Oh, Florence, What Did You Do? Where Did the Male Nurses Go, and Where are They Headed?
February 24, 2013
Dawn Horvath
A Brief History
Every year nurses and nurse educators around the world celebrate Florence Nightingale’s birthday on May 12th. The “lady with the lamp” during the Crimean War is commonly thought of as the “founder” of professional nursing, and nursing has definitely been known as a woman’s profession since Nightingale’s reign, but what about the Parabolani Brotherhood in Rome in the third century? Or the Knights Hospitalers of St. John of Jerusalem, the Teutonic Knights, and the Knights of Lazarus comprised of brothers in arms who provided nursing care to their sick and injured comrades during the Crusades? What of the Alexian Brotherhood, organized in 1431, which was a knighthood order of the Middle Ages originally created to carry the wounded from the battlefield and provide care? 1
In more modern times, male nurses served both the Confederate and Union armies during the Civil War. The Confederate Army assigned thirty men in each regiment to care for the wounded–a prelude to modern combat medics. The Union also had its force of male nurses, perhaps most notable was Walt Whitman. 1 Female Union nurses, however, seem to have achieved much more lasting fame. “Clara Barton, Mary Ann Bickerdyke, and Dorothea Dix “were mostly volunteers who simply managed to outlast the doctors who opposed them,”2and are names we recall easily from history lessons.
A few years before the American Civil War, in 1854, Nightingale and her team of 38 volunteer nurses were sent to modern-day Istanbul to tend to soldiers during the Crimean War. Based on her experiences there, on her return to England, she laid the foundation of professional nursing with the establishment, in 1860, of her nursing school at St Thomas’ Hospital in London, the first secular nursing school in the world, now part of King’s College London.3 Her legacy continues as The Nightingale Pledge, named in her honor, is taken by new nursing school graduates every year, assuring her place at the forefront of nursing history.
At the turn of the century, female nurses started to organize. In 1896, delegates from ten alumnae associations met at Manhattan Beach Hotel, near New York City, for the purpose of organizing a national professional association for nurses. In 1897, the constitution and bylaws were completed, and the Nurses’ Associated Alumnae of the United States and Canada was organized. The Nurses’ Associated Alumnae of the United States and Canada had their first annual meeting in 1898. In 1901, The Nurses’ Associated Alumnae affiliated with the American Society of Superintendents of Training Schools for Nurses to form the American Federation of Nurses for the purpose of applying for membership in the National Council of Women. In 1911, The Nurses’ Associated Alumnae changed its name to the American Nurses’ Association. It wasn’t until 1930, as the result of a bylaw amendment, that provision was finally made for male nurses to become members of the American Nurses’ Association.4
Today there are 2,909,357 licensed registered nurses in the United States. Approximately 168,181 are men which represents about 6% of the total nursing population.5 (Representation of male nurses in the military is much higher even though men were excluded from serving as nurses when the Army Corp of Nurses was founded in 1901 and not permitted back into the military until after the Korean War. In the Army, 67% of CRNAs are men, 40% of the OR nurses are men, 34% of ED nurses are men, 29% of critical care nurses are men and 39% of medical/surgical nurses are men.)1
Why are men such a minority in the field of nursing? And why has this trend continued for so long?
The Issues
In nursing school classes nationwide, male student populations remain small, and while equality for all students is the goal, male students must be prepared for challenges they may encounter in classes, clinicals, and practice. The American Assembly for Men in Nursing is an organization that can trace its origins to 1971 and is committed to encouraging men of all ages to become nurses and join together with all nurses in strengthening and humanizing healthcare; supporting men who are nurses to grow professionally and demonstrate to each other and to society the increasing contributions being made by men within the nursing profession; advocating for continued research, education and dissemination of information about men’s health issues, men in nursing, and nursing knowledge at the local and national levels; and supporting members’ full participation in the nursing profession and its organizations and using the Assembly for the previously stated objectives.6
AAMN commissioned the Bernard Hodes Group, in 2005, to conduct a study around the issue of the small percentage of men in nursing; 498 men participated in the study. In the study the special challenges to men who wanted to pursue nursing careers were primarily:
[fivecol_four]
Fighting stereotypes
Entering a traditionally female profession
Other professions being seen as more appropriate for men
Lack of male role models/mentors
[/fivecol_four] [fivecol_one_last]
73%
59%
53%
42%
[/fivecol_one_last]
The top three reasons the participants gave for choosing a nursing career were a desire to help people, a growth profession with many career paths, and a desire to have a stable career. What is interesting to note is that in this study almost half of the men surveyed chose nursing as a second career (44%) and an equal amount (45%) planned to return to school for an advanced degree. 7
Though men represent only [about 6%] of the U.S. nursing workforce, the percentages of men in baccalaureate and master’s nursing programs are 11.4% and 9.9%, respectively. In doctoral programs, 6.8% of students in research-focused programs and 9.4% of students in practice-focused programs are men.8
Whether working toward their education or career goals, men reported similar challenges. While attending a nursing program, men listed difficulty of being a minority gender (57%); males nurses seen as “muscle” by female nurses (56%); men being perceived as “not caring” (51%); and communication issues with female counterparts (32%) as the top issues. In the workplace, similar trends were reported with male nurses seen as “muscle” by female nurses at the top with 71% with difficulty of being a minority in terms of gender (49%); communication issues with female counterparts (47%); and men being perceived as “not caring” (34%) rounding out the top four.7
The “muscle” issue is significant, because as male students are expected to do the heavy lifting on a floor, they often do it at the expense of their own assignments.9With regards to “caring,” the issue is most likely not that male nurses lack caring, but perhaps that they demonstrate a different caring style.9
Four fifths of the men surveyed believed that misperceptions about men in nursing existed and needed to be overcome. Chief among the misperceptions were that male nurses are homosexuals (51%), nursing is a female profession (26%), and men are not caring (15%).7
With widely reported shortages of nurse educators and professionals by 2025, the nursing profession must consider the needs of its more masculine side. How often do we see the term “she” when referring to a nurse, even in textbooks? This article, in some ways, perpetuates the delineation as it distinguishes “male nurses” from the rest of the population in its title. Will we ever get to a point when we simply refer to all members of the profession as nurses?
