THE
MALE NURSE:
challenge to traditional role identities
a
by Patricia J. Bush
HY does he do it?” From our perspectives, the
choices of others often seem so curious, unreasonable, or irrational, that we seek motivations for their behavior. Furthermore, when we encounter a person who has assumed an identity incongruent with our expectations, we are uncomfortable. Therefore, in a culture that defines nurses as female, we find it difficult to know how to relate to a man who claims the nurse position. We are suspicious of his apparent choice of a position traditionally reserved for the lower status sex; and we cannot understand the choice of an identity which seems likely to incur negative sanctions. Status assigment is culturally determined. While our society may be less rigid than others in allowing for talent and innovation, race and sex-related rules frequently control entry to occupations. That the term “male nurse” exists testifies to one such sex-related rule. There are historic reasons why
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nursing is a woman’s occupation. Nursing varies from other health professions in that, as it does not possess a unique body of knowledge, it is defined by its integration of technical with affective skills. These affective skills, such as nurturing, caring, tendering, are those traditionally assigned to, or assumed to be intrinsic in, women. Thus nursing on its affective side is an extension of mothering from the home to the greater society. Given this inherent sex typing and the historic lower status of women in society, it is not surprising that the “women only” rule has meant that less than 2 percent of United States’ nurses are males. The role of men, which carries such expectations as masculine strength, aggressiveness, assertiveness, self-control, and leadership may conflict with the affective role of the nurse as caring, tender, warm, and sympathetic. Thus, lacking a definition of cultural behavior, male nurses not only can experience
NURSING FORUM
391
a conflict as to whether to present themselves as males or as nurses, but their presence discomfits others who do not know whether to act toward them as males or as nurses. (Hughes, 1972) Furthermore, we imagine that violation of normative expectations incurs swift and certain sanctions from others. However, our expectations that such sanctioning will occur may be, as Becker (1955) and Kitsuse (1962) suggest, merely a social control mechanism. In the real world of confrontation, the imposition of sanctions is problematic and situationally bound. It seems likely, that from the male nurse’s perspective, from his perception of opportunities, i.e., his appraisal of the ratio of possible rewards to costs that might result if he were to follow such a course, his behavior must appear reasonable. His expectations of negative sanctions must be less than ours, or he has found a way to avoid them, or he perceives the rewards as worth the costs incurred. This suggests that men will not become nurses unless they perceive support for their role identities from at least one significant social audience. An alternative suggestion, made by Hughes ( 1972), is that some persons are so individualistic they are able to reward themselves for making a status protest. He also suggested that society will find a way to deal with the unexpected in social positions. (Hughes, 1971) One strategy is for occupants to keep out of troublesome situations, thus reducing the force of status contradiction. Greenberg and Levine (1971) found that the choice of a specialty by male nurses conformed to this strategy. In the long run, however, solutions lie in repression, enlargement of definitions, elaboration of the system to permit the group with unexpected identity a defined position, or a broadening and redefining of women’s and therefore men’s roles in society. Recent increases in the
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1976
number of men entering and graduating from nursing schools suggest that the social tide of change is running against repression and toward accommodation and redefinition. HOW AND WHY MENDECIDE ON A
NURSING CAREER
The purpose of the small study reported here was to investigate how and why men decide to become nurses; which forces in society are inhibiting, which are encouraging; and how these forces are perceived and accommodated in the effort to maximize social benefits and minimize social costs. In the fall of 1975, the author carried out focused interviews of white males - student and graduate nurses - at a midwestern university. Of ten respondents, six were students - two were sophomores, two were juniors, and two were seniors. Four of the ten respondents were graduate registered nurses - two attendStudy Methods ed graduate school, and two were full-time employees, one as an instructor in the nursing school and one in the university hospital. Seven of the ten respondents were married. While names were drawn at random from the various strata, no generalization to the student or graduate nurse population is intended. Eight interviews were held in the interviewer’s office and two in locations selected by the respondents (rooms in the school of nursing and the school of public health). The interviewees were told that a graduate student was writing a paper on persons who had broken some social norm, and that no respondent would be identified in the paper by name. Demographic data were collected on a structured face sheet, and the rest of the interview was tape recorded, with the help of an interview guide of questions and probes used by the
NURSING FORUM
393
interviewer to give some structure to the conversation, and to jog the memory of the interviewer when areas were not covered in the normal course of the conversation. (Appendix I ) An attempt was made to ask questions in terms of the past, the present, and the future. There was no evidence that the presence of the tape recorder constrained interviews, which varied in length from 40 minutes to one and one-half hours, depending on the articulateness and loquaciousness of the interviewee. Initially, the research questions were to be directed toward eliciting, in addition to their own experience, the experience of male nurses in general as viewed by several informants, and interviews with the remainder of the sample would be confined to the male nurse’s own experiences. When it was perceived that a respondent frequently attributed characteristics to others that he did not attribute to himself, this plan was dropped. Furthermore, because of their relatively small numbers and the rapid changes in the profession, male nurses seemed unlikely to be an interacting consensus group with shared experiences and a strong normative value system. Because it was uncertain that an informant’s views would be representative of the group, essentially all respondents were treated as informants. Who are they? A profile of the male students and graduate nurses in the sample suggests that they tend to be like their female counterparts in some respects and disStudy similar in others. The similarities were in backHabits ground and mobility. Like their female counterparts, the respondents tended to be from rural areas or small towns and to be from lower middle-class backgrounds. (Mauksch, 1972) The assignment of social
