Men at Work
Thanks in part to campaigns designed to appeal to masculine sensibilities, more men are entering nursing—and discovering the joys of a profession traditionally dominated by women

By Cathryn Domrose
August 27, 2003

At the most recent American Nurses Association annual convention, Gene Tranbarger, Ed.D., RN, saw signs that times might finally be changing for men in nursing: They were on the bathroom doors.

Tranbarger, president of the American Assembly for Men in Nursing, has attended ANA conventions since the late 1950s. "One of the first actions was to declare all the bathrooms female," he said-a common practice at conventions of any group where most members are women. Men had to go to their hotel rooms or into another building to use the facilities, he said.

This year, he saw signs on every men's room door reading, "Ladies, out of consideration for our male colleagues, please do not use this room."

It seems like a little thing, Tranbarger said, but he sees it as a tremendous change from even two or three years ago. The image of nursing as an exclusively women's domain finally may be going the way of crisp white uniforms and hats. "I think more and more men are being welcomed into the profession and are being sought out," Tranbarger said.

Driven by the nursing shortage, nursing schools and hospitals are making a concerted effort to woo a previously untapped base of men, as well as trying to change the image of nursing as a women's profession. Campaigns with slogans like "Looking for a Few Good Men" and "Are You Man Enough to be a Nurse?" have attracted national media attention, with stories in The New York Times and the Associated Press.

According to the March 2000 National Sample Survey of Registered Nurses, 146,902-or 5.4 percent-of the estimated 2.7 million RNs in the United States were men. More recent figures from the U.S. Department of Labor show numbers as high as nearly 7 percent, up from less than 3 percent in 1980. The number of men going into nursing is expected to continue to increase, as nursing jobs remain plentiful in an unstable economy.

Attitude adjustment

But, as some men point out, recruitment is not enough. To successfully bring in and keep men in nursing, they say, the profession needs to examine its own attitudes about why men have been excluded in the past and work to eliminate factors that might be keeping them away or making them drop out now.

The last time Tranbarger remembers so much publicity about men in nursing was in the '50s, when he and other men were pioneering the male movement into a profession that had been almost exclusively female since the beginning of the 20th century. "Then, we were like Siamese twins," he said. "We were an oddity."

No longer. Nursing schools are changing the colors and photos on their brochures, eliminating the pastel pinks and lavenders and the pictures of smiling young women. Recruiters for schools and hospitals are placing ads in sports magazines and at sporting events.

A Harley rider, a black belt, a snowboarder and a combat medic are among the nine nurses staring toughly from billboards and buses under the headline, "Are You Man Enough … to be a Nurse?" The poster, which has been distributed to middle and high schools throughout Oregon, is part of a recruitment campaign by the Oregon Center for Nursing, a nonprofit organization dedicated to solving the nursing shortage.

The "Man Enough" campaign touched a national nerve when it was unveiled last fall, said Deborah Burton, Ph.D., RN, executive director of the Oregon Center for Nursing in Portland. She recently has sold the rights to the poster to two corporations, one in Louisiana and one in Southern California, that plan to use it to recruit men into nursing in those areas.

The Oregon center has been deluged with calls from guidance counselors, young men and their parents and older men who are looking for a second career, she said. Guidance counselors who have the poster on their wall tell Burton it still generates more interest and discussion among students than any other promotional material they have received.

Besides the poster and school visits from the nine featured nurses, the Oregon center also has organized a Saturday class for high school boys called "Men in Scrubs," taught by male nurses and nursing students. "We fill every class and there's always a waiting list," Burton said.

The University of Iowa College of Nursing publishes a 10-page booklet, also available online [www.nursing.uiowa.edu], aimed at potential male students. It includes a timeline of the history of men in nursing, testimonials from male nurses and answers to questions like: Will I have to take orders from physicians? What kind of income can I expect as a nurse?

The school also has created a Men in Nursing Mentoring Task Force that plans to use male alumni to promote its programs and to create a support group for male students.

The publication and other promotional materials are aimed at parents as well as potential students, said Kennith Culp, Ph.D., RN, associate professor at the University of Iowa College of Nursing in Iowa City, and a member of the task force.

"Parents often actively discourage their sons from going into nursing," Culp said. "I still hear it from my mother and I've been practicing for 20 years."

Samuel Clemmons, RN, diversity coordinator for Caldwell Memorial Hospital in Lenoir, N.C., is working with church leaders in his community to convince African-American parents that nursing is a good career for their sons as well as their daughters.

African-American men are one of the most underrepresented groups in nursing in his rural community, Clemmons said, and the most difficult to recruit.

"They say that they do not see themselves doing this kind of work," Clemmons said. But many in the community are looking for jobs. "We want to be there for them, to make them the offer of a possibility for them to consider."

Many nursing schools are using male students and alumni as recruiters in high schools and middle schools. "The males have always been my best recruiters," said Dani Eveloff, MS, RN, recruitment coordinator for the College of Nursing, University of Nebraska Medical Center. "They're a minority in nursing, and they know it helps if a male talks to another male."

When they talk to potential male nursing students or nurses, many recruiters emphasize career flexibility, technology, excitement and money, as well as the satisfaction of caring for people. "We never used to talk about money in nursing, but that's what interests many men and boys," Eveloff said. She recently amazed her 8- and 10-year-old nephews by telling them that advanced degree nurses could make up to $150,000 a year. "They seemed interested and I know it was because of the money."

