Thursday, February 8, 2007

Men in Nursing: Past, Present and Future







INTRODUCTION
When one pictures a nurse, one most likely visualizes a personable and smiling woman wearing colorful scrubs and flat closed shoes. This image is most prominent in the United States because of the social and gender stereotypes regarding male and female roles that permeate the media and dominate the thinking of many individuals in American culture. What most people are unaware of is that nursing is a profession that has been impacted by males as well as females, and that nursing has changed drastically since its origin. It is important that the role of men is taken into account when looking back at nursing and its development and transformation into what it is today. Even though nursing is still generally known today as a female profession, men have played an integral part in the history of nursing, and men have and will continue to play a pivotal role in the inevitable evolution of nursing in the future.
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THE HISTORY OF MEN AND NURSING
Although predominately thought of as a female profession, two thousand years ago only men were allowed to enter the workforce as a part of the healthcare team (Achtberg, 1990). During ancient times, masculinity and aggressiveness were often praised above all other qualities, and in order to exemplify this omnipotence of masculinity, the working class was comprised solely of males. Achtberg (1990) explained that this resulted because the dominant belief during ancient times was that healers were to be associated with the sacred, thus embodying the gods. Since the most powerful reigning gods were male, only men were allowed to be healers (Burkhardt & Nathaniel, 2001).


The first documented nursing schools in the world originated in India in around 250 B.C. These schools only allowed the enrollment of men because it was believed that only men were “pure” enough to be healers. Similarly, men continued to dominate the nursing profession worldwide from 300A.D. during the Byzantine Empire all the way to the pre-civil war era in the mid-1800’s. As a fairly new country, the first American nurses originated in the 1800’s and both female and male slaves were identified to be nurses prior to the civil war. The United States fought in the Crimean War with England, and both male and female nurses participated as volunteers, including such famous male nurses as Walt Whitman. The first American nurses were medics in the civil war, and the once male dominated profession began to change as the war allowed many women to enter the field as nurses (Menstuff, 1996).


It was not until civil warfare began in 1861 that nursing transformed from a male dominated profession to a profession composed primarily of women. The development and formation of the United States Nursing Corps greatly facilitated this transformation, as these organizations were strictly feminist movements. In 1917, the Nurses Associated Alumnae became the American Nurses Association (ANA), and this organization, comprised only of women, further prohibited the involvement of men in the nursing profession. Since a vast majority of males were participating in the military as a part of the army in the civil wars of the mid-1800”s, women represented the free population that was needed to nurse the soldiers back to health. Since the female nursing organizations successfully excluded men from military nursing, nursing became and stayed predominately female (Menstuff, 1996).
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WALT WHITMAN
Known as one of America’s greatest poets, Walt Whitman was also a famous male nurse. Son of a Quaker carpenter, Walt Whitman attended public schools but claimed his meaningful education came from outside of school. He educated himself by visiting museums, going to libraries, and attending lectures. During the 1840s and 1850s, he worked as a newspaper editor at the Brooklyn Eagle and the Brooklyn Daily Times, and after writing strong editorials about certain topics that were controversial at the time, was fired from both positions. You might ask yourself how one can go from being a great poet to being a nurse, but it is possible. His defining moment as a nurse came during the Civil War when he found out his brother was wounded. After rushing to the battlefield in Virginia and taking care of his brother, he went to Washington DC and served as a volunteer hospital nurse during the Civil War. There, he cared for wounded Union soldiers and continued to do this for five consecutive years. He actually never received formal training as a nurse but was an early practitioner of holistic nursing and he incorporated encouragement, active and nondirective listening, and use of therapeutic touch into his nursing care (Folsom, 2006).
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JAMES DERHAM
Born into slavery in Philadelphia in 1757, James Derham was owned by three doctors. Encouraged to practice medicine by his third owner, Derham’s interest in the medical field grew and, as a result, Derham began working as a nurse. After saving enough money throughout his years of nursing practice, he was able to buy his freedom in 1783. In addition to buying his freedom, he also opened a medical practice in New Orleans in 1783. As a result, he became the first black physician in America not professionally trained in a medical school. Even though he was not trained in a traditional medical school setting, he was educated by several noted physicians. Derham soon became nationally renowned as a leading specialist in throat disorders and in study of relationships between climate and disease, giving Derham deserved respect and admiration from his colleagues. By giving back to the community through his inherent caring and love for medicine, James Derham demonstrated how nursing changed his life, and he continued to allocate high quality care to those in need around him(PaigeWise,2006).
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WHY MEN ENTER THE NURSING PROFESSION
There are many factors that persuade men to enter the nursing profession. The most influential factors include flexible hours, high paying salary, influence from family and peers, helping and caring for others, and numerous opportunities for advancement in the profession through advanced degrees and research (MedZilla, 1994). A recent survey (University of Washington School of Nursing, 2006) through the University of Washington touched upon the influencing factors that cause men to enter nursing in greater detail. This survey can be viewed at this website.
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THE TREATMENT AND VIEW OF MEN IN NURSING BY THE AMERICAN PUBLIC
Overall, it has been proven through various studies that patients view and treat male nurses well. Sometimes male nurses are even preferred and requested by patients. However there are some lingering stereotypes of male nurses: gay, feminine, or underachieving. The last one is the most common, with patients asking “why would a man want to be a nurse rather than a doctor?” Patients do not always understand that men choose to be in nursing for reasons other than sexuality or aptitude. The patients who most commonly feel uncomfortable with male nurses are those in Women’s Health because women often feel too vulnerable and uncomfortable to accept care from a male nurse.


