The Stubborn Stigma of the Male Nurse

Michael Simon used to help high-school dropouts get back on track. He was always searching for jobs where his clients — often men and women with a history of legal or drug problems — could build a lasting career.

As he combed through job statistics in Pennsylvania, one field regularly stood out: nursing. Those health-related occupations were always hiring, and they paid decent money. That held true even in the midst of an economic recession.

But whenever he suggested nursing to one of the young men who dropped by his office, he got the same scornful response: “No way — that’s a girls’ job!”

They wanted to do something in construction or one of the trades, no matter how poor the employment prospects. For two years he pushed the health-care track. Not a single guy ever took him up on it.

Across the country, when the mills close and the factories shutter, often the largest employers that remain in economically depressed communities are hospitals, nursing homes, and other health-care providers. Four of the five fastest-growing professions are health-care related, according to the Bureau of Labor Statistics.

Although these employers are hiring, men — both those who once worked the assembly line and those, like Mr. Simon’s advisees, fresh to the workplace — aren’t applying for the jobs. The fields are dominated by women: Ninety percent of registered nurses are female, and the gender imbalance is similarly lopsided for home health aides, nurse practitioners, and physician assistants. While some of these positions, like in-home aides, are menial work and poorly paid, many require at least some college-level training and come with salaries at or above the national average.

The growth in sectors that hire large numbers of women comes as traditionally male occupations have contracted. Over the past two decades, health care and education have added nine million jobs, while male-heavy manufacturing shed five million. As America’s population ages, demand for nurses and other health-related workers is only expected to swell.

Despite the fields’ divergent trajectories, a sort of occupational sex segregation persists, particularly among men with a high-school diploma or less. The jobs of the future are going to women, while their male counterparts, in seeming contradiction to their own self-interest, cling to remnants of the economy of the past. They talk — as did politicians last fall seeking their votes — about reviving coal or steel or textiles, not about new careers in health care. Rather than go into professions like nursing, some men are even opting out of the work force altogether. One in five working-age men today isn’t in the labor pool.

What results is a deepening gulf between an entire demographic group, underemployed men, and the enterprise of higher education. They are skeptical of college as the solution, unable to see how postsecondary training can work for them. If colleges are key to economic mobility, this large group of people is stuck.

“There are a lot of angry, frustrated men waiting around for manufacturing jobs to reappear, but there’s never going to be the kind of mass employment we once had,” says David H. Autor, a labor economist at the Massachusetts Institute of Technology. “It’s not that there aren’t jobs out there. There just aren’t jobs that men want to do.”

Well, perhaps most men. Mr. Simon, in fact, decided to take his own advice. He went back to school and earned a nursing degree; he had his choice of jobs even before graduation. Today, at 31, he’s director of two units at Pittsburgh’s Allegheny General Hospital, oncology/telemetry and surgical/trauma, supervising 250. Nursing has brought financial stability, and Mr. Simon and his wife, a physical therapist, just had a second daughter. “Ever since I got into nursing,” he says, “I feel like I’ve been on a path to success.”

The person perhaps most responsible for cementing nursing’s image as women’s work is the profession’s most famous member, Florence Nightingale. Before Ms. Nightingale, both men and women worked as nurses. Accounts of monks caring for the sick date back a millennium.

By the mid-19th century, when Ms. Nightingale felt a calling to work as a nurse over her wealthy parents’ objections, the occupation had a bad reputation. Nursing was done mostly by men and women from the lower classes; there was no training and little thought to proper sanitation or hygiene.

In Health Care, Women Are Often the Majority
Health-care occupations are some of the fastest-growing in the country – and some of the most heavily female. From dental assistants to dietitians, registered nurses to respiratory therapists, women dominate the health-related professions, many of which promise decent paychecks and steady work.

To professionalize nursing and to make it a field fit for women of her background, Ms. Nightingale, an early feminist, sought to appeal to Victorian mores. She argued that the role of nurse was natural and innate to women, complementary yet distinct from that of a physician. “Every woman, or at least almost every woman, in England has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid,” she wrote in Notes on Nursing. “In other words, every woman is a nurse.” That is, she added, with the proper training.

Marci Cottingham, an assistant professor of sociology at the University of Amsterdam, studies issues of masculinity and nursing. “In order for nursing to become a profession and to make it possible for women to work outside the home, she had to carve it out as something gendered,” Ms. Cottingham says. “You can’t rebrand nursing now and ignore that history.”

