News media around the world assess the current status of men in nursing
March 8, 2014 -- In recent months press sources around the world have run helpful pieces about men in nursing. These reports typically note that the percentage of men in nursing is still no more than 10%, but that it is slowly increasing as stereotypes start to fade due to the Truth's work (just kidding). The articles generally focus on at least one man in nursing, from students to senior ward managers, describing the man's path into the profession and giving some sense of what he does at work. On July 10, 2013, USA Today ran a piece from The Tennessean by Lexy Gross. The article provided basic information about the growing number of men in U.S. nursing--from about 2.7% of nurses in 1970 to about 9.6% in 2011, according to a recent U.S. Census Bureau report--with background from nursing experts. The piece also profiled a Tennessee nurse who considers it a "manly job" because of the fortitude it requires. On September 27, 2013, the Guardian (UK) ran an installment of its "Day in the life of..." series of health care profiles written by "student nurse" Alex Collyer, a combat medical technician studying nursing at the University of Southampton. We're not fans of the term "student nurse," which suggests that students are already nurses, but Collyer's piece was an engaging account of the rigors of his education, especially the clinical component. On October 9, 2013, the Los Angeles Times ran Ari Bloomekatz's long, powerful profile of David Fuentes, a recent UCLA nursing graduate who overcame a tough background to achieve his dream of becoming a nurse. That piece described some specific things Fuentes does for patients. It also included good quotes from UCLA nursing dean Courtney Lyder, who addressed the stereotypes that remain. And today, the Western Australian published a shorter piece by Connie Clarke that profiled veteran nurse Ian Suttie, a ward manager at Royal Perth Hospital who started out as a London musician. That article also included very good commentary on men in nursing from the Western Australian Health Department's acting chief nurse and midwifery officer Brett Evans. On the whole, these pieces give the public an accurate vision of a future with more men in nursing, while acknowledging the slow pace of progress and the social barriers that remain. We thank those responsible.
The USA Today article is "More men join nursing field as stigma starts to fade." Early on, the piece says that the U.S. Census Bureau has reported that 9.6% of U.S. registered nurses were male in 2011. The piece says "that percentage has tripled in three decades, from 2.7 percent in 1970." We're not so sure about all of the reporter's math there--we count 41 years--but in any case, that is encouraging growth.
The article briefly profiles two men in nursing. The first is Ryan McFarland, a nurse at Sumner Regional Medical Center in Gallatin, Tennessee. He addresses the stereotype of men in nursing:
I guess my friends thought, since I played sports in high school, that I would take on a more manly job. But this is a manly job. There are so many things in this field that aren't easy -- most people don't have the stomach for it.
The piece explains: "Bandages, bedpans, moving patients from bed to bed -- all require fortitude." We guess that is okay as far as it goes; nursing does require strength, although that is not just a male characteristic. But this also seems like another in a long line of efforts to reconcile nursing with traditional notions of masculinity, rather than to question whether those notions are helpful or to stress that nursing is a good choice for any gender because it requires strong intellectual and social abilities. Bandages, bedpans, and moving patients doesn't quite cover it.
The piece also introduces Tom Marquart, a "senior nursing student" at Belmont University. Marquart "dabbled in history, education and construction before he finally found his calling in the nursing program." The piece says that he "considered becoming a physician's assistant after he graduates"--which would be an unusual choice for a new RN--"but after some research decided to become a nurse practitioner, which allows him to diagnose illnesses and prescribe treatment on a limited basis." We could have used a little more explanation of "limited basis"; does that mean limited by state law, or limited by NPs' actual skills, a notion that research has shown to be incorrect? Marquart notes that the "nursing model is much more care-based, and it fits me better." He also says that "his friends teased him but never seriously questioned his decision to apply for the nursing program." However, his part-time job at "a downtown Nashville honky-tonk" suggests the stereotypes are changing since "when he tells customers he is in the nursing program at Belmont, they congratulate him on his choice." That's good, although we note that Marquart's friends' teasing about nursing school is not from some bygone era; he is still in nursing school.
The piece consults Vanderbilt nursing professor Peter Buerhaus, who "said he believes the social stigmas associated with men in nursing are disappearing." He also thinks the economic benefits are attracting more men, since nursing weathered the recent recession better than many fields. Buerhaus suggests that "people notice that when they come out of high school, there's no longer a negative stigma," which seems a bit inconsistent with comments by the practicing nurses who note that some stigma remains. Buerhaus does make helpful comments about why men choose nursing rather than other health careers, noting that nursing places more emphasis on prevention and involvement with patients and the community, with less focus on disease pathology and specific treatments. Also, the simple fact that the piece quotes a nursing professor at Vanderbilt may counter somewhat the suggestion that nursing is all about bedpans and bandages.