Many times, the image patients get of men in nursing is from the negative image presented by the media. From the nurse named “Gaylord” in “Meet the Parents” to the female doctor in “Scrubs” who is ashamed to date a male nurse, images such as these in the media are very influential in creating a negative view of men in nursing. In “Scrubs,” the main character refers to her boyfriend as a “murse,” only further promoting the idea that it is socially acceptable to patronize male nurses today. This kind of image creates a lasting prejudice against men in nursing. Also, although it is not politically correct to insult or make jokes about women working in male-dominated fields, it is considered neither in bad taste nor uncommon to make fun of a male nurse. This shows that gender inequalities still persist in society today, even though many steps have been taken to promote equality between the genders
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THE VIEW AND TREATMENT OF MEN IN NURSING IN THE HEATLHCARE WORLD
Advantages:

Discrimination in the nursing workplace is changing today. There seems to be less bias toward men from other nurses and doctors, and there are subtle signs that men in nursing are becoming more accepted. For instance, the American Nursing Association declared in the 1950s that all bathrooms for nurses were to be female (Domrose, 2006). Because of this, men were forced to change and use the restroom in other buildings, which is obviously inconvenient. The president of the American Assembly for Men in Nursing, Gene Tranbarger, reflects as of this year, there were signs on men’s restroom saying “Ladies, out of consideration for our male colleagues, please do not use this room (Domrose, 2006).” In addition to restrooms, nursing brochures have purged the pink and purple colors and have changed the pictures so that it does not just show women as nurses (Domrose, 2006). While many male nurses believe that there is a great amount of discrimination in the workplace, there are also many sources that contradict this argument and say that they have not run into much prejudice at all. In fact, Joan Evans (1996) writes that “even in female- dominated occupations such as nursing, patriarchal gender relations which reflect a high valuation of all that is male and masculine, play a significant role in situating a disproportionate number of men in administrative and elite specialty positions.” This ties in with Christine L. Williams’ (1992) concept of a “glass escalator” and men’s advantage to be promoted before women. She relates this “glass escalator” to the professions of nursing, librarianship, elementary school teaching, and social work; essentially, she is examining the men’s roles in chiefly female professions. She reports that many male sources said they had an advantage when getting hired simply because they were a man in a female occupation. After getting hired, many men also experienced the effects of the “glass escalator” which causes men to “face invisible pressures to move up in their professions. As if on a moving escalator, they must work to stay in place.” Essentially, men move up more quickly than women in their job’s hierarchy and end up in positions of power, authority, with more income (Williams, 1992). Besides being channeled up in the hierarchy, Williams (1992) says that men are also pushed into more “masculine” fields, which, as luck would have it, means they are being pushed into jobs with more prestige and pay. Along with men’s status in the heath care hierarchy, men are also more likely to be supervised by other men mainly because “men are overrepresented in administrative and managerial capacities” (Williams, 1992). Williams’ studies also show that many men create close ties with their male supervisors and consequently can reap the benefits. She reports one of her nurse sources saying that he was transferred to an emergency staff position, which is apparently an impressive advancement, simply because he was friends with the physician of the project (Williams, 1992). It may appear that the 6% of men in nursing (Hilton, 2006) have a disadvantage because they are operating in a “woman’s” job, yet they are not as stymied as one might think. According to sources and studies, men are being discriminated against less in the present day as many are making efforts to reduce the biases. They are also receiving more opportunities for promotions in the workplace than women and as such are receiving better income and benefits.

