Gender based Professions: the impact of the Professionalisation of nursing on male nurses during the nineteenth and twentieth centuries.

University Degree Subjects allied to Medicine

Title:Gender based Professions: the impact of the Professionalisation of nursing on male nurses during the nineteenth and twentieth centuries.

By M M A Coulter. Source: Foundations of Professional Nursing, Semester 1, undergraduate (2006).

Abstract: The professionalisation of nursing during the nineteenth and twentieth century was a contributing factor in marginalizing male nurses but it appears from research that it is not the most important contributing factor in today’s society that keeps men from taking up nursing. During the nineteenth century Nightingale promoted a model of a gender based profession that put in place physical barriers that excluded males, and their roles within the profession were marginalized. Males became a token gender in nursing due to the need for physical strength to restrain clients in asylums and mental institutions and men were pushed into this perimeter during the first one hundred years of the nightingale nursing model. During the last fifty years, however, anti-discrimination laws have been put in place to open up nursing to males but this seems to have had little impact on male nursing numbers. This essay hypothesizes that males have been rejecting nursing as an occupation over the last fifty years because it does not fit with their, or the communities beliefs and attitudes of a valid male occupation. The essay discusses the point that the real reason males remain a token gender in nursing is because of the social acceptance from the community that nursing is a sex-oriented profession for women. The essay goes on to explain that it is much harder to break down inherent social barriers than it is to break down physical barriers such as obvious gender discrimination. In conclusion, this paper argues that while professionalisation of nursing did exclude males at its beginnings in physical and social ways, it was obvious after the anti-discimination laws were enacted in 1947 that there were other subtle but strong influences keeping men from taking up the nursing role. Ultimately, this essay presents that it is inherently the males responsibility to step up and claim their centuries old right to nurse, and the females responsibility to support and encourage this acceptance from the broader community.

This paper will trace the changing prevalence of men in nursing during the nineteenth and twentieth centuries. It will outline the roles men have undertaken in nursing, consider the impact of nursing training during the late nineteenth and twentieth century and will argue that whilst the professionalisation of nursing has had a role in marginalizing male nursing numbers, the intrinsic nature of men and the informal belief from the community that nursing is ‘women’s work’ has also been an important component of the reason why men are still the token gender of nursing (Fottler, 1976 & MacIntosh 1997). The history of male nursing goes back many centuries, but their inherent value has been undermined and their gender marginalized by the closure of monasteries and nursing houses in the sixteenth century and the influence of dominant females, such as Florence Nightingale, who successfully took the role of nursing and made it a female occupation through physical barriers inherent in training and education programs (MacIntosh, 1997).

Romem (2006) explains that men provided nursing care for soldiers until Nightingale made her mark and within ten years, male nurses had not only be excluded from mainstream nursing but were also excluded legally from the USA Navy.

Prior to the nursing profession reform of the nineteenth century, men worked in caring roles in monasteries and through religious order (MacIntosh 1997). They cared for lepers, mentally ill and members of the community who found themselves deathly sick.

When the monasteries were dissolved in the sixteenth century, there was no form of organized care and it was during the next two hundred years that nursing fell into disrepute as handy-women sprang up of low morals, and usually with criminal backgrounds to fill the nursing need and provide a means of income support.

As there had been no formal nursing structure since the closure of the monasteries, Nightingale was able to control the direction of nursing in whatever way she saw fit. The Board of Governors at the time had not ruled that nursing was exclusively womens’ work (MacIntosh 1997). They had included in the nursing Act that men would manage infirmaries and asylums as attendants and that the female gender would be involved in the day to day caring, bandages and hygiene. In the mid nineteenth century following the 1834 Poor Law act there was a surge in numbers in the workhouses and infirmaries.

Sivulka (1999) points out that Nightingale pushed for the role of nursing as sex specific by using the point that women had superior skills in the tasks of tidiness, cleanliness and domestic sanitary economy. Nightingale successfully created nursing as a profession for women and the public began to accept it as they saw a higher class of educated altruistic women filling nursing positions. Women expanded their role in the nursing sphere and promoted the inherent right of women to perform nursing duties. Men worked in this segregated environment ensuring safety of the inmates, whilst the inmates effectively had to care ...

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Florence Nightingale, was a highly educated upper class member who saw the prevalence of disease and death connected to poor hygiene, infection control and lack of education. She fuelled the gender segregation by her aggressive approach that nursing was inherently ‘women’s work’ and she bought community approval by ensuring that nurses were trained, well educated and of reasonable class standing (MacIntosh, 1997).

Florence’s return from the Crimean war saw her come back with celebrity status and money was raised for her to start the first hospital for training nurses. Nightingale enforced a strict criteria for entry into the nursing education and training that had visible physical barriers excluding men. In the nursing professions early years, men were marginalized into caring roles such as workhouse infirmaries, asylums, private associations and military service (MacIntosh, 1997).