By the turn of the century, the majority of nurses in Britain and the United States, where Nightingale-style nurse training had also taken hold, were women. Some professional associations even limited their membership to female nurses.

It was only in 1982 that the U.S. Supreme Court ruled that a state-operated nursing school could not bar men. Justice Sandra Day O’Connor wrote in the majority opinion that the Mississippi University for Women was wrong to reject a male applicant to its nursing program solely because of his gender.

“Rather than compensate for discriminatory barriers faced by women,” Justice O’Connor wrote, “excluding males from admission to the School of Nursing tends to perpetuate the stereotyped view of nursing as an exclusively woman’s job.” The policy, she added, “lends credibility to the old view that women, not men, should become nurses, and makes the assumption that nursing is a field for women a self-fulfilling prophecy.”

If Ms. Nightingale helped make nursing an acceptable path for women, for many men, the road to work went directly from the high-school classroom to the smelter, the mill, or the mine. These were good jobs, paying solidly middle-class wages, what Patricia A. Roos, a sociologist at Rutgers University at New Brunswick who studies gender and work, calls the “blue-collar aristocracy.”

Over the past 40 years, automation and foreign competition have decimated manufacturing, and the recession a decade ago accelerated the decline. Of the 7.5 million jobs lost to the downturn, three-quarters were held by men.

Predominantly female professions have also been subject to some of the same forces, of course. Cellphones and computers, for instance, have rendered much of what secretaries do obsolete, but, says Mr. Autor, “no one is shedding a tear” for executive assistants.

That’s not only because many other female-dominated fields have been fast growing but because women have also moved into traditionally male — and frequently higher-paying — occupations like law and business. Men have historically been less likely to go into so-called pink-collar professions, Ms. Roos has found, and those who do are typically from low-income or minority backgrounds.

Women’s upward occupational mobility is thanks, in large measure, to their increasing education levels. Today women earn almost 60 percent of all four-year degrees.

The secretaries have gone to school, while the steelworkers haven’t.

For Health Care and Manufacturing, Divergent Paths
Female-dominated occupations, especially those in health care, have been growing in recent years. But employment in many manufacturing fields, like machinists, has been contracting, decimated by automation and foreign competition. Despite those divergent trajectories, occupational sex segregation has persisted, as stubborn biases keep men from training for booming professions like nursing.

Lack of education beyond high school may limit the options of men struggling to hold on to disappearing manufacturing jobs, stymying efforts to occupationally retool. An analysis by Jed Kolko, chief economist at Indeed, an online job site, shows that the least-educated men work in the most male-dominated jobs, with half of men with a high-school diploma or less working in occupations that are at least 80 percent male.

Put another way, the male workers positioned least well to navigate the new economy are concentrated in the jobs most vulnerable to its swings.

One of the reasons men, especially displaced workers, may not consider nursing or many other health-related jobs is because they require a certain level of education — at minimum, an associate degree — and math and science skills. Some colleges have made concerted efforts to attract men to their programs — setting up recruitment booths at sporting events, for instance — only to find few who meet their prerequisites. A former blue-collar worker who hasn’t set foot in a classroom for years simply might not have the academic wherewithal to earn a nursing degree.

“Nursing,” Ms. Roos says, “may not be a solution for out-of-work steelworkers and miners.”

Quick, what’s the plot line of Meet the Parents?

You might not remember much about a 17-year-old Ben Stiller movie. But for men in nursing, the film — in which Mr. Stiller’s character, Greg Focker, is needled endlessly by his future father-in-law because of his job — is shorthand for the stereotypes they face in a predominantly female profession.

“Among my male friends, I was universally mocked,” says Michael Simon, the career-counselor-turned-nurse. “They would say, ‘What are you going to be, Greg Focker?’”

The cliches about men in nursing can be both pervasive and contradictory. Even the way nursing is talked about is feminized. Think about how we refer to a man in the field, says Hope M. Moon, interim dean of health and wellness and a professor of nursing at Lorain Community College, in Ohio. “It’s not a female nurse and a male nurse,” Ms. Moon says. “It’s a nurse and a male nurse.”

Men who become nurses are seen as effeminate, even gay. But at the same time, they can be viewed as potential sexual predators, eager to prey on vulnerable patients, says Chad O’Lynn, director of evaluation and innovation at Chamberlain University and author of several books about men in nursing. Such stereotypes can act as a barrier to entering the field and discourage those who do.