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status was self-perceived. There is an inherent reluctance of persons to assign themselves to the extremes, thus it is likely that some of the respondents would occupy the lowest status if the Hollingshead two-factor index had been used. Only two respondents with professional fathers were clearly upper middle class. Seven of the ten stated they had or expected to have a social status higher than their fathers; six attributed their upward mobility to education, and one to both education and occupation. The mean age of the six undergraduates was 23.6 years with no respondent less than 23. The two graduate students were 29 years, although their dates of graduation were no earlier than 1972. Three held degrees in other .fields, and four had two to three years of college before applying to nursing school. Thus, it would appear that males who enter the baccalaureate nursing program are more likely to be older, to be married, and have more education than female nursing students.
“. . . men may reduce role strain b y redefining nursing”
Why do h e y do it? The answer to this question is an abstraction from two related questions: “Why do they say they do it?” and “Why are they allowed to do it?” When asked why men choose nursing, the respondents gave quite consistent answers. Their own reasons, while providing some elaboration, did not deviate very much from their perceptions of other’s reasons. Three reasons were usually mentioned: job security and opportunity, interest in the biological sci-
NURSING FORUM
395
ences, and a desire to work in a humanistic field. One respondent, a graduate student in hospital administration, selected nursing as a stepping stone to administration; several, speaking of other male nurses, said that nursing was a secondary choice. One respondent used the phrase, “backing down into nursing.” when the first choice (usually medicine) was perceived as blocked by competition or lack of money. Nine respondents stated that nursing was their own first choice; the tenth said it was an equal choice with the field in which he already had a degree but couldn’t find employment. Several of the men interviewed claimed that nursing school entrance was as difficult as medical school entrance, and if they had so wished, they could have become physicians. Sour grapes? Or does this statement suggest that when a choice of a career requiring considerable investment and risk is made, individuals reward themselves for making that choice by assigning to the career desirable attributes which may be inconsistent with reality. Such reassurance may be more pronounced when there are perceived pressures from others to keep them from making such a choice. Most of the overt pressures to dissuade men from entry into nursing come from their parents, the strongest pressures coming from fathers. However, in time, parental opposition tends to diminish or even turn to pride, as the tape interviews indicate: My dad was strongly opposed. He really felt that informal rule, but he got over it because others were supportive even strangers. I guess it kind of embarrassed my father even. My parents were really opposed especially my father - he’s fairly traditional -but he’s really behind it now. It was kind of embarrassing for him but he got a lot of reinforcement.
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Although I think a lot of that is false -people to make polite conversation.
are just trying
Yeah, my old man really didn’t like it; we didn’t talk about it for awhile, but last time I was home, he started asking me questions about it - so maybe he’s changing. My younger sister teases me some, but no one else seems to care. My parents tried to discourage it. My mom was a nurse and the ones she knew were effeminate or not very good. Now she’s proud.”
I got some hassle from relatives I didn’t care a toot about.
Two respondents denied that anyone tried to pressure them. However, one stated that others assumed he was pressured. “People say, ‘Bet you got a lot of hassles.”’ When probed, the other respondent only said, “Well, there might have been some who considered it kind of funny,” but when asked if anyone said or did anything to make him feel that way, his reply was, “Not really.” One of those interviewed already had eight years of associated nursing experience in the Navy, so his parents did not perceive a change except as a transition to valued officer status. The respondent who became a nurse as a stepping stone to hospital administration, intimated his “not really being a nurse” effectively relieved him of negative family sanctions. Respondents reported that when their friends were told of their decision to enter nursing school, they were usually supportive or unconcerned. However, one who distinguished between college friends and working friends without a college education, said the latter were much more likely to make remarks such as “Yuch! What do you want to do that for?’.’ A similar remark was made by another respondent who thought male nurses might have problems in a very small town com-
NURSING FORUM
397
posed of “real masculine working men like steel workers.” Male nurses apparently believe that with education comes tolerance toward their new identity. Most respondents recognized they were breaking an unwritten rule when they decided to become nurses and they expected some negative sanctioning. Actually they got less than they expected. They stated that those persons who initially were disapproving of them tended to change their minds, and that positive reinforcements were much more frequent than negative.
