Men in Nursing: Let's Talk

In recent years, there have been growing efforts to increase the number of men in nursing, globally and in Australia, the rationale being to address the worldwide nursing shortage, which is predicted to reach 10 million by 2030 (World Health Organization 2022). Currently in Australia, men account for 11.8% of the registered nurse workforce (Nursing and Midwifery Board of Australia 2024). Similarly, men make up between five to 12% of the registered nurse workforce in the United Kingdom, United States of America and Canada. Targeted recruitment initiatives from prominent organisations, for example, the Australian College of Nursing (ACN) ‘It's ok to care’ and the American Association for Men in Nursing (AAMN) ‘Do what they love and love what they do’ campaigns have had some success, with an increasing trend of young men joining the profession. However, there is a need to consider how the recruitment of more men into nursing may impact on women in the profession. Men bring their gender privilege into women dominated professions. The ‘glass escalator’ is a metaphor for the structural advantages that men have in woman dominated professions; men ride a glass escalator to the higher paying and more prestigious positions. The concept of the glass escalator is not new and was first introduced over three decades ago. An online search of men in nursing literature suggests varying viewpoints on this concept with some authors implying it is anecdotal. This is demonstrably untrue, with contemporary research highlighting the glass escalator does indeed exist in nursing. For example, men are disproportionally represented in nursing leadership positions in both clinical and academic settings and they progress at a younger age and more rapidly than their female colleagues (Jackson et al. 2022; Punshon et al. 2019). Additionally, a gender pay gap has been reported between men and women nurses in the United Kingdom (UK), United States of America (USA) and Germany (Greene et al. 2017; Muench and Dietrich 2019; Punshon et al. 2019). In an Australian study of nurse academics, East et al. (2024) reported that women had significantly higher teaching allocations compared with men who had higher research workload allocations. This would largely contribute to the gender disparities in career progression and funding opportunities that have been reported in the academic nurse workforce (Jackson et al. 2022). In addition, questions have been raised regarding bias in the selection of studies for citation by nursing researchers. Despite women having more publications and higher citation metrics than men in nursing academia, research metrics consistently rank men higher (Jackson et al. 2022). The prevailing counterargument is that men in nursing are in more senior positions and are paid more, as they are more likely to work full time; consequently, men have more experience and are more qualified. Implicit within this argument, is that women are more likely to be primary carers, take parental leave and work part-time. Notwithstanding the need to challenge the narrative that motherhood cannot coexist with a successful career, Wilson et al. (2018) reported a gender pay gap of 10% in the USA even after adjusting for differences in work and demographic characteristics. In addition, there is evidence that men in nursing are being promoted with less experience and less qualifications than their women colleagues (Gauci et al. 2023) and that they are ‘groomed’ and ‘tapped on the shoulder’ for promotion and opportunities (Gauci et al. 2022). However, interestingly, men's privileges are rarely discussed in the men in nursing literature. It is important to remember that human capital such as work experience and qualifications are still subject to discrimination. The notion of subjectivity in performance evaluations for women and minority groups has been well documented (Bishu and Alkadry 2017). Whilst working full time and no career breaks are significant predictors of career progression in nursing, and in many other professions, women experience gender bias in the workplace regardless of whether they are a primary carer. Muench et al. (2016) reported that in nursing, women with no children earned $6207 less per year than men with no children. By trying to rationalise it, we ignore the real but pervasive issue of discrimination. Men are promoted in nursing because it is considered unsuitable for them to be doing care work, it is perceived by society as more appropriate for them to be managing the women who should be doing the caring. It has been argued that normalising men in nursing through increasing their numbers, is actually key to overcoming the glass escalator (Davidson, Ferguson, and Farley 2022). Understandably, this may not be a theory that women nurses wish to test, given the inequity they currently experience. Men being seen as leaders and women perceived as carers is indicative of a wider societal problem; there is bias around what a nurse looks like and what a leader looks like. Whilst it is difficult to change the perceptions of broader society, as a profession we need to be mindful that the conversation around men in nursing does not perpetuate bias for women nurses. For example, it has been suggested that men must