The article includes a surprising amount on the history of men in nursing, perhaps because the recent Census Bureau report provided ready material on that subject. The piece notes that men did act as nurses in military and religious contexts long ago, but that started to change with the U.S. Civil War when women stepped in (a bit of an oversimplification) and came to dominate, so that men were actually excluded from nursing schools and many nursing positions until well into the 20th Century. The piece quotes nurse McFarland, who says he thinks the stigma is "disappearing" but admits that some people still regard nursing as a women's profession. He says patients have doubted his ability because of his gender, but that changes after they have a positive care experience. McFarland also suggests that progress on this issue could improve care, referring to times in nursing school when male and female students saw things differently; he says that with "varying perspectives" "you may get better solutions." The piece also quotes nursing practitioner Taylor Fife, president of the American Assembly for Men in Nursing at Vanderbilt: "Not many days go by that I'm not mistaken for being a doctor. Even when I tell them I'm not -- the stereotype of men as doctors and women as nurses is still there."
The piece closes with a short discussion, apparently based on the Census Bureau report, about gender-based pay disparities in nursing. The report notes that full-time female RNs earn only 93 cents for every dollar male RNs earn, and female NPs earn only 87 cents for each male dollar. The piece does point out that the gap is narrower than the average gap for all professions, which is 77 cents to the dollar. The article does not get into why the gap might exist except to note that the Census Bureau "reports that men are reaching for higher-paying nursing positions more often than women." We think there might be a little more involved.
The Guardian item by nursing student Alex Collyer is part of a series of short pieces in which different professionals explain their work. The headline is "A day in the life of ... a student nurse." Collyer uses the term in the piece as well. Of course, most readers will understand that he is not actually a nurse yet. But our concern is that the terms "nurse" and "nursing" are often used so broadly--to encompass everything from unskilled tending to breastfeeding--that it is best to be precise. We have not often heard medical students referred to as "student physicians," which suggests a more careful effort to avoid any confusion about who is a physician.
Otherwise the piece is strong. Collyer is enthusiastic about his "varied and challenging" program studying for a bachelor's degree in nursing at the University of Southampton, which he says includes about 50% classroom components and 50% clinical placements. He notes that he has finished his first year, but that he previously spent four years in the ambulance service, and that he is still a combat medical technician in the Provincial Army, having served in Iraq.
Collyer describes his clinical placements, which seem to have a pediatric focus, in some detail. His first placement was at the children's assessment unit (CAU) at Queen Alexandra hospital in Portsmouth. Collyer explains that the unit handles children referred from various sources, including "community nurses."
It is a 24/7 unit with nurses and doctors on 12-hour shifts starting at 7.30 am. My day on CAU started with the night team bringing us up to speed with those patients already in the unit. The mornings there could be a bit of a whirlwind -- assessing, treating, playing, talking to families, observing and dispensing medication -- as we attempted to get as many children as possible to the point where they could be safely discharged home. For the children who were not well enough to go home, we arranged for them to be admitted to either a medical or surgical ward. And, seriously ill children were stabilised before being transferred to the paediatric intensive care unit at Southampton general hospital.
Collyer also had a placement with a community health team where he was able to "study child development," and his next placement is at a hospital's neonatal unit. He says that over the next few years he will have a variety of other rotations in National Health Service settings.
Collyer explains that he has been part of a pilot project called the National Junior Leadership Academy, set up by the University of Nottingham's Stacy Johnson, that works to "identify nurse leaders at an early stage." Apparently this involves periodic meetings with other students to discuss health care reform ideas and efforts to implement the ideas locally.
Collyer also includes some general information about the life of a nursing student: "Student nursing is time intensive, we work nights and weekends and, when we're not on the wards, we have essays to write and pharmacology and anatomy exams to get ready for." He notes that students in this environment form close bonds, with their "common goal of helping others and caring for those in need." He admits to having "a slight moment of apprehension when I realise I have to be up in five hours to get back to the ward," but says he does not mind because "there is nothing else I would rather be doing." Upon graduation, he hopes to work in intensive care or emergency, building on his prior work with the ambulance service.
This is a helpful quick picture of the life of a nursing student. Collyer doesn't get into much detail about his studies, but it's clear he is pursing a rigorous university science program. The descriptions of the program's clinical components also give some sense of the complexity and intensity of the work. The brief description of the "nurse leaders" program is also helpful. And there is no significant angel-oriented imagery. There are a few references to caring for others, but that's fair enough, obviously, and there is nothing about "tender loving compassion" or anything else that might suggest to readers that the work is really about low-skilled hand-holding.
One notable element is that Collyer says nothing about being a man in nursing, suggesting that it really isn't an issue. Certainly that subject is worth considering, as in the other press articles discussed here, but there is also value in pieces like this that simply present a man in nursing as normal and unremarkable. Perhaps other elements of Collyer's background--the combat and ambulance experience--helped to persuade those involved with this piece that there was no need to address whether he or his new career was "manly" enough.