What are the conditions under which men will decide to enter nursing? Among the ten respondents, at least one of two conditions were met: Men in the sample had associated work experience, such as service as medical corpsmen or as hospital workers, usually as orderlies, or if they had no prior associated work experience, a “significant other,” usually a nurse, had introduced them to the possibility of nursing as a career. Furthermore, if the introduction was through a person, the prospective student sometimes sought out work in a hospital to confirm his choice. It seems when the culture does not provide an accepted definition of a role, an aspirant finds it in personal experience. This personal experience must lead one to the conclusioin that at least some of the gate keepers actively support passage. Why is the enrollment of men in nursing schools increasing?* Respondents attribute this to changing perceptions of ‘Thirteen percent of sophomores are males, up from 5 percent of seniors. Of one school, over fifty percent of the students are reported to be male in the incoming class.
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roles in society in response to the women’s lib movement, more familiarity with men in nursing roles through military experience, changing opportunities in nursing - “bedpans are out, physicians’ assistants are in” - and a belief that people are becoming less likely to stereotype others. However, one must distinguish between the outside agents of social control and the inside agents who are the true gate keepers. The latter must believe that encouraging men to enter nursing will result in a gain to present occupiers of nursing roles. Two facilitating forces may be operating: The first, the promise of the women’s lib movement not to deny a woman equal pay for equal work or promotion because of her sex. The second, the nursing profession is in a struggle for power and status with other health professions. For nurses, men are needed as measuring sticks. Members of the profession cannot make a claim for “equal pay for equal work” if there are no men against which to assess claims of equality. While there is much internal dissension, the general strain is toward more independence, more authority, and more administrative tasks. Of course, along with these would come that ever sought-after reward, higher pay. Thus, several respondents suggested that nurses with power (in schools, hospitals, and professional organizations) are encouraging the entry of men because they expect them to rise to administrative and authority positions, to demand more pay, thus raising the power and prestige of the entire profession. In both school and work, respondents said they feel advantaged. Several observed that men are more likely to be elected to association offices. (Indeed, the National Student Nurses Association has had two male nursing students as presidents; one of whom is currently serving in that office. Moreover, approximately one-third of the state delegates to
NURSING FORUM
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the Association’s 1976 national convention were male student nurses.) However, several respondents expressed regret at their favored treatment. “I get treated preferentially so I will like it and stay in - but I don’t think it’s fair.” “At work I don’t get stepped on like a new female nurse might. Guys who make errors are left alone or babied by the head nurse.” However, one respondent, a working RN, reported that he received less “favorable discrimination” on the job than he had been led to expect during his school experience. If men are to be encouraged to become nurses, both school and work structures must accommodate change. While a school may take the position that men and women students are the same, that the nursing role is asexual, the respondents generally saw this denial of sexuality as unrealistic. “It is a problem for most female classmates to have me give them a bed bath. The dependency that patients have in hospitals simply doesn’t exist in classrooms.” Problems in the work situations were also remarked on: Older, traditional nurses try to use me as an orderly to d o lifting. After several frustrating months and appealing to superiors, I finally solved it by stating very clearly that I was going to perform my nursing duties for my own patients and the other nurses should d o the same. I’m more likely to be given men patients. If I have a woman, chances are she doesn’t need any personal care.
