Not long ago, I was a panelist for an event entitled Building Ourselves: New Paradigms of Masculinity. As can be discerned from the event’s title, the panelists were expected to provide erudition on the evolving construct of masculinity. The great thing about being publicly asked about one’s ideas and values is that one gets the privilege to think aloud; the auditory feedback loop in the brain allows the speaker a second to weigh what was just said—to know oneself better.
Growing up, I didn’t have a particular idea of what masculinity should look like. I had a notion, based on what I saw in a male parent, about which male-identified behaviors were to be emulated, but I didn’t ponder my own version of masculinity. Social prejudices at the time and place where I grew up hinted that gay teenagers like myself didn’t have many career opportunities. I was likely to fulfill a stereotype threat, the risk of confirming, as self-characteristic, a negative stereotype, until a sudden twist of fate intervened. I enrolled in nursing school.
“Nurse” and “nurse-midwife” are two of the very few job titles which are historically gendered, with a lingering image that nursing is an unshakably female virtue. Although more men have joined the nursing ranks since the 1970s, when only 3% of nurses were men, the percentage of male-identifying nurses has remained stable at around 9.6% since 2018. The National League for Nursing (NLN) reported that the percentage of men enrolled in pre-licensure nursing programs remained stable at 13% to 15% between 2014 and 2020. These trends make me wonder if men in nursing have hit a plateau, or will the pandemic inspire more of them to become nurses? Notwithstanding the numbers, men who join the nursing profession are a case study in point on the current recalibration of masculinity and its unwanted cousin, toxic masculinity, and its impact on the health of boys and men, and the society at large.
In 2018, the American Psychological Association issued the first ever guidelines for practice with men and boys. The basic premise of the guidelines was to enhance gender- and culture-sensitive approaches when caring for boys and men from diverse backgrounds. Central to this discussion was the reexamination of the traditional masculinity constructs that loom large in society, such as anti-femininity, achievement, renouncing weakness, risk-taking, and violence.
Decades of research show that subscribing to traditional masculinity is detrimental to the overall health and well-being of men and boys. Harmful masculinity, a harbinger of violence, is believed to stem from negative masculine ideals that value toughness, heterosexist roles, and lack of emotional sensitivity. Studies have shown that men with strong beliefs in traditional masculinity are less likely to seek out preventive healthcare than men with moderate beliefs. The same study has shown that men with higher education and socioeconomic status who subscribe to strong notions of masculinity are less likely to access preventive healthcare. Help-seeking behaviors for mental health are negatively correlated with strong notions of traditional masculinity or hypermasculine tendencies.
One of the proposed solutions to this complex phenomenon is to promote healthy relationships that put less emphasis on traditional gender roles. Could it be that for men, learning to be a nurse and practicing as one, might be an antidote to toxic masculinity? I say this based on the notion that acquired negative masculinities can be unlearned. If patriarchal male socialization turns boys into men, I’d like to imagine that becoming a nurse transforms them into gentlemen caregivers. Gender equity may mitigate the ill effects of toxic masculinity. In short, gender diversity in nursing is good for the profession and the health of the nation.
The nurse in a man
The lingering bias that nursing is better suited for women can potentially hinder authentic self-expression, which is closely tied with caring practices and productivity of gender-diverse nurses. Colleagues and patients with biases (implicit or explicit) against sexual- and gender-minority nurses confirm a fact: Inclusivity looks good on paper, but it may not be the lived reality of some. Ethnic stereotypes influence how male nurses are perceived. One study reported that college students see Asian American men as less manly than Black or White American men. Experts have pointed out that the nursing profession may not be as welcoming to Black men. The intersection of race, sexuality, and geography make the experience of male nurses more nuanced.
As a holdover of traditional gender roles, society may perceive male nurses as not possessing the synergies of compassion and empathy, virtues typically seen as feminine attributes. As a result, it’s possible that some male nurses may self-edit (for example, remain stoic in the face of an emotional clinical encounter) to conform with the normative image of masculinity. Doing so denies the patient a caring moment, and the nurse misses an opportunity to practice to the fullest extent of their caring competencies. As a nurse during the Civil War, Walt Whitman embodied the sensitivities of a man nursing another man. His poem, The Wound-Dresser, is an unapologetic lament on the passions of male caregiving amidst great suffering.
Role modeling nursing
I doubt if my students or my friends see me as a model for a certain masculinity. But as nursing faculty, I’m keenly aware that I directly or indirectly role model, for all genders, patterns of behavior, such as work ethic, sensitivity, comportment, and resiliency. I’d like to think that I’m able to embody a certain humanity, as opposed to a brand of masculinity. Male nurses need community and friendship to bring out better versions of each other. It might be relevant to examine the influences of one’s image of masculinity, and how it affects the authentic expression of self. Do we prize virility over virtue? And are we willing to ask these questions of ourselves and not be afraid of the answers?
American Psychological Association. APA guidelines for psychological practice with boys and men. August 2018. apa.org/about/policy/boys-men-practice-guidelines.pdf
Smiley RA, Ruttinger C, Oliveira CM, et al. The 2020 national nursing workforce survey. J Nurs Regul. 2021;12(1):S1-96.
U.S. Department of Health and Human Services. 2018 national sample survey of registered nurses: Brief summary of results. bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nssrn-summary-report.pdf
Fidelindo Lim is a Clinical Associate Professor at New York University Meyers College of Nursing