As a nursing student in the 1980s, Mr. O’Lynn wasn’t allowed to witness a childbirth during clinical rotations. He has had to call a female patient’s husband to get permission to treat her.

Mr. Simon says he has had patients, particularly older women, refuse to allow him to help them even when “nature’s calling and I’m the one that day taking care of them.” They request a female nurse instead.

Mr. Simon is also regularly asked why he isn’t a doctor. The subtext, says Mr. O’Lynn, is that male nurses have entered the field as a backup because they aren’t smart enough to succeed in medical school. “You try not to take offense,” Mr. Simon says. “Nursing is what I want to do.”

In recent years, nursing has tried to upend those stereotypes by marketing itself in ways that it hopes will appeal to men. One recruitment campaign asked, “Are you man enough to be a nurse?” Another featured men engaged in extreme sports like mountain climbing, snowboarding, and off-road biking. The idea, says Ms. Cottingham of the University of Amsterdam, is “you can be an independent, rugged, tough guy, but you can still go into nursing.”

But Ms. Cottingham questions the use of such images. On one hand, she wonders about their efficacy — what does nursing have to do with mountain climbing? But she also worries the advertising sends messages that run counter to the skills nursing actually values. The campaigns highlight macho, loner men, while nursing prizes teamwork, empathy, and the ability to connect with patients. “To what extent could we create a retention problem,” Ms. Cottingham asks, “when these guys realize nursing isn’t always an adrenaline rush?”

Florence Nightingale’s contention about women’s inherent suitability for nursing might have been largely canny political positioning, Victorian style.

But she also might have been hitting on something about the way women are more likely to develop the caregiving skills that translate to nursing, even if they’re more the result of nurture than nature. Even today, when both parents work outside the home in the bulk of two-parent households, women tend to take on more of the child-rearing duties.

Daughters are more likely than sons to care for aging parents. Even young girls have a better chance of honing their caregiving abilities early on. An analysis of thousands of online babysitter profiles found that those who get paid to watch kids are disproportionately female.

One way to think about this is that because of lack of exposure, many men, particularly older, displaced workers, lack the confidence and the comfort level to minister to others’ needs, something that’s required of nurses and other health-care professionals. Another, perhaps less charitable view, is that, as Bridget Ansel, a policy analyst at the Washington Center for Equitable Growth, says, “a lot of female-dominated professions are jobs that have traditionally been done in the home — for free.”

Nursing, of course, has become increasingly well compensated over past decades, a fact that reflects the mounting demand for such workers as Americans grow older and sicker. In fact, nursing ranks ninth on a list of the highest-paying college majors compiled by Glassdoor, a job and recruitment site.

But, on average, jobs in which the majority of workers are women pay about 83 cents to the dollar made in heavily male fields.

It’s a chicken-and-egg question, Ms. Ansel says: Do men not go into feminized jobs because they pay less, or do the positions pay less because of the lack of men? Indeed, there’s some evidence that salaries rise in traditionally female fields when more men take those jobs, a phenomenon known as the “glass elevator” effect. “We pay,” Ms. Ansel says, “for what we value.”

Policy makers should focus on raising the wages of all caregiving jobs, she says. Doing so could attract more men but would also better compensate the women already in these fields.

But the fact that men are no more likely to become registered nurses than home-health aides — a job that makes only about a third of what a trained nurse pulls down — suggests that pay differentials don’t explain everything.

There’s something else going on about men’s view of nursing and other health-care work, something that cuts to the core of their identity, says Janette S. Dill, an assistant professor of sociology at the University of Akron. “The stigma around nursing runs deep,” she says.

Robin Leidner, a sociologist at the University of Pennsylvania, has examined the attitudes of men and women to work. Men’s masculinity, she says, is a lot more tied up in their job, and “they care whether the work they are doing is construed as manly.”

“Traditionally, paid work has not been part of what it means to be a good woman,” Ms. Leidner says. “For men, being a provider is seen as important to what it means to be a man.”

Joan C. Williams, a professor at the University of California’s Hastings College of Law, has written a book, White Working Class: Overcoming Class Cluelessness in America, about last year’s election. President Trump won over blue-collar voters, she says, precisely by talking about bringing back manufacturing jobs — in other words, manly work.

Proposing that out-of-work men take up nursing or other pink-collar professions is fruitless, Ms. Williams says. She argues instead that colleges should do more to train men for the relatively small number of fast-growing majority-male jobs, like wind-turbine technician. “You are suggesting,” she says, “that they forget their masculine pride.”