The sadness in his eyes
One striking thing about Ari Bloomekatz's Los Angeles Times profile of new nurse David Fuentes is Mel Melcon's photo of Fuentes with an ICU patient at UCLA Medical Center. Fuentes is making an adjustment in the ventilator tubing or central IV line close to the patient while peering intently upwards, out of the frame, presumably at a monitor. It's a bit of an awkward position for Fuentes, but the photo clearly suggests that he is doing something technically difficult and important--pretty rare for a still image of nursing.
Consistent with the headline, "A nurse who is healing patients and himself," this piece is very much about Fuentes's background and the role it has played in his decision to become a nurse. The report tells how he wanted to be a nurse from the time when, as a kid, he saw his mother exit the local retirement home where she worked, dressed in scrubs. Apparently his mother dreamed of becoming a registered nurse, but was unable to do so; the report does not specify what her job was. It does make clear how hard Fuentes's childhood was, describing his father's physical abuse, his mother's addiction, and Fuentes having to take care of his siblings. Now 26, he "wanted to fulfill for my mom what she envisioned for herself, but could never do." And he has done so, recently graduating from UCLA nursing school and getting a job in the intensive-care unit at UCLA in Santa Monica. Fuentes describes his nursing work as therapeutic, explaining that he loves it because "everything is left behind." The piece quotes Fuentes's mother, Guadalupe Perez, who praises his "instinct for caretaking":
Sometimes I feel that maybe he grew up a little bit too fast because he wanted to make things easier for me. Always got the impression that he kind of knew what was going on, like he just understood.... You could see the sadness in his eyes. ... He has a good heart, he was always there for his little brother. Maybe it's just something that ... got into him, always being there to help someone.
Generally speaking, sentiments like these, with their focus on "instinct," "heart," and "help," could reinforce the unskilled angel image of nursing. But not here, where the real-world struggle is so evident and the piece also offers considerable information about nursing skill.
That information comes in the reporter's descriptions of Fuentes's interactions with patients. The piece notes that certain aspects of Fuentes's appearance--like his lip ring and tongue ring--"might seem intimidating if it weren't for the delicate way Fuentes presses on the legs of a 99-year-old patient to check her blood flow, or how he cups his hands and drums on her back to help her breathe more easily." The patient, who has been in septic shock, "is blind and mostly unresponsive, but Fuentes asks politely, his voice soft but direct: 'I'm going to take your temperature ... OK?'" The report notes that "Fuentes will be there the whole night standing guard -- giving her medicine and monitoring her pain and breathing on his 12-hour overnight shift."
The report briefly describes another clinical interaction in connection with its discussion of men in nursing. The piece says Fuentes finds it "natural" that "some patients feel more comfortable with nurses of the same gender, but mostly, he says, it doesn't come up." Toward the end of Fuentes's training, "he was checking the oxygen flow into patient Russell Sherman's nostrils when the 87-year-old looked him over admiringly and said he remembered when the only nurses at hospitals were women in white." But Sherman, who had a pulmonary embolism, says that it "doesn't faze me at all. I think it's a good thing for men to be able to do a job without shame."
And in this regard, the piece has some of the same information as the Tennessean article, including the percentage increase in U.S. male nurses based on the recent Census Bureau report. The LA Times article says that reasons for the increase include "diminished legal barriers, increasing demand for nurses as the U.S. population ages, and middle-class pay." The report also discusses the gender-based pay disparity, even asking a group of undergraduate nursing students outside the UCLA hospital--eight women and one man--why they think it exists. The students struggle to respond; the report might have been better off consulting someone with expertise in the issue.
Who might that be? Well, how about UCLA nursing dean Courtney Lyder (right), the male nursing expert the piece does consult about the profession's slow demographic shift. The piece says that Lyder is "one of Fuentes' heroes" and the nation's "first male minority dean of such an institution." Lyder himself was reportedly inspired by his dean at Chicago's Rush University, Luther Christman, the nation's "first male dean of a school of nursing." Christman was reportedly "tall and muscular" and he "debunked a lot of preconceived myths about nursing." Lyder notes that in nursing school he was one of five men in a class of 200, but he says stereotypes are fading and 11% of UCLA nursing students in the 2012-2013 academic year were men. Lyder concedes that "we still have a long way to go," and that seems right--translating that 11% to the 200 in his own nursing class, that would still be just 22 men. In fact, Lyder himself has shown leadership in trying to improve nursing's image, such as by holding conferences on nursing and Hollywood at UCLA in 2011 and 2012. And in this article he offers some good, punchy quotes comparing the traditional image of nursing with the reality:
Men are seeing that this is a viable option that pays well, you have a good lifestyle, you give back to society. ... Nursing doesn't have a gender. Society and media have portrayed nursing as feminine. It's not.