Most of the respondents reported acceptance by patients, with just a few rejections from older women patients. Not only are agents of social control operative at the time of the male student’s decision to enter nursing, their control mechanisms may continue to be felt. Men in nursing must develop coping skills to deal with these. One strong control
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mechanism which functions to keep men out of nursing is the attribution to them of homosexuality. About one third of the respondents volunteered that others questioned whether they might be “queer” or “gay.” One reported, “I constantly have people rib me - especially in my ROTC unit. They ask about my uniform insignia, and when I answer, I get ‘thay, you’re a nurse,’ and a laugh. Anyone who says they don’t [get ribbed] is living in a really protected world.” Of the remaining respondents, two denied that such attributions were made. While most suggestions are in the form of raised eyebrows, occasionally attributions are overt. One reported that a female nurse once said to him “every male nurse looks under the patient’s covers to see what he’s got.” Respondents were quick to point out that they were not gay themselves, and didn’t find more gays in nursing than anywhere else. The attribution of deviance may serve as a mechanism to keep men from entering traditionally female occupations and to help answer the question, “Why do they do it?” How do they cope? There was no consensus among the respondents as to coping skills. They ranged from denial that an attribution of homosexuality exists to “I tell them to get screwed,” or “I joke back - I affect an effeminate stance by talking in a ‘queer’ way or I’ make some reference to ‘the problem my wife has with me’.’’ Two of the men interviewed reported they were initially quite hurt by the responses of others; one of them said he was initially defensive. Both changed their attitudes so that now, they say, they really try to explain their reasons for going into nursing, or just accept that some people are going to “be that way” and forget it, or “Such people aren’t worth bothering about.” While one
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interviewee said he has had some “real frank discussions” with other male student nurses under the general subject of how to deal with stereotypes, male nurses do not appear to be a cohesive ingroup with shared rules or a joking relationship. Several of the men said that a male nurse has to “have a good grip on himself” - to “really know who he is” and “why he’s doing what he’s doing.” Several said they had benefited from the support and help of their wives. The reaction of patients also may serve as a control mechanism. While some respondents said that patients are likely to blame them as individuals if they are perceived to have failed in the performance of a technical skill, but if perceived to have failed in the affective area, male nurses as a group would be blamed. Others responded that patients do not expect male nurses to be warm and sympathetic, therefore, are not disappointed. In fact, the appropriate performance of affective skills is likely to earn male nurses more praise from patients than might be accorded female nurses. The consensus was, however, that individual relationships are quickly established between patients and nurses, and men are equally as responsible as women in the affective area. The interviews have suggested that in the absence of a cultural definition of their status, male aspirants to nursing must develop coping skills that facilitate acceptable definitions of themselves. Such adaptive mechanisms will be most successful if they reduce the role conflict between maleness and the affective area of nursing. In addition, to those mechanisms adapted to deal with friends, family, and patients, men in nursing may, as Hughes (1971) suggests “try to decrease the force of status considerations by keeping out of troublesome positions.” In conformity with Hughes’ suggestion, respondents reported steering clear of the following
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specialties : pediatrics (one respondent noted that children continually challenge their right to nursing status) and obstetrics. Traditionally, male nurses have become anesthetists or have gone into psychiatry or urology, for neither specialty requires “hands on nursing,” and nontraditional costumes may be worn. Only one respondent said he just wanted to be a ward nurse. Several indicated they do not think men are satisfied to remain as floor nurses. The rest intended to enter public health nursing, administration, surgical specialties, or were undecided. Role strain can be reduced by the selection of specialties that do not require giving personal care and in which nontraditional clothing may be worn. Also, men may reduce role strain by redefining nursing. As a quick check on this posibility, an equal number of lay persons and respondents were asked to give five adjectives describing nursing. An attempt was made to divide these adjectives into categories as they were more likely to relate to technical skills or affective skills. While some adjectives were unclassifiable (e.g. “white”), 15 percent of the adjectives provided by the ten male nurses were judged affective; and from the lay persons, 40 percent of the adjectives were judged affective.
CONCLUSION At the present time, there are forces within nursing which encourage the entrance of males and give support to their status. In the greater society, while there is some overt sanctioning, it is situational. However, positive support is more frequent than negative sanctioning. Although men crossing the sex boundary in occupations risk being typed as homosexuals, men will not cross this boundary unless they have had personal contact with nursing which convinces them
N U R S I N G FORUM
403
that the gains will compensate for any negative sanctioning they may incur. Male nurses develop coping skills to deal with reactions to their status. To minimize role conflict, they tend to select nursing specialties where potential conflict will be reduced. Men who choose nursing as a career generally view themselves as pioneers or innovators; they believe their sex will be an advantage because others in the profession expect them to be leaders, administrators, and change agents. The desire of men to achieve recognition in nursing by being different may be more significant than most would admit. With this in mind, the rather poignant remark of one student is provocative. “I guess I enjoy being special. Being a white male in society can be a pretty unpleasant experience right now.”
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REFERENCES ‘Becker, H. S., “Marihuana Use and Social Control,” Social Problems, 35-44, 1955. ZGreenberg, E., and J. B. Levine, “Role Strain in Men Nurses: A Preliminary Investigation,” Nursing Forum, 10:416-30, 1971. 3 Hughes, E. C., Where People Meet, New York: The Free Press, 1972. 4Hughes,E. C., The Sociological Eye: Selected Papers, New York: Aldine, 1971 5Kitsuse, J. I., “Societal Reaction to Deviant Behavior,” Social Problems, 9 :247-56, 1962. eMauksch, H. O., “Nursing, Churning for a Change,” Handbook of Medical Sociology (H. E., Freeman, S. Levine and L. G. Reeder, eds.) , Englewood Cliffs, N. J. : Prentice Hall, 1972. ‘McCall, G. J. and J. L. Simmons, Identities and Interactions, New York: The Free Press, 1966.