be given opportunities for higher paying, and more autonomous and advanced roles to encourage them to enter the profession (Blackley, Morda, and Gill 2019). Graduate entry accelerated programs to fast-track men into a nursing career has also been proposed (Harding et al. 2018), the idea being to decrease the financial burden on men and time taken to attain post graduate qualifications and thus fast-track promotion. However, given the nursing shortage, why are these strategies not also suggested for women? Prioritising the success and career progression of men over their women counterparts reinforces patriarchal views that women are subordinate to and less valuable than men. There is also the recommendation that to attract more men to the profession we must first increase pay. Historically nursing has always been behind other graduate professions with respect to pay and career earnings potential. Women nurses have been lobbying for years to be adequately renumerated for the work they do and the qualifications they hold. Consequently, suggestions that nursing can justify higher pay through increasing the representation of men are offensive and serve to further discriminate against women. Fair pay is critical to recruitment and retention for all staff regardless of sex and gender. The outdated ‘damsel in distress’ trope is being pushed by nursing organisations across the world. The women- dominated nursing workforce has an image problem and male nurses are portrayed as the knights in shining armour that nursing needs. As reported in a recent editorial in the Lancet ‘Perhaps the biggest barrier that continues to stifle the profession concerns gender and stereotypes’ (The Lancet 2019, 1879). Most nurses are women; nursing is considered less influential than other health professions and subservient to the medical profession. It is broadly believed that nurses do little more than complete personal care for patients, and there is limited understanding within the community that nursing is a science-based profession. The rhetoric of men saving and improving nursing through greater remuneration and increased recognition of professional knowledge and skills is pervasive in the literature. This is not a new concept, as research shows that as the number of men increase in woman dominated professions, pay and prestige also increases (García-Mainar, Montuenga, and García-Martín 2018). However, the idea that men will legitimise our work and make it worthy fundamentally devalues the contribution women have made to the profession. The underlying issue is the devaluation of women and the work they do. Nurses are the backbone of healthcare systems worldwide, so we need to showcase the impact of what we do, and we need to insist on being equal partners at the policy making table. Nursing does not need men to save the profession, what we need is an overhaul of the perception of nursing as an unskilled vocation. Further to the above, is the idea that men are a valuable asset who will ‘provide balance’ to the profession. For example, in a study by Blackley, Morda, and Gill (2019), one participant stated ‘I've seen some wards that can get quite a toxic culture when they only have women on them, and I don't know if that's just because they are so female-dominated or other factors, but I think throwing a few guys into the mix somehow it just changes the atmosphere in a good way’ (p. 693). In another study a participant states, ‘They (men nurses) tend to be more calm and less inclined to the ‘bitchyness’ [sic] and ‘catiness’ [sic] that comes in a predominantly female workplace’(Ramjan et al. 2024, 1645). Indeed, the more concerning aspects of the men in nursing conversation include the archaic stereotypes and gendered language used to describe women and women dominated workplaces. Whilst a more in-depth discussion on this issue is beyond the scope of this commentary, the examples cited above are typical in the nursing literature. Interestingly, men being referred to as ‘male nurse’ which has caused so much consternation in the men in nursing literature (Juliff, Russell, and Bulsara 2016), seems to be more of an issue than language that disparages women. This should at least raise some questions. Whilst men are underrepresented in the nursing workforce, they are not oppressed. There is a persistent disregard of male advantage in the conversation around men in nursing that needs to be addressed, as does language which positions men and what they do as more important than women and what they do. Nursing does not need to offer additional resources, privileges or expanding job opportunities to a gender that already has inherent advantage. What we do need is an open and honest discussion about men in nursing to ensure that the pursuit of more men into the profession does not result in strengthening patriarchal advantage. All authors have agreed on the final version and meet at least one of the following criteria (recommended by the ICMJE*): (1) substantial contributions to conception and design, acquisition of data or analysis and interpretation of data. (2) drafting the article or revising it critically for important intellectual content. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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