms "nursing" and "nurse" are sexist since they refer to lactation – a female-specific attribute and akin to the term "nursemaid." Many hold the sentiment that the name of the profession itself will have to change before true equality can be achieved. Men report equal disapproval with the term "murse' for male nurse.

Although the term male nurse is used in this training for simple convenience and ease of reading, no disrespect is meant to men in the profession. Whenever possible, the phrase "men in nursing" or "nurses" is used. America no longer has firemen, the term firefighters is used. Mailmen are now referred to as mail carriers. O’Lynn and Tranbarger (2007) discuss a study where the number of young men interested in nursing increases dramatically when the name is changed from registered nurse to the gender-neutral title registered clinician (p. 245). However, no title has been suggested that meets the approval of the organizations that would need to support a change from the term "nurse." That remains an open item on the agenda of several key leadership groups.

Demographics of Men in Nursing

The final report from Bernard Hodes Group (2005) provided an overview of male nurses and confirmed the demographics determined by prior and subsequent studies. Because the results mirror and encapsulate the findings of numerous other studies, it is used here to provide an overview of the status of men in the profession of nursing along with their views on the best methods of recruiting, training, and retaining other men in the nursing field. The highlights are expanded upon later in the training and both supported and augmented with additional research studies.

The participants of the Bernard Hodes Group (2005) study were nearly all active RNs, with a small percentage being nursing students. They were primarily Caucasian, with an average age of 44 years. An Associates Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) degrees accounted for the majority of their basic nursing education; one quarter of respondents had earned graduate degrees. The largest percentage of participants were from the Western and Southeast regions of the United States and were considered representative of the population.

The men had an average of 14 years’ experience in the profession and less than five years’ tenure with their current employers. The men entered the nursing profession for much the same reasons as their female counterparts, primarily to help others and for the personal and professional growth opportunities the profession offers. There were numerous comments about being able to make a difference and nursing being a calling, not just a profession.

Perhaps due to their minority status, the male nurses surveyed did not attribute their career choices to the influence of other health care professionals, parents or a lifelong ambition built on an early awareness of career possibilities. Only 20 percent of respondents came to the profession immediately following high school and only 16 percent began to consider a nursing career while 18 years or younger. Many of the RNs plan to return to school for an advanced degree as well as to pursue health care education and other training opportunities.

Why Men Enter Nursing

Boughn (2001) found that women and men both choose nursing as a career in order to help others. Additionally, men were more likely to communicate practical reasons – including salary, job security, career opportunities, and working conditions. The Bernard Hodes Group (2005) revealed that on a scale from 1-5, men rated a desire to help people and growth profession with many career paths as the top reasons male RNs gave for choosing a nursing career. Career stability and a variety of geographic career choices were also rated highly as reasons for an RN career choice. Parental influence, funding and a lifelong ambition were among the least important reasons for their career choice.

One fifth of respondents indicated that their career path progressed from high school directly to a nursing program. Of the remaining RNs, over two fifths came to nursing after another career and 17% came to the profession following military service. Others entered nursing from college (numerous majors) and via the health care field itself (e.g., paramedic, CNA, technician).

A stable career with growth in many career paths, the ability to practice in a variety of geographic areas and a career with few layoffs/downsizings were seen as the top unique selling points of being a nurse. Over four fifths of respondents would encourage their male friends to become nurses. The majority of respondents indicated that they have been successful in recruiting male friends into the nursing profession.

Barriers to Men Entering Nursing

Only 15% of RNs surveyed say they are personally involved in initiatives to attract more men into the nursing profession. Male RNs see the fact that nursing is a traditionally female occupation as the top reason that more men are not attracted to the profession. Other key issues are stereotyping as gay, poor pay and lack of role models/awareness. Eighty-two percent of respondents believe that misperceptions about men in nursing exist and need to be overcome. Chief among the misperceptions are that male nurses are gay, that nursing is a female profession and that men, as a group, are not caring. Stereotyping is seen as the top challenge to men who want to pursue a nursing career.

Stereotyping is seen as the top challenge to men who want to pursue a nursing career.

Family influences, the perception that nursing is not high tech and cultural influences are seen as least challenging to men hoping to become RNs. Male nurses share similar workday dislikes with their female counterparts. Chief among these are: workload/pressure, inadequate staffing and paperwork. Four fifths of respondents indicated that they would become a nurse all over again. Most provided emotional reasons for their choice: their love of what they do and the rewards of helping others. Variety of experience, growth and the stability the profession provides were also mentioned as inducements to "doing it all over again."