NURSING FORUM
405
MALE NURSE:
challenge to traditional role identities
a
by Patricia J. Bush
HY does he do it?” From our perspectives, the
choices of others often seem so curious, unreasonable, or irrational, that we seek motivations for their behavior. Furthermore, when we encounter a person who has assumed an identity incongruent with our expectations, we are uncomfortable. Therefore, in a culture that defines nurses as female, we find it difficult to know how to relate to a man who claims the nurse position. We are suspicious of his apparent choice of a position traditionally reserved for the lower status sex; and we cannot understand the choice of an identity which seems likely to incur negative sanctions. Status assigment is culturally determined. While our society may be less rigid than others in allowing for talent and innovation, race and sex-related rules frequently control entry to occupations. That the term “male nurse” exists testifies to one such sex-related rule. There are historic reasons why
390
VOLUME X V
NO. 4
1976
nursing is a woman’s occupation. Nursing varies from other health professions in that, as it does not possess a unique body of knowledge, it is defined by its integration of technical with affective skills. These affective skills, such as nurturing, caring, tendering, are those traditionally assigned to, or assumed to be intrinsic in, women. Thus nursing on its affective side is an extension of mothering from the home to the greater society. Given this inherent sex typing and the historic lower status of women in society, it is not surprising that the “women only” rule has meant that less than 2 percent of United States’ nurses are males. The role of men, which carries such expectations as masculine strength, aggressiveness, assertiveness, self-control, and leadership may conflict with the affective role of the nurse as caring, tender, warm, and sympathetic. Thus, lacking a definition of cultural behavior, male nurses not only can experience
NURSING FORUM
391
a conflict as to whether to present themselves as males or as nurses, but their presence discomfits others who do not know whether to act toward them as males or as nurses. (Hughes, 1972) Furthermore, we imagine that violation of normative expectations incurs swift and certain sanctions from others. However, our expectations that such sanctioning will occur may be, as Becker (1955) and Kitsuse (1962) suggest, merely a social control mechanism. In the real world of confrontation, the imposition of sanctions is problematic and situationally bound. It seems likely, that from the male nurse’s perspective, from his perception of opportunities, i.e., his appraisal of the ratio of possible rewards to costs that might result if he were to follow such a course, his behavior must appear reasonable. His expectations of negative sanctions must be less than ours, or he has found a way to avoid them, or he perceives the rewards as worth the costs incurred. This suggests that men will not become nurses unless they perceive support for their role identities from at least one significant social audience. An alternative suggestion, made by Hughes ( 1972), is that some persons are so individualistic they are able to reward themselves for making a status protest. He also suggested that society will find a way to deal with the unexpected in social positions. (Hughes, 1971) One strategy is for occupants to keep out of troublesome situations, thus reducing the force of status contradiction. Greenberg and Levine (1971) found that the choice of a specialty by male nurses conformed to this strategy. In the long run, however, solutions lie in repression, enlargement of definitions, elaboration of the system to permit the group with unexpected identity a defined position, or a broadening and redefining of women’s and therefore men’s roles in society. Recent increases in the
392
VOLUME XV
NO. 4
1976
number of men entering and graduating from nursing schools suggest that the social tide of change is running against repression and toward accommodation and redefinition. HOW AND WHY MENDECIDE ON A
NURSING CAREER
The purpose of the small study reported here was to investigate how and why men decide to become nurses; which forces in society are inhibiting, which are encouraging; and how these forces are perceived and accommodated in the effort to maximize social benefits and minimize social costs. In the fall of 1975, the author carried out focused interviews of white males - student and graduate nurses - at a midwestern university. Of ten respondents, six were students - two were sophomores, two were juniors, and two were seniors. Four of the ten respondents were graduate registered nurses - two attendStudy Methods ed graduate school, and two were full-time employees, one as an instructor in the nursing school and one in the university hospital. Seven of the ten respondents were married. While names were drawn at random from the various strata, no generalization to the student or graduate nurse population is intended. Eight interviews were held in the interviewer’s office and two in locations selected by the respondents (rooms in the school of nursing and the school of public health). The interviewees were told that a graduate student was writing a paper on persons who had broken some social norm, and that no respondent would be identified in the paper by name. Demographic data were collected on a structured face sheet, and the rest of the interview was tape recorded, with the help of an interview guide of questions and probes used by the
NURSING FORUM
393
interviewer to give some structure to the conversation, and to jog the memory of the interviewer when areas were not covered in the normal course of the conversation. (Appendix I ) An attempt was made to ask questions in terms of the past, the present, and the future. There was no evidence that the presence of the tape recorder constrained interviews, which varied in length from 40 minutes to one and one-half hours, depending on the articulateness and loquaciousness of the interviewee. Initially, the research questions were to be directed toward eliciting, in addition to their own experience, the experience of male nurses in general as viewed by several informants, and interviews with the remainder of the sample would be confined to the male nurse’s own experiences. When it was perceived that a respondent frequently attributed characteristics to others that he did not attribute to himself, this plan was dropped. Furthermore, because of their relatively small numbers and the rapid changes in the profession, male nurses seemed unlikely to be an interacting consensus group with shared experiences and a strong normative value system. Because it was uncertain that an informant’s views would be representative of the group, essentially all respondents were treated as informants. Who are they? A profile of the male students and graduate nurses in the sample suggests that they tend to be like their female counterparts in some respects and disStudy similar in others. The similarities were in backHabits ground and mobility. Like their female counterparts, the respondents tended to be from rural areas or small towns and to be from lower middle-class backgrounds. (Mauksch, 1972) The assignment of social