Disadvantages:

Today in America, men represent almost 6% of the population of nurses (Hilton., 2006). This number is incredibly small, yet the biggest since the 1900s (Hilton, 2006), and as such according to various sources, men are receiving mass amounts of discrimination in the workplace. However, though many say that there is a prominent amount of discrimination for men in the health care profession, it must be noted that many sources also say that discrimination toward men is diminishing and that men may also have the upper hand over women in nursing. One source, Eddie Hebert, explained, “I was not allowed to enter the delivery room because I was a male student, but had to stand at the door of the room to catch a glimpse of the delivery” and “I was also not allowed to have a female patient. This all had to do with gender (Chung, 2006).” In fact, there are many who report being ostracized from obstetric and gynecology units as well as other women’s health units simply because they were male. Many of these men also experienced a lot of discrimination from their female charge nurses. There are several sources that confirm that some of this prejudice toward men still lives on today through various women in the profession. Other than being specifically in the workplace, the image of men in nursing is demoted through textbooks in nursing school. Eddie Hebert reflects that his textbooks would not refer to men unless they were the patient (Chung, 2006). He says, “All educational materials were oriented to the female gender”. He also claims, “Males were seen in nursing texts as the anatomy to be studied—the one in need of female assistance. Every picture seemed to identify the nurse as the ‘caring female individual,’ while the patient was always a ‘male in need of care (Chung, 2006).’” Hilton’s article (2006) also has other accounts of discrimination toward men including Sylva Emodi’s experience. Apparently in 1996 Emodi felt so much discrimination when teaching in the labor and delivery areas that he felt compelled to leave that particular field. In Emodi’s case, the head nurse would not let him take his students into labor and delivery because he was “not a medical doctor”. Eventually, Emodi had to go to a doctor to get access into the areas so as to teach his students and sidestep the head nurse (Hilton, 2006). Hostility and discrimination have remained through the present day toward men in the nursing profession and that there need to be some efforts to change male nurses’ situation in and outside of the workplace.
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ETHICAL IMPLICATIONS PRESENT IN MEN IN NURSING
When analyzing almost any aspect of the nursing profession, it is almost inevitable that some ethical implications and dilemmas will emerge. As in almost any aspect of nursing, men in nursing has its own moral and ethical dilemmas relating mostly to issues of social justice. By viewing this case study, many of these ethical issues are raised and can be analyzed.

Case Study:
Mr. Carlson is a Registered Nurse who works in the Emergency Department. A dedicated and adept worker, Mr. Carlson has been committed to his job for fifteen years now, always providing the best care for each of his patient's individual needs. One day a woman is brought to the Emergency Department who has suffered severe blood loss due to a car accident. When brought into the Emergency Department, the female patient refuses the help of Mr. Carlson, saying that she would prefer to have a female nurse allocate her care. In the process, the female patient asks Mr. Carlson, "Why do you want to be a nurse anyway when you can just be a doctor?"

Think about it!
• Is upholding patient privacy and autonomy more important than ensuring that Mr. Carlson is allowed to uphold his duty as a male nurse?
• What ethical and moral implications are introduced?
• Does the patient's viewpoint represent an ethnocentric perspective that has been greatly influenced by the media? How and in what way?
It has also been discussed further in "The View and Treatment of Men in Nursing in the Healthcare World"that men are often prohibited from working in certain departments of a hospital setting. Women often make up the total population of nurses working in women's pavilions such as labor and delivery, postpartum, and gynecology.
• Is it ethical to prohibit the entrance of men into certain departments of a hospital?
• Would it be ethical to allow men to enter these hospital departments when female patient privacy and autonomy could possibly be violated?
• What about male-doctors? How, if at all, are they different?
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FUTURE OF MEN IN NURSING

In the 1950’s, male nurses started to integrate back into the nursing profession, but today only approximately 6% of the 2.2 million nurses nationwide are male. In the year 2000, survey data showed that almost 13% of nursing school students are men (Menstuff, 1996). Although gender inequities persist, the amount of men entering the nursing profession has been increasing steadily over the past fifty years. The future for men in nursing is a bright one, and this is primarily due to the recent nursing shortage, which has allowed the public to see the need for more men in nursing to both equalize gender roles in the work force and to eliminate the shortage in the future (Male Nurse Magazine, 2002). According to an essay by Williams CL. (1995), more men are entering the work force as nurses because of the hidden advantages they receive by doing so. It has been proven empirically that men in nursing earn more money on average than women do, and men have better chances of receiving promotions (Williams CL., 1995). It is precisely because of this preferential treatment that more and more men will continue to enter the nursing profession in the future, making the term “male nurse” more credible as time continues. Within the United States, cultural, gender, and social stereotypes regarding masculinity often influence men to enter some of the best-paying and most prestigious nursing specialties (Williams, 1992). In general, the media’s representation of men in nursing is changing, and the presence of such male nursing organizations as the American Assembly of Men in Nursing provide support and spread the word that both female and male nurses are a credible part of the nursing population (AAMN, 2006).