Prior to embarking on a career in nursing, respondents perceived the profession as one traditionally dominated by females and not the most appropriate profession for men to enter. Half of RNs felt that they encountered difficulty in the workplace due to being in a traditionally female profession. Nearly 71% of RNs who encountered difficulties in the workplace felt that their female counterparts saw male nurses as muscle. Nearly half found difficulties by being a gender minority and having communication issues with female RNs. Additional difficulties included being seen as failed doctors, being passed over for promotions and sexual harassment.

Meadus and Twomey (2007) explored the literature and identified the primary reasons men are not entering nursing as:

One barrier cited in the literature is the perceptions that most men who nurse are effeminate or gay. According to Jinks & Bradley (2004), little has changed in societal attitudes toward these stereotypes.

LaRocco (2007) identified a trajectory of four linear stages that encompass the path men travel to become nurses:

Each phase has a corresponding theme and various positive and negative aspects that must be encountered and successfully navigated and negotiated. It is unlikely that any two men have the exact same experiences as nurses but many are similar.

Statistics from The Bernard Hodes Group Men in Nursing Survey (2005)*
Overview

85% initially thought it was not an appropriate profession for men.
83% would now encourage their male friends and family members to become nurses.
82% believe that misperceptions about men in nursing exist and need to be overcome.
80% would become a nurse again if given the opportunity.
73% felt nurses were inaccurately stereotyped.
71% felt that their female counterparts saw male nurses as muscle.
57% have been successful in recruiting male friends into the nursing profession.
50% felt that they encountered gender-based difficulties.
49% had difficulties being a gender minority.
48% have communication issues with female nurses.
15% were personally involved in formal initiatives to attract men into nursing.

Reasons Men Chose Nursing as a Career (Scale of 1-5)

4.24 - Desire to help people
4.00 - Growth profession with many career paths
3.67 - Career stability
3.45 - Variety of geographic career choices
2.77 - Fulfill a lifelong ambition
2.55 - Funding
2.12 - Parental influence

Path to Nursing

44% - Second career
20% - After high school
19% - Other (primarily medical specialties such as paramedic, nursing assistant, etc.)
17% - After military service

Top Seven Barriers to Men Entering Nursing

59% - Nursing is a traditionally female profession
53% - Other professions seen as more male appropriate
38% - Nursing remains a female-dominated occupation
29% - Male nurses are stereotyped as gay
15% - Poor pay
15% - Lack of role models/awareness
12% - Cultural influences
4% - Family influences

Top Four Myths about Men in Nursing

51% - Male nurses are gay.
26% - Nursing is a female profession.
15% - Men, as a group, are not caring.
7% - Nursing is not high tech.

Top Three Reason to Recommend Nursing to Other Men

77% - Varied specialties
69% - Varied geographical areas
58% - Few layoffs/downsizings

Major Complaints about Nursing

19% - Workload/pressure
17% - Inadequate staffing
14% - Too much paperwork

*498 respondents completed the 34-question survey.

General Observations from Men in Nursing (Executive Summary)

Respondents in Bernard Hodes Group (2005) reported that after they were trained and working as a nurse, they stayed for the stability, career options, geographic mobility and job security. They indicated that these should be the leading benefits and selling points of the profession to prospective men. Most male nurses would encourage their male friends to become RNs primarily for these reasons and many had been able to recruit male friends and family members into the profession. When asked to reflect on the recruitment methodology they would recommend to reach students in elementary through high schools, most believed that presentations hosted by a male nurse (preferably in a high-tech/trauma unit) would dispel much of the profession’s persistent stereotyping and showcase the dynamic role that nursing plays in the health care field.

For more mature student audiences, it was felt that more information about the profession’s benefits (e.g. compensation, mobility and autonomy) could be added to presentations. Additionally, respondents felt that active imagery portraying the nurse as hero in a high-tech, teamwork driven environment would work best for recruiting males into the profession. Imagery to be avoided included extremes such as egregiously macho symbols and generic, faceless hospital settings with RNs in white uniforms.

The majority of male RNs surveyed felt they had encountered difficulty both as students in nursing programs and as professionals in the workplace. In both arenas, male nurses had found that being a gender minority has given rise to stereotyping and communication issues between the sexes. The men identified the major misperceptions about men in nursing center on the male persona, including being perceived as gay, bad fit within a female profession and an image of not caring.