394
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NO. 4
1976
status was self-perceived. There is an inherent reluctance of persons to assign themselves to the extremes, thus it is likely that some of the respondents would occupy the lowest status if the Hollingshead two-factor index had been used. Only two respondents with professional fathers were clearly upper middle class. Seven of the ten stated they had or expected to have a social status higher than their fathers; six attributed their upward mobility to education, and one to both education and occupation. The mean age of the six undergraduates was 23.6 years with no respondent less than 23. The two graduate students were 29 years, although their dates of graduation were no earlier than 1972. Three held degrees in other .fields, and four had two to three years of college before applying to nursing school. Thus, it would appear that males who enter the baccalaureate nursing program are more likely to be older, to be married, and have more education than female nursing students.
“. . . men may reduce role strain b y redefining nursing”
Why do h e y do it? The answer to this question is an abstraction from two related questions: “Why do they say they do it?” and “Why are they allowed to do it?” When asked why men choose nursing, the respondents gave quite consistent answers. Their own reasons, while providing some elaboration, did not deviate very much from their perceptions of other’s reasons. Three reasons were usually mentioned: job security and opportunity, interest in the biological sci-
NURSING FORUM
395
ences, and a desire to work in a humanistic field. One respondent, a graduate student in hospital administration, selected nursing as a stepping stone to administration; several, speaking of other male nurses, said that nursing was a secondary choice. One respondent used the phrase, “backing down into nursing.” when the first choice (usually medicine) was perceived as blocked by competition or lack of money. Nine respondents stated that nursing was their own first choice; the tenth said it was an equal choice with the field in which he already had a degree but couldn’t find employment. Several of the men interviewed claimed that nursing school entrance was as difficult as medical school entrance, and if they had so wished, they could have become physicians. Sour grapes? Or does this statement suggest that when a choice of a career requiring considerable investment and risk is made, individuals reward themselves for making that choice by assigning to the career desirable attributes which may be inconsistent with reality. Such reassurance may be more pronounced when there are perceived pressures from others to keep them from making such a choice. Most of the overt pressures to dissuade men from entry into nursing come from their parents, the strongest pressures coming from fathers. However, in time, parental opposition tends to diminish or even turn to pride, as the tape interviews indicate: My dad was strongly opposed. He really felt that informal rule, but he got over it because others were supportive even strangers. I guess it kind of embarrassed my father even. My parents were really opposed especially my father - he’s fairly traditional -but he’s really behind it now. It was kind of embarrassing for him but he got a lot of reinforcement.
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1976
Although I think a lot of that is false -people to make polite conversation.
are just trying
Yeah, my old man really didn’t like it; we didn’t talk about it for awhile, but last time I was home, he started asking me questions about it - so maybe he’s changing. My younger sister teases me some, but no one else seems to care. My parents tried to discourage it. My mom was a nurse and the ones she knew were effeminate or not very good. Now she’s proud.”
I got some hassle from relatives I didn’t care a toot about.
Two respondents denied that anyone tried to pressure them. However, one stated that others assumed he was pressured. “People say, ‘Bet you got a lot of hassles.”’ When probed, the other respondent only said, “Well, there might have been some who considered it kind of funny,” but when asked if anyone said or did anything to make him feel that way, his reply was, “Not really.” One of those interviewed already had eight years of associated nursing experience in the Navy, so his parents did not perceive a change except as a transition to valued officer status. The respondent who became a nurse as a stepping stone to hospital administration, intimated his “not really being a nurse” effectively relieved him of negative family sanctions. Respondents reported that when their friends were told of their decision to enter nursing school, they were usually supportive or unconcerned. However, one who distinguished between college friends and working friends without a college education, said the latter were much more likely to make remarks such as “Yuch! What do you want to do that for?’.’ A similar remark was made by another respondent who thought male nurses might have problems in a very small town com-
NURSING FORUM
397
posed of “real masculine working men like steel workers.” Male nurses apparently believe that with education comes tolerance toward their new identity. Most respondents recognized they were breaking an unwritten rule when they decided to become nurses and they expected some negative sanctioning. Actually they got less than they expected. They stated that those persons who initially were disapproving of them tended to change their minds, and that positive reinforcements were much more frequent than negative.