The work for nurses and attendants was of low status and low pay but it fit with the role Nightingale had of women being inherently self-sacrificing and altruistic. Fitzpatrick (1997) points out that Nightingale was able to improve the standards of nursing care through nursing training even though opposition to this was great. Nightingale was able to take the role of caretaker or handywoman and distinguish her nurses through training and education. Women were subordinate to men and worked in a hierarchy where the male physician was the head of the team, followed by the Matron and her subordinates.

By the mid twentieth century nurses were beginning to gain autonomy in making decisions and were becoming independent from the male physicians. The nursing profession had to struggle with male opposition to increasing autonomy, but they held a vice-like grip on their inherent gender based role, excluding men through physical barriers such as nurse boarding houses. The increasing needs of the physician meant a role of physicians assistant grew and nurses were increasingly ready to take on this role. Nightingales training and education regime created a sisterhood of non-religious order in nursing that men had no role in and where further marginalized by the physical barriers of a sexist profession (MacIntosh 1997).

These barriers were accepted by the community and the feminist approach to nursing training meant Men were marginalized to the asylums, infirmaries and the infantry. There was no room in student nurses homes for men and this further marginalized men’s ability to train and enhance their role in the profession (MacIntosh 1997). Potter & Perry (2005) state that gender bias is typical in occupations of female majority and this bias questions their masculinity. This ‘role-strain’ blends role conflict and role ambiguity. Nurse boarding homes were a physical barrier that excluded men from participating in training, and the social barriers were put in place by the acceptance by the community of a sex-oriented profession.

Men had to defend their role in nursing infirmaries as aggressive professionalisation of the nursing industry and gender segregation was set to revolutionise the infirmaries and asylums during the twentieth century (MacIntosh 1997). Males were not prepared to allow the takeover of their hold in this area. Men were working towards increasing their grasp on this male threshold through associations such as the Medico-psychological Association and a register of ‘good attendants’. The Temperance Male Nurse Co-operation Ltd provided male nurses to clients with three years training in areas such as catheter cases, medical, surgical and mental areas.The royal Army Medical Corp was also an area where trained males could use their nursing skills.

General hospitals selective trainee criteria, nurses registration and the Nursing Council register ensured women had control over their own profession, and that male nurses were scarce. Bashford (2000) notes that there was a broad shift toward a more professionalized culture of scientific grounding rather than philanthropy and self sacrifice and this professionalization of the nursing industry was in direct opposition of the role Nightingale had pushed as the natural nurse being a woman and by the mid twentieth century there was a shortage of nurses and so the picture had to change.

The shortage was linked to the general hospital expansion and the increasing options for alternative jobs for women (MacIntosh 1997). Age restriction altering and an advertising campaign of ‘vocationalism’ did little to help, but a small number of men began to take up nursing places.

The registration Acts were reshaped and male nurses were actively being canvassed and recruited. The Working party on the Recruitment and Training of Nurses in 1947 reported that male and female nursing roles should be open to both genders without discrimination. Following this the Mens register amalgamated with the womens register and schools of nursing began to allow male nurses to educate and train at their facilities. The professional mores were changing but social mores take longer to dismantle. In spite of the subsequent lack of professional barriers to male nurses in this female occupation, males still did not take up nursing in large numbers (Fottler 1976). It could be seen that social and cultural norms were the real barriers to males taking up nursing after the anti-discrimination laws had opened the profession to all. Romem (2005) suggests that social processes, so very subtle, inhibit the males inclinations to nurse in a female dominated profession.

Although the expansion was great there were still a number of factors that remained important in the retention of males (MacIntosh1997). The community still believed nursing was ‘women’s work’ and that male nurses must be homosexual because they were working in a woman’s occupation. As well as this the community believed that men should not be working in a female profession. Studies and surveys of male nurses have found that one of the most difficult aspects for men working in a female dominant occupation is the atmosphere that surrounds them (MacIntosh 1997). Fottler (1976) points out that segregation occurs in occupations where there is an extremely high majority gender and where this majority gender is generally accepted by the broader community. Kanter (1991) describes a token minority as that number that is less than 15% of the total. This reflects the statistics of the twenty first century where the figure for male nurses is around 5%.

Over the last one hundred and fifty years males have filled a token role in nursing, mostly at the expense of their self esteem and feelings of masculinity brought about by the accepted beliefs of the community on the intrinsic understanding that nurses are female. Fottler goes on to explain that because of the informal belief from the community in general that this is how it should be, nursing can be classified as a ‘…sex-typed feminine occupation’, but why is this so (Fottler 1997, p.99). With the opening of the training institutes to males and the joint registration of males and females, and the lack of professional discrimination from government levels, it is obvious that the professionalisation of nursing may have been the initial force behind males not taking up nursing but it has not been the overall governing reason, over the last fifty years for the low number of males in nursing. This can be directly linked to attitudes of men and the broader intrinsic attitudes and beliefs of the community. The lack of male role models and the perceived threat to sexuality as well as role strain and social isolation can be seen as an important contributing factors that keep men away from nursing (McMillan Morgan & Ament 2006).