AMERICAN ASSEMBLY FOR MEN IN NURSING
The American Assembly for Men in Nursing is an organization comprised of both male and female nurse members, and it promotes discussions on various topics for the purpose of strengthening health care for the future. The AAMN’s main purpose “is to provide a framework for nurses as a group to meet, discuss, and influence factors which affect men as nurses” (AAMN, 2006). Gene Tranbarger, the elected president of the organization, says that admission to the AAMN is open to all of those nurses who share “our beliefs that nursing is a profession, not a gender-based profession” (Menstuff, 1996). This organization, functioning nationally online at www.aamn.org, explains its four main objectives: to encourage men of all ages to become nurses, to support men who are in the nursing profession, to advocate for further research regarding men in nursing, and to “support members’ full participation in the nursing profession” (AAMN, 2006). Organizations such as the AAMN have been somewhat successful in advertising and campaigning for male nurses, and this support has been responsible for an increasing interest in the health care profession among males. The fact that men feel a need to form a nursing organization primarily dealing with males and their impact on the profession shows that while stereotypes and gender inequalities still remain, new steps are being made to raise the consciousness of the public and to persuade young men to enter the nursing profession. Other campaigning tools such as the fairly new “Men in Nursing” magazine and the new slogan “Are you man enough to wear white” have been working to break the stereotype of nursing as a women’s profession, and, in turn, have started to promote a more masculine approach to the profession (Swingle, 2002).


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CONCLUSION
Nursing is undeniably a profession that is constantly changing and evolving as a result of the constant demand for health care professionals. Whether looking to the past, the present, or the future, it is unequivocal that men have impacted nursing in many ways throughout different time periods in history. As more men enter the nursing profession, there is hope that social stereotypes about masculinity and femininity will be replaced with a respect for all nurses, no matter their gender, and nurses will be seen as reliable and trustworthy individuals whose primary purpose is to care for people who are in need of assistance. Advances have already been made in gender equality because of the dedication of organizations like AAMN encouraging more men to enter the nursing profession. In addition, with the nursing shortage creating the need for more health care professionals, men, along with women, will continue to enter nursing as they have for the past fifty years.
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REFERENCES

All Nursing Schools. What percentage of American nurses do males comprise? November 3, 2006, From the World Wide Web at: http://www.allnursingschools.com/faqs/men.php

American Assembly for Men in Nursing. About Us. November 3, 2006, From the World Wide Web at: http://aamn.org/aboutus.htm

American Association of Colleges of Nursing. (1998). The Essentials of Baccalaureate Education for Professional Nursing Practice (2nd Ed). Washington, DC: Author

Associated Press. Is There A Male Nurse In The House? November 3, 2006, From World Wide Web at: http://www.cbsnews.com/stories/2002/09/06/health/main
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Brown, R.G.S., & Stones, R.W.H. (1973). Male Nurse. London: The Social Administration Research Trust.

Burkhardt, M.A., & Nathaniel, A.K. (2002). Ethics & Issues in Contemporary Nursing (2nd Ed). New York: Delmar Learning

Chung, V. Men In Nursing. October 27, 2006, From World Wide Web at: http://www.minoritynurse.com/features/nurse_emp/08-30-
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Domrose, C. Men at Work. November 15, 2006. From World Wide Web at: http://www.nurseweek.com/news/features/03-08/manenough.asp

Evans, J. (1996). Men in Nursing: Issues of Gender Segregation and Hidden Advantage. Journal of Advanced Nursing, Vol. 26 (No. 2), pp. 226-231.

Folsom, E., & Price, K.M. Walt Whitman. November 3, 2006. From the World Wide
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Groutage, Michele. Men: A Solution to the Nursing Shortage. November 1, 2006. From the World Wide Web at: http://www.medzilla.com/meninnursing.html


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Wilson, B. Men in American Nursing. November 1, 2006, From the World Wide Web at:
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