Male Entry into a Discipline Not Designed to Accommodate Gender: Making Space for Diversity in Nursing

Apr 16, 2013, 9:00 AM

Michael R. Bleich, PhD, RN, FAAN, is Maxine Clark and Bob Fox dean and professor at the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Mo. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2000-2002).


With help from co-authors Brent MacWilliams, PhD, ANP, and Bonnie Schmidt, PhD(c), RN, in our recent American Journal of Nursing article summarizing research on men in nursing—and further inspired by a manuscript by Dena Hassouneh, PhD, ANP, entitled Anti-Racist Pedagogy: Challenges Faced by Faculty of Color in Predominantly White Schools of Nursing in the July 2006 issue of the Journal of Nursing Education—I am in a reflective place. After a nearly 40-year journey as a male in nursing, I now realize the discipline was never designed for me.

"Why did the faculty not do more to buffer me from faculty who were overtly gender-disparaging? Why were the gloves in procedural kits always sized for smaller hands?"

That is not to say that I have not had a fabulous career, worked with the finest colleagues one could imagine, or had opportunities that provided continuous challenge and opportunity. But as a discipline, nursing has had its broad shifts.  Florence Nightingale was a master of evidence-based practice and spent a lifetime elevating nursing to a discipline in a world that was political, gender-biased against women, scientifically evolving, caste-oriented, and more. The gift of structure, process, and outcomes she gave nursing are irreplaceable.

But, as with many charismatic leaders, there were not enough others to stand alongside her or to pick up the mantle. So nursing eventually lapsed for a time and developed through an apprentice model, where the dominant mental model prevailed and left us to staff wards under a “superintendent” of nurses, a “head” nurse, and/or to assist physicians and follow their “orders.”

During my master’s thesis literature review, I recall early 1900s literature where physicians decided and approved nursing courses. One article in the American Journal of Nursing reflected the debate led by a physician who advocated that nurses should be allowed a course in psychology as part of their training. He made this call not because it would add to nursing’s knowledge of caring for the patient but so that nurses could communicate and convey information to physicians, who intended to control the use of nurses as information gatherers for the benefit of a medical lens. This simple example illustrates the control that others had over the discipline at the time and shows what we have overcome as a discipline in the years since.

I recall a time when nursing’s terminal degree was the master’s, a time when the science of nursing came exclusively through other disciplines such as sociology, anthropology, or education.  And I am grateful to be where we are today—a time when nursing stands beside other health disciplines with its own unique lens of holistic decision-science capacity, contextually-bound through a lens of the individual, family, and community.  

At some level, I understand that nursing is part of a Euro-centric female history, and I respect the work of women to overcome the hypocrisy of societal beliefs.  

But I also reflect on whether Nightingale could have done more to influence social structures that would have favored both genders. Or perhaps she was fatigued doing all she did, and embracing gender norms in nursing was beyond her?  

Why did nursing fail to use affirmative action to shift the gender and ethnic/cultural paradigm in nursing when other disciplines (like athletics, law, and medicine) did so (note the last summer Olympics and how American women led the medal count)?  

Why did the faculty not do more to buffer me from faculty who were overtly gender-disparaging? Why were the gloves in procedural kits always sized for smaller hands?  Why did feminist nurses act toward me and other men in hostile ways, suggesting that we were advantaged by being men, failing to realize  that  men  endure discrimination within and from outside the discipline because they choose to be nurses?  

The world seems focused on diversity these days. We all want it. I know first-hand the feeling of being a token in a female-dominated profession. I know I’ve been invited to gatherings simply because I am “different,” and then have found myself isolated from the group.

Sadly, it’s no different today than when I was first hired to lift patients on an orthopedic unit in the 1970s—not because of my ‘brains’ or my ability to care for patients, but because of my perceived brawn.

Too often, we “feel good” because we have an ethnic minority, a culturally diverse, multi-generational, and/or an underrepresented gender in academic and service positions.  But do we then honor the perspectives these individuals bring to bear?  Do our organizational structures fully embrace divergent ideas, experiences, and perspectives?  Or is the unspoken ideal one that appreciates diverse individuals only to covertly “train” them with an expectation that they adapt to Euro-centric female values, beliefs, and practices?

This blog poses the opportunity to reflect on personal, group, and organizational norms.  I look forward to conversing with you around the following questions, or other comments you may have.

  1. What is the difference between diversity and inclusion?
  2. What structural or procedural barriers could be reduced in health care to encourage inclusion?
  3. How do we and should we welcome diverse individuals into the profession?  Into our organizations?
  4. Why do men seem to self-select into certain clinical settings more than others?  Why are there “gender-safe” settings?
  5. How do we shift social norms so that men do not have to explain their choice to be nurses? We don’t question women who choose to be physicians, pharmacists, or other health professionals, but why do we ask these questions of men who want to be nurses?

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.