What are the conditions under which men will decide to enter nursing? Among the ten respondents, at least one of two conditions were met: Men in the sample had associated work experience, such as service as medical corpsmen or as hospital workers, usually as orderlies, or if they had no prior associated work experience, a “significant other,” usually a nurse, had introduced them to the possibility of nursing as a career. Furthermore, if the introduction was through a person, the prospective student sometimes sought out work in a hospital to confirm his choice. It seems when the culture does not provide an accepted definition of a role, an aspirant finds it in personal experience. This personal experience must lead one to the conclusioin that at least some of the gate keepers actively support passage. Why is the enrollment of men in nursing schools increasing?* Respondents attribute this to changing perceptions of ‘Thirteen percent of sophomores are males, up from 5 percent of seniors. Of one school, over fifty percent of the students are reported to be male in the incoming class.
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roles in society in response to the women’s lib movement, more familiarity with men in nursing roles through military experience, changing opportunities in nursing - “bedpans are out, physicians’ assistants are in” - and a belief that people are becoming less likely to stereotype others. However, one must distinguish between the outside agents of social control and the inside agents who are the true gate keepers. The latter must believe that encouraging men to enter nursing will result in a gain to present occupiers of nursing roles. Two facilitating forces may be operating: The first, the promise of the women’s lib movement not to deny a woman equal pay for equal work or promotion because of her sex. The second, the nursing profession is in a struggle for power and status with other health professions. For nurses, men are needed as measuring sticks. Members of the profession cannot make a claim for “equal pay for equal work” if there are no men against which to assess claims of equality. While there is much internal dissension, the general strain is toward more independence, more authority, and more administrative tasks. Of course, along with these would come that ever sought-after reward, higher pay. Thus, several respondents suggested that nurses with power (in schools, hospitals, and professional organizations) are encouraging the entry of men because they expect them to rise to administrative and authority positions, to demand more pay, thus raising the power and prestige of the entire profession. In both school and work, respondents said they feel advantaged. Several observed that men are more likely to be elected to association offices. (Indeed, the National Student Nurses Association has had two male nursing students as presidents; one of whom is currently serving in that office. Moreover, approximately one-third of the state delegates to
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the Association’s 1976 national convention were male student nurses.) However, several respondents expressed regret at their favored treatment. “I get treated preferentially so I will like it and stay in - but I don’t think it’s fair.” “At work I don’t get stepped on like a new female nurse might. Guys who make errors are left alone or babied by the head nurse.” However, one respondent, a working RN, reported that he received less “favorable discrimination” on the job than he had been led to expect during his school experience. If men are to be encouraged to become nurses, both school and work structures must accommodate change. While a school may take the position that men and women students are the same, that the nursing role is asexual, the respondents generally saw this denial of sexuality as unrealistic. “It is a problem for most female classmates to have me give them a bed bath. The dependency that patients have in hospitals simply doesn’t exist in classrooms.” Problems in the work situations were also remarked on: Older, traditional nurses try to use me as an orderly to d o lifting. After several frustrating months and appealing to superiors, I finally solved it by stating very clearly that I was going to perform my nursing duties for my own patients and the other nurses should d o the same. I’m more likely to be given men patients. If I have a woman, chances are she doesn’t need any personal care.