Altogether, the LA Times piece offers a powerful look at one man in nursing and the overall increase in male representation in the profession. It arguably understates the extent to which gender stereotypes still plague the profession, but readers do see why the stereotypes are misplaced, which is probably more important. Perhaps the most helpful aspects of the piece are the brief depictions (including the photo) of Fuentes's clinical interactions, in which he is adjusting complex technology, checking blood and oxygen flow, monitoring pain and breathing, and "standing guard"--a surprisingly good phrase to describe what nurses do for patients.
Strong leaders and astute problem solvers
Connie Clarke's quote-driven piece in the Western Australian is "Nursing job for the boys: Health sector looks to change gender imbalances in the profession." The man in nursing profiled here is veteran Royal Perth Hospital ward manager Ian Suttie (right). The piece notes that in the late 1990s, Suttie was a rock musician in his late twenties living in London when he decided to "get a real job" and "went back to university." Suttie explains his path:
I realised our band wasn't going to be the next Motley Crue, so it was time to find a proper career. Nursing interested me because it was varied and challenging. I wasn't really fazed by the stereotypes about men who went into nursing until an elderly patient asked me one day if I'd been unemployed and the government had made me go into nursing. A lot of those old stereotypes have broken down now -- I think my job is tough and I've witnessed some things in nursing that I would not witness in most other jobs. It's very unpredictable. I could be doing paperwork one minute and propelled into a full-blown emergency situation, where we are trying to save a life, the next. I go home every night feeling like there has been some real purpose in my day.
We have to note that, in what has to be a coincidence, "varied and challenging" is the same way Alex Collyer described the profession in his Guardian piece six months earlier. In any case, Suttie's comments given a good thumbnail portrait of men in nursing; we were particularly struck by the idea that the government had forced him to become a nurse because he was unemployed. Don't laugh--policy makers have proposed that nursing is a good path for those on public assistance.
The piece leaves Suttie and moves on to the wider context. It explains that only 9 percent of the State of Western Australia's registered nurses and midwives are men. But with new hospitals reportedly opening next year, "the push to attract more men to the sector is well under way." The piece quotes "WA Health's acting chief nurse and midwifery officer Brett Evans" (right), who concedes that nursing has not (in the piece's words) "completely shrugged off its tag of being a job for girls" but urges young men to consider it anyway.
You don't hear people refer to someone as a 'female nurse', or 'male doctor', but for some reason we label our men as 'male nurse' -- as if they are different. Many young guys disregard the option of nursing or midwifery based on preconceived ideas about it being a job for girls, or that it's a subservient role where the nurse or midwife wasn't smart enough to become another type of health professional. We want our nursing workforce to reflect the population we look after, so increasing the number of males is certainly a priority for us. We are working on projects that will educate everyone in the community about the real image of nursing and midwifery. Nurses and midwives are well paid and educated professionals who are strong leaders and astute problem solvers and not the kinds of exaggerated, two dimensional characters portrayed for dramatic or comedic effect.
That's a pretty great summary of the continuing stereotypes and why they're wrong, making clear that nurses are autonomous health experts and pointing specifically to the troubling role the mass media often plays in perpetuating the unskilled and handmaiden images. Evans also reportedly said that (in the piece's words) "men were often drawn to the more technical areas such as intensive care or emergency departments, but could be found across the healthcare system, including in mental health, education and management roles." The piece closes by noting that publications and DVDs debunking myths about nursing are being distributed, presumably by Evans's Health Department, to high schools around the State, and that research on recruiting more men into nursing is underway at the State's five universities.
On the whole, the piece offers a good balance between frank acknowledgement of the stereotypes that men in nursing still face, on the one hand, and showing why the stereotypes are wrong and men like Suttie are wise to consider the field, on the other. Indeed, to a great extent that is the challenge for each of these recent reports on men in nursing, as it is for all pieces about recruiting the next generation of nurses: conveying vital information about nursing's problems while also showing why there is no more important and fulfilling health profession.
See the articles:
"More men join nursing field as stigma starts to fade: The number of male nurses has increased dramatically over the last few years, in a female-dominated profession," by Lexy Gross, originally from The Tennessean, posted on the USA Today website on July 10, 2013.
"A day in the life of ... a student nurse," by Alex Collyer, posted on The Guardian's website September 27, 2013.
"A nurse who is healing patients and himself," by Ari Bloomekatz, posted October 9, 2013 on the Los Angeles Times website.
"Nursing job for the boys: Health sector looks to change gender imbalances in the profession," by Connie Clarke, posted March 08, 2014 in the West Australian website.