Boschma (et.al 2005) points out that being fit for particular work is not reliant on gender, and that this barrier, of females being the appropriate nurse gender, is based on the beliefs and attitudes of society. These beliefs and attitudes stereotype an occupation to its gender. Nursing in particular and its social acceptance, is linked to women and femininity because of the gender discrimination from the nineteenth century brought about by the professionalisation of nursing and the beliefs and attitudes from the general community. It can be seen that the belief that nursing cannot be a masculine role if it is believed in the community to be a feminine role is where the questioning of male nurses masculinity arose…through the beliefs and attitudes imposed by the community of what a ‘real’ males occupation is. Peter (2002) states that divisions of gender within professions are mutually constituted but are not natural.The introduction of training did not give men the same opportunities, status and respect in the early twentieth century because nursing was feminine coded with social and physical barriers. Traditional work of private duty nursing and community health work was dwindling with the increase of public hospitals so there were many opportunities in mental health work. But the mental health system was problematic and had large numbers of incurable patients with a high level of violence which subsequently brought about a high staff turnover. Women were employed for their supposed better ability to care and were able to attain Registered Nurse status where the men still did not have this option available. The Depression years focused on acquiring female nurses in the mental health area. Nursing training during these times focused on an apprenticeship type training (MacIntosh 1997).

Boschma (et.al 2005) found male nurses chose nursing as a profession based on childhood experience or knowledge of someone in the nursing field. Care by men in psychiatry was most common due to the nature of the patient and the need for male strength in client restraint. The exclusion of males from equal professional recognition meant males reacted strongly against the traditional gendered beliefs of nursing and men and women in nursing identified with an expert nursing culture by the 1960’s. Fottler (1976) suggests that males often don’t take up positions in nursing because they work under women and are therefore in a subordinate position which undermines their ‘manhood’ or ‘maleness’ and that the dominance of females in this occupation leads to prejudice, discriminations and attitudes that are unacceptable to them. Fottler (1976) also points out that research has shown that intelligence test, psychological tests and tutors’ assessments have shown that males are equally suited to nursing as females. Males may take up nursing positions less frequently than women due to the lack of inclination to take up training in a profession that does not line up with their self image of ‘men’s work, and they feel they will not have opportunities to promotion and training.

Although it is expected that female nurses would present attitudes and gender based cultural norms directed towards males, research has found that female nurses who have had exposure to male nurse colleagues do not view the male nurse as a threat to their role in nursing or their ability to gain promotion. Fottler (1976) found that the nursing profession is accepting of male nurses and therefore the

‘The reasons for the sex segregation of nursing undoubtedly

emanate from the traditional social, cultural and economic

values of the society and the nature of the nursing role itself”

Fottler, 1976, p.108

Brady & Sherrod (2003) point out that nursing should reflect the population it serves reflecting the ethnic, racial and cultural needs of it and that the influence of friends and relatives of male nurses is the most likely reason men take up nursing. Nursing education centres themselves continue to use terminology that is female oriented. Justification by a male nurse of his occupation and defense of his masculinity are some of the reasons men state they don’t stay in nursing.

The nursing profession needs to attempt to dispel stereotypes of male nurses of homosexuality and promote acceptance, tolerance and diversity within the broader public community. Nursing throughout history has shown that men have always had a role in nursing and that prior to the monasteries being closed, it was a male dominated arena (MacIntosh 1997).

Florence took the role of nursing and inherently argued its place as a woman’s occupation. She professionalized the role by educating the nurses and applying a disciplined approach to nursing strategies as well as putting in place physical barriers to prevent males entry. While there were barriers of sexual discrimination and segregation put in place by the nursing profession at this time, these were effectively removed by 1947. Male nursing numbers did increase after this dismantling but there has been no influx of male nurses to balance the gender equation and they still remain a token gender.

What does appear to be the main reason men don’t take up nursing is the acceptance of nurses, as males, by the broader community and the internal attitudes and belief patterns linked intricately within society mores. Effectively these social mores are what continues to marginalize male nurses within the nursing profession. It can be argued that had nursing not been professionalized as a female centred occupation by Nightingale at the onset of training and education, that the social mores and acceptance from the community would have been greater. It can be seen however, that at the point where the Anti-discrimination laws were enacted and the physical barriers were dismantled, the subtle social barriers became more obvious. For the last fifty years there appears to have been no change in the numbers of male nurses. Male nurses need to take ownership for their own token numbers in an occupation that has for sixty years not discriminated against them institutionally, and whose inherent value has been demonstrated throughout the centuries. With the twenty first century attitude of acceptance of the ‘Sensitive New Age Guy’ these social attitudes may be more quickly broken down and men may find their role within the nursing profession more balanced and equal. Males need to take responsibility for claiming their right to nurse and female nurses need to support and encourage acceptance within the community before the profession will reflect an equal balance of gender.

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