Even Brent MacWilliams concedes that you’d be hard-pressed to find a more “hypermasculine” profession than his former career. For years Mr. MacWilliams was a commercial fisherman in Alaska, wresting king crab, halibut, and salmon from the northern Pacific’s choppy waters.

Nursing was in Mr. MacWilliams’s family. Both his sisters had pursued nursing careers, and his wife was constantly on call as a nurse at a remote clinic in Kodiak. Still, Mr. MacWilliams stuck with fishing, even after he moved south, to Washington State. One day, visiting the hospital where his wife worked, he met two male intensive-care nurses, big, burly guys who worked part of the year as loggers. Nursing was steady employment, they told him, not subject to logging’s seasonal oscillations, and the ICU an intense, high-energy workplace. Most of all, they liked seeing the impact they had on patients and their families.

Mr. MacWilliams hadn’t been the most stellar student — he once wrote a letter to his wife that contained, he claims, “no discernable English” — but he felt instinctively that nursing would be something he could do well. Days on the boat had honed his engineering and technical abilities, and he thought of himself as someone with high emotional intelligence. He decided to enroll in nursing school.

Twenty-five years later, Mr. MacWilliams is a nurse practitioner with a doctorate in education. At the University of Wisconsin at Oshkosh, where he moved to be closer to family, he is interim assistant dean of nursing and has taught — coached, he calls it — a generation of students. Once, when his mother was ill, he took her to a local hospital emergency room; every nurse there was a former student, he says.

Men, argues Mr. MacWilliams, who serves as president of the American Assembly for Men in Nursing, rarely happen into nursing, not even someone like him, with nursing practically in his blood. They need role models to help them navigate into the profession.

Instead, too often, Mr. MacWilliams says, they are steered in the opposite direction. A school-age boy with an affinity for science will be directed toward engineering or medicine, while a female classmate will be encouraged to consider nursing. Guidance counselors and teachers in high school — maybe even earlier — need to do a better job of promoting the full range of health- and science-related careers, including nursing, to both boys and girls.

“The stereotypes cut both ways,” Mr. MacWilliams says. They also die hard.

There are some signs that younger men may be growing more open to nursing careers. Men make up just 6 percent of the registered nurses licensed before 2000, according to the National Nursing Sample Survey, but account for nearly 10 percent of those receiving a license since that time.

Some individual nursing programs report even higher male participation. Fifteen percent of the roughly 900 nursing graduates last year at the Community College of Allegheny County, where Mr. Simon earned his degree, were men. In recent years, their share has been as high as 18 percent, says Kathy Mayle, the dean of nursing. The college tries to take special care to include men in its marketing materials so that prospective recruits will see students who look like them.

Exposure matters, experts like Mr. MacWilliams say. A man who came into contact with nurses after illness or an accident, his own or a loved one’s, may view the profession differently. So, too, may someone who has had hands-on experience with caregiving. There has been a sharp increase in recent years in the number of men who serve as caregivers to aging parents and other family members.

And men who work in fields that regularly interact with nurses may be introduced to the job that way. Lorain Community College has a special accelerated pathway into its nursing program for paramedics that allows them to bypass some of the entry-level coursework. Nationally, about two-thirds of paramedics and emergency medical technicians are male, as are the majority of students in Lorain’s paramedics pathway, says Ms. Moon, the dean.

There is the sense, though, that when men do go into nursing or other health-related fields, they select a fairly narrow band of jobs. The handful of specialities with higher proportions of men tend to pay better and focus more on technical aspects than direct patient care. Radiation therapy, for instance, was the only health-care profession whose work force became significantly more masculine in the last 15 years, according to a study conducted by Ms. Roos, the Rutgers professor. Meanwhile 40 percent of nurse anesthetists, whose median pay is nearly double the national average, are men.

The other thing such positions have in common, says Ms. Dill of Akron, is that they tend to be new enough to have not yet been defined as women’s work.

But if men cherry-pick a small number of jobs, health care as a whole would still remain a largely pink-collar ghetto.

Ultimately, substantial change will require lots of people to gain a new perspective. Economists, of course, look at labor-market data and see that expanding your employment options makes the most rational sense. But out in the real world, the average person may struggle to see all of those choices.

It’s no surprise, maybe, that many men just want their old jobs back.

Karin Fischer writes about international education, colleges and the economy, and other issues. She’s on Twitter @karinfischer, and her email address is karin.fischer@chronicle.com.