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On Masculinity and Nursing

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By: Fidelindo Lim, DNP, CCRN

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.

Reexamining masculinity

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?

References

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

4 Comments. Leave new

  • Scherlie Faulkner Devine
    September 14, 2022 7:18 am

    Thank you for this piece. I first encountered male nurses in the late 60s when I entered the Navy. It was an eye opener for this newly-educated and graduated R N. I was pleasantly surprised to see that many of the nursing attributes I valued, skill, appropriateness, kindness, awareness of the whole person, etc, were evident in a species that was pretty foreign to this young nurse. What a wonderful experience and the men I met in that experience painted the picture for the rest of my career! I met many amazing, wonderful nurses, some men, some women. There were a few less-than-admirable nurses, of both sexes, but, for the most part, I found little differentiation. The patients sometimes required education, but the officer-enlisted environment helped to manage those unrealistic attitudes in a modern, advancing society. I was privileged to be in a field that helped move the balance of sexual discrimination action forward. It was a sort of “reverse” attitude change as women were beginning to move out from traditional roles as well. I have a lot of respect for the men who stepped up to help make the changes we see today, just like I am delighted to see my grandchildren who are young women make their way in a world that is still, by some measure, dominated by men. But thanks to all who are making the world a bit more equitable. I

    Reply
    • Fidelindo Lim
      October 13, 2022 3:54 pm

      Hello Scherlie,

      Thank you for sharing your insights and experiences as a nurse. There is much that we can learn from one another. The nursing profession can count on diversity as a strength. Best wishes to you and your grandchildren.

      Regards,

      Fidel Lim

      Reply
  • I retired after 20 years as a nurse and nurse practitioner. I can attest to the bias against men as nurses, though much less as nurse practitioners. After graduation as an RN, where all the women in the class had multiple job offers, I had none. One interview I went on was for OR nursing where the job included a long training course. The interviewer told me that even though I was well qualified to do the job she could not hire me because, “The doctors want women.” Yes, that’s a quote. I finally got a job working nights in an ortho unit. I was being precepted by (Really) an LPN. I was never given any instructions about skills lists, using the computer system, or what certain orders meant. My first day I was given 6 patients (post-op) and had to hang blood for three of them. Good thing I remembered my school instructions because the LPN didn’t know anything about hanging blood. I was excluded from all group activities. Fortunately, while helping to lift a patient into a bed I developed an inguinal hernia and was off for a month. I never went back. I found a job in LTC where my previous skill in computing and management made me extremely qualified for a position as Resident Assessment Coordinator. Three weeks into that job, I was weekend house supervisor on a holiday weekend and the only RN on duty for 4 days. I couldn’t even go home. The DON, who was also the Administrator, was out of town and I had zero back-up. After two years, and being overlooked several for an Assistant DON position, I found a position as an Associate DON and gave notice. After a few years at that position the facility was sold and the DON was replaced. The next day she called me into her office and told me I was being terminated. She said that it was because, “men had no place in nursing.” (Another quote) I found several other LTC positions where I could use my previous and learned skills including how to run a LTC facility and keep it from having bad surveys. Though I instituted methods that made good surveys easier and, in one case, I licensed a new facility with the inspector saying this was the best initial survey he had ever seen, six months later I was replaced by a nurse whom I had trained in LTC. She felt terrible about it. We remained friends and eventually she came to work with me again. This could go on and on, but it always came down to the same thing of gender. I decided to try research at our local university. That turned out to be a pathway to becoming an NP. Unfortunately, once I graduated and was licensed, there was no money to pay for the position they had trained me for. However, I had met and worked with many physicians who were associated with the university and one of them offered both me and a graduating fellow the opportunity to take over her practice. However, there weren’t enough patients to give two people (guys) a paycheck and after a year I was let go, but I was treated very fairly. Within a week I had another job offer and I spent almost 12 years with that practice. It was all male providers. I helped to grow the practice and earned a good living while doing it. So, try as I did to overcome the gender bias as an RN, I had at best, marginal success. As an NP it didn’t seem to matter that I am a man. I got lucky, and I never left the field. I felt really disheartened for the first half of my career, but my wife kept cheering me on. Today, our daughter in as RN and she loves it. I can honestly say that I had the privilege of helping patients and residents feel better about themselves. I taught and encouraged my peers to learn all they could and never kept someone from trying to get a better position. I miss the NP work but, not so much, the RN part.

    Reply
    • Fidelindo Lim
      October 13, 2022 3:58 pm

      Dear Steve,

      Thank you for writing. I appreciate your narrative and the context you provided. There is no doubt that nurses you have trained and mentored over the year continue to carry on your inspiration.

      Best regards,

      Fidel Lim

      Reply

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