In academic settings, the drop-out rates for most university professional programs hover around 46%. The drop-out rates for men in nursing education programs have, at times, approached 100%.9Nurse educators need to continue improving recruitment and retention of male nursing students and must consider what steps need to be taken to reduce bias. While some may argue that female patients may have concerns being treated by a male nurse in an Ob/Gyn setting, do we consider that a male patient may prefer a male nurse when discussing conditions relating to sexual and reproductive health?
“’Patients are much more receptive to health care providers of similar cultural and ethnic backgrounds, and that may well translate to gender as well,’” says Vernell DeWitty, PhD, MBS, RN. “DeWitty is deputy director of New Careers in Nursing, a program funded by the Robert Wood Johnson Foundation (RWJF) that supports students in accelerated baccalaureate and master’s nursing programs, which tend to attract relatively high numbers of men.”10
Equality across all nursing specialties should be the goal which is why AAMN has created 20×20: Choose Nursing.6 With men comprising only 12% of the students in BSN programs,11 the goal is to have 20% male enrollment in nursing programs throughout the United States and the world by the year 2020.
“Men account for only 5% of full-time faculty teaching at baccalaureate and higher-degree schools of nursing, and only 4.5% of the nation’s 838 nursing schools deans are men, according to the American Association of Colleges of Nursing (AACN).”11 With such low numbers it’s no wonder that role models are lacking, and young males may not effectively be made aware of career opportunities in nursing that are available to them.
Sources
1http://www.malenursemagazine.com/historyofmalenurses.html
2http://scrubsmag.com/a-tribute-to-men-in-nursing/
3http://en.wikipedia.org/wiki/Florence_Nightingale
4http://www.nursingworld.org/FunctionalMenuCategories/AboutANA/History/BasicHistoricalReview.pdf
5Dept. of Health and Human Services, Office of Minority Health, 2009..
7http://aamn.org/docs/meninnursing2005survey.pdf
8http://www.aacn.nche.edu/news/articles/2012/enrollment-data
9http://ijahsp.nova.edu/articles/Vol9Num2/pdf/Wolfenden.pdf
12http://www.amsn.org/cgi-bin/WebObjects/AMSNMain.woa/wa/viewSection?s_id=1073744077
13http://www.discovernursing.com/
14http://thefutureofnursing.org/IOM-Report
Contributors
Michael M. Evans, MSN, MSEd, RN, ACNS, CMSRN, CNE is an instructor of Nursing at Penn State Worthington-Scranton, where he primarily teaches in the RN to BSN program. He also maintains his clinical skills through his per diem work at Moses Taylor Hospital in the Pediatric Unit. He earned his undergraduate degree from Penn State Worthington Scranton, his MSN in Adult Health with a sub-specialization in nursing education from Misericordia University, and his MSEd with a focus in Professional Studies from Capella University. His research interests include nursing interventions to improve glycemic control in adults with diabetes mellitus and innovative teaching strategies to improve student outcomes.
Pamela Gardner, MSN, RN, graduated from Fitchburg State College in Massachusetts with a BSN and began her career in the Neonatal ICU at Johns Hopkins. She and her husband then moved to Missouri where she worked in Iowa as director of a community OB department. She received her MSN (maternal/child and education) from the University of Missouri in 2000. She taught at Missouri’s only public liberal arts and sciences institution, Truman State University, from 2000 – 2011. In 2008 she received the school’s Educator of the Year Award and the Governor’s Award for Excellence in Higher Education. She joined Kaplan full time in 2010 as a Nursing School Consultant.
Stephen Hadwiger, PhD, RN, is a Professor of Nursing at Truman State University in Missouri where he teaches nursing research and critical care nursing. He also instructs an interdisciplinary course on race and ethnicity. He earned his BSN at Northwestern Oklahoma State University, his MS(N) in nursing education at University of Oklahoma, and his PhD at Sinclair School of Nursing, University of Missouri.
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