In response to academic and career difficulties, responding RNs made a number of recommendations to attract men into nursing: more knowledgeable career counselors, school visits showcasing male nurse presentations and media targeted to young males. Responding RNs believed that helping people and the ability to make a meaningful contribution to society are the top rewards of a nursing career and these attributes may well provide key content areas for on-site presentations in schools and media promotions for the profession. The majority of male RNs felt that men are dissuaded from becoming nurses; additionally, few belong to organizations or associations specific to men in nursing. These aspects underscore the need to better articulate the benefits of the profession to male audiences as well as provide more customized content (brochures, flyers, marketing gifts, etc.) for male RN ambassadors to utilize in their recruitment efforts.

Apart from stereotyping and the need for recruitment programs directed specifically at men, RNs share many of the same workday likes and dislikes as their female counterparts. Both genders thrive on providing patient care and making a difference, and both struggle with burdensome workloads, short staffing and extensive paperwork. Nonetheless, four fifths of males surveyed said they would do it all over again. Pride in professionalism is the hallmark of RNs, and male nurses are indistinguishable from their female peers in this regard. While currently a minority, men are as dedicated to improving their own lot within nursing as they are to raising awareness of the vital role all RNs play in the health care field.

Even though men have been providing nursing care to the wounded, ill, injured, and dying members of society since the beginning of recorded history (Evans, 2004), they were not always called nurses and their presence in the female-dominated profession – at least since the 19th Century’s Nightingalian era – has been diminished and the vast majority of their accomplishments in the United States have been overshadowed or erased from nursing history. The reasons for this are numerous, complex, and beyond the scope of this training. More research is needed on this topic and is being accomplished by leading scholars around the nation. When available, it will be presented in future training initiatives.

However, the main points are discussed in the context of how they relate to developing effective strategies for recruiting, training, and retaining men in the field of nursing. The bottom line can be summed up by the words of Meadus and Twomey (2007) when they stated "men defy the traditional image of a nurse – that of angel, sex symbol, doctor’s handmaiden and notably, woman." These along with other inaccurate perceptions and stereotypes remain the largest limiting factor of men being successful in the role of nurse (Anthony, 2004).

The foundation for creating strategies for the best way to approach recruitment, education, and retention issues is to understand the key issues faced by the "invisible" male nurses (Evans, 2004). It is important to make the caveat here that while some men clearly face discrimination (Rangel, Kleiner & Kleiner, 2011), others never or rarely experience or perceive anything except positive acceptance. The reasons for this disparity of experiences are still largely unknown and more research on the topic is indicated. It is likely that the reasons surround personality components, socialization of the male and female personnel involved, and certain characteristics indicative of geographical regions of the country. More details on these are provided later in the training.

What men verbalize is a strong belief that each man makes his own way in the field of nursing and encounters unique situations. There is some evidence that men working in larger metropolitan areas encounter a broader acceptance than those working in rural areas. Additionally, men working in advanced practice, administration, and emergency medicine tend to experience more positive feedback than those working in other areas.

Future Trends for Men in Nursing

Future Trends for Men in Nursing

The U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 published very positive updated information on registered nurses in March 2012 stating that the median salary was approximately $65,000 per year, that there were 2,737,400 jobs with a 26% increase anticipated before the year 2020. The same report indicated that men represent a disproportionately higher rate in leadership positions than do their female counterparts. However, the numbers remain much lower in certain specialties such as obstetrics, gynecology, and pediatrics (Evans, 2004). This is partially because of patient discomfort and partially because of being guided away by nursing school faculty and employers.

The Bernard Hodes Group (2005) reported that the top specialties among male RNs include: critical care (27%), emergency department (23%) and medical/surgical (20%). Other top areas of expertise include middle management (19%), educator (15%), director and nurse practitioner (10% each). Responses in the "other" category included: home health, long-term care and nurse informatics.

In October 2011, the Robert Wood Johnson Foundation and the Institute of Medicine jointly released The Future of Nursing: Leading Change, Advancing Health. The authors referred to it as a blueprint for strengthening nursing care and preparing nurses to lead in the healthcare reform initiatives primarily by increasing the number of nurses with a bachelors degree to 80% and doubling the number of nurses with a doctoral degree by the year 2020. Additionally, they recommend phasing out the diploma nursing programs and increasing second-degree accelerated programs for degree completion. These emerging programs are now enrolling more men than the traditional nursing programs.



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