Most of the respondents reported acceptance by patients, with just a few rejections from older women patients. Not only are agents of social control operative at the time of the male student’s decision to enter nursing, their control mechanisms may continue to be felt. Men in nursing must develop coping skills to deal with these. One strong control
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mechanism which functions to keep men out of nursing is the attribution to them of homosexuality. About one third of the respondents volunteered that others questioned whether they might be “queer” or “gay.” One reported, “I constantly have people rib me - especially in my ROTC unit. They ask about my uniform insignia, and when I answer, I get ‘thay, you’re a nurse,’ and a laugh. Anyone who says they don’t [get ribbed] is living in a really protected world.” Of the remaining respondents, two denied that such attributions were made. While most suggestions are in the form of raised eyebrows, occasionally attributions are overt. One reported that a female nurse once said to him “every male nurse looks under the patient’s covers to see what he’s got.” Respondents were quick to point out that they were not gay themselves, and didn’t find more gays in nursing than anywhere else. The attribution of deviance may serve as a mechanism to keep men from entering traditionally female occupations and to help answer the question, “Why do they do it?” How do they cope? There was no consensus among the respondents as to coping skills. They ranged from denial that an attribution of homosexuality exists to “I tell them to get screwed,” or “I joke back - I affect an effeminate stance by talking in a ‘queer’ way or I’ make some reference to ‘the problem my wife has with me’.’’ Two of the men interviewed reported they were initially quite hurt by the responses of others; one of them said he was initially defensive. Both changed their attitudes so that now, they say, they really try to explain their reasons for going into nursing, or just accept that some people are going to “be that way” and forget it, or “Such people aren’t worth bothering about.” While one
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interviewee said he has had some “real frank discussions” with other male student nurses under the general subject of how to deal with stereotypes, male nurses do not appear to be a cohesive ingroup with shared rules or a joking relationship. Several of the men said that a male nurse has to “have a good grip on himself” - to “really know who he is” and “why he’s doing what he’s doing.” Several said they had benefited from the support and help of their wives. The reaction of patients also may serve as a control mechanism. While some respondents said that patients are likely to blame them as individuals if they are perceived to have failed in the performance of a technical skill, but if perceived to have failed in the affective area, male nurses as a group would be blamed. Others responded that patients do not expect male nurses to be warm and sympathetic, therefore, are not disappointed. In fact, the appropriate performance of affective skills is likely to earn male nurses more praise from patients than might be accorded female nurses. The consensus was, however, that individual relationships are quickly established between patients and nurses, and men are equally as responsible as women in the affective area. The interviews have suggested that in the absence of a cultural definition of their status, male aspirants to nursing must develop coping skills that facilitate acceptable definitions of themselves. Such adaptive mechanisms will be most successful if they reduce the role conflict between maleness and the affective area of nursing. In addition, to those mechanisms adapted to deal with friends, family, and patients, men in nursing may, as Hughes (1971) suggests “try to decrease the force of status considerations by keeping out of troublesome positions.” In conformity with Hughes’ suggestion, respondents reported steering clear of the following
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specialties : pediatrics (one respondent noted that children continually challenge their right to nursing status) and obstetrics. Traditionally, male nurses have become anesthetists or have gone into psychiatry or urology, for neither specialty requires “hands on nursing,” and nontraditional costumes may be worn. Only one respondent said he just wanted to be a ward nurse. Several indicated they do not think men are satisfied to remain as floor nurses. The rest intended to enter public health nursing, administration, surgical specialties, or were undecided. Role strain can be reduced by the selection of specialties that do not require giving personal care and in which nontraditional clothing may be worn. Also, men may reduce role strain by redefining nursing. As a quick check on this posibility, an equal number of lay persons and respondents were asked to give five adjectives describing nursing. An attempt was made to divide these adjectives into categories as they were more likely to relate to technical skills or affective skills. While some adjectives were unclassifiable (e.g. “white”), 15 percent of the adjectives provided by the ten male nurses were judged affective; and from the lay persons, 40 percent of the adjectives were judged affective.
CONCLUSION At the present time, there are forces within nursing which encourage the entrance of males and give support to their status. In the greater society, while there is some overt sanctioning, it is situational. However, positive support is more frequent than negative sanctioning. Although men crossing the sex boundary in occupations risk being typed as homosexuals, men will not cross this boundary unless they have had personal contact with nursing which convinces them
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that the gains will compensate for any negative sanctioning they may incur. Male nurses develop coping skills to deal with reactions to their status. To minimize role conflict, they tend to select nursing specialties where potential conflict will be reduced. Men who choose nursing as a career generally view themselves as pioneers or innovators; they believe their sex will be an advantage because others in the profession expect them to be leaders, administrators, and change agents. The desire of men to achieve recognition in nursing by being different may be more significant than most would admit. With this in mind, the rather poignant remark of one student is provocative. “I guess I enjoy being special. Being a white male in society can be a pretty unpleasant experience right now.”
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REFERENCES ‘Becker, H. S., “Marihuana Use and Social Control,” Social Problems, 35-44, 1955. ZGreenberg, E., and J. B. Levine, “Role Strain in Men Nurses: A Preliminary Investigation,” Nursing Forum, 10:416-30, 1971. 3 Hughes, E. C., Where People Meet, New York: The Free Press, 1972. 4Hughes,E. C., The Sociological Eye: Selected Papers, New York: Aldine, 1971 5Kitsuse, J. I., “Societal Reaction to Deviant Behavior,” Social Problems, 9 :247-56, 1962. eMauksch, H. O., “Nursing, Churning for a Change,” Handbook of Medical Sociology (H. E., Freeman, S. Levine and L. G. Reeder, eds.) , Englewood Cliffs, N. J. : Prentice Hall, 1972. ‘McCall, G. J. and J. L. Simmons, Identities and Interactions, New York: The Free Press, 1966.
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