Between one-quarter and one-third of nursing students at the University of Texas-Houston Health Science Center are men, well above the national average of 8.3 percent of nursing school students reported in 2002 by the American Association of Colleges of Nursing. The university eliminated its pastel-colored recruiting materials and began including photos of male nurses a few years ago, said Renae Schumann, Ph.D., RN, coordinator and assistant professor of acute and continuing care at the university.

"We don't have quotas," she said. "We just have a program that's appealing to men." Many have a degree in another field, she said, and have researched nursing schools extensively. Many told her they were attracted by the university's access to nationally known clinical facilities. Last year, she said, the school had 900 applications for 100 spots.

"The people at UT make men feel very welcome here," said Ruben Herrera, a senior nursing student at the university who has a degree in health care administration and worked as a manager for six years before deciding to become a nurse. "Even in the clinical setting, I haven't felt anything that would make me think twice about my career choice."

Mixed message

Not everyone agrees with all aspects of the new recruitment campaigns. Some find the macho approach a little over the top. Others worry that by emphasizing money, excitement and technology, nursing will attract those who aren't interested in caring for people.

"I personally prefer the Johnson & Johnson approach," said Bruce Wilson, Ph.D., RN, a professor in the department of nursing at the University of Texas-Pan American in Edinburg, who has written extensively about the history of men in nursing. The J&J campaign, launched last year, includes profiles of male nurses explaining why they decided to enter the field and why nursing is a great career. "It portrays men in a wide variety of nursing roles," Wilson said. "It doesn't matter whether or not you scuba dive."

Herrera has spoken to students and Hispanic groups about nursing, and doesn't believe the profession requires much selling. "All the elements are there for a good career, whether you're a man or a woman," he said. "If you present all the facts, it will shine through."

But Burton argues that previous campaigns haven't appealed to men enough to overcome an ingrained public perception that men in nursing must be somehow feminine. Even the J&J campaign, which she considers gender neutral, was not enough to overcome that image, she said. When junior high and high school students see the poster of nine seriously macho men hanging on the door of a counselor's office, their first comment is, " 'They can't be nurses,' " she said. "But they are. And they'll come to your school to prove it."

Burton said she has heard objections to the "Man Enough" campaign from some who think it undermines what they see as the feminist element of nursing, and some who think it's unfair that a man would be accepted into a competitive nursing program over a woman with equal or greater qualifications. The last objection concerns her the most, she said, because she doesn't want anyone to feel excluded from nursing.

No single approach or group of people is going to solve the nursing shortage, said Richard Brock, MA, RN, director of medical/surgical nursing at Good Samaritan Hospital in Los Angeles. He welcomes a variety of recruitment methods aimed at a variety of people.

"When you're trying to get people's attention, you can't hold back," he said. What's important, he said, is getting good people-men and women-into the field.

Career of choice

A few years ago, Brock interviewed 100 men about why they became nurses. He received many interesting answers. Rock musicians said they wanted a steady job between gigs. One man said he decided to become a nurse so he could meet women. Brock himself, a former teacher, went into nursing thinking it would be his summer job.

But those reasons faded after they became nurses. "What kept people in was that they got so fascinated" with their work, he said. "They cared about their colleagues, they cared about their patients. It takes a really uncommitted person not to get sucked up into it."

Cormac O'Sullivan, MSN, CRNA, never envisioned going into nursing, even though his brother and sister did. He describes himself as a hammer-and-saw kind of guy. His father was a maintenance man, and O'Sullivan gravitated to fixing athletic fields and working at a sewage plant over hospital work. He considered becoming an architect or an engineer. But when he got to college, he realized he wanted a degree that would give him a meaningful, well-paying job right out of school. Nursing fit that bill.

He spent about eight years working in Level One trauma centers around the country. He loved the fast pace, the technology, the excitement. But eventually the intensity of inner-city emergency rooms began to get to him. He and his wife wanted to move to a small town to raise their children.

"I coded too many patients," he said. "I'd seen too many people die and they just kept coming. I started thinking about getting into advanced practice nursing."

O'Sullivan went back to the University of Iowa and became a nurse anesthetist. He works as a staff nurse anesthetist at University of Iowa Health Care and is the associate director for the university's nurse anesthetist program. He said he derives great pleasure when he wakes patients after surgery who often can't believe the ordeal is over, when he watches them walk out the door with their families. He also participates in difficult surgeries that provide the excitement he loved so much in emergency care.

"Nursing has been a wonderful career for me," O'Sullivan wrote in an e-mail explaining why he chose the profession. "I have been challenged at many different levels and been able to constantly grow, expand and advance, while maintaining patient contact, which I greatly enjoy."

Long way to go

But he has not seen much change in the profession from the days when he was the only man in a class of 100 women, he said. Salaries and respect for nurses have not increased much. Hospital administrators still tend to think, "a nurse is a nurse," without acknowledging the specialization and skill required for the job, he said.

"It might be more socially acceptable" for a man to be a nurse now, he said. That and the changing economy may bring more men into nursing.

Keeping them, however, is another story.

"We are definitely making a better attempt to recruit men into nursing, but we are still far behind," said Jerry Lucas, RN, publisher of Male Nurse Magazine, a magazine for male nurses that is expected to launch in the fall. "We get them in, but we can't keep them in."

Some studies have shown that men drop out of nursing school and the profession at a greater rate than women do, although reasons for this are unclear and need further research. One possibility is stress resulting from gender discrimination; another is that the work does not meet expectations-a common reason for new female nurses to drop out.

In an online survey Lucas conducted and published on Male Nurse Magazine's Web site, 113 of 126 respondents said they did not feel that men were "fairly represented within nursing." More than two-thirds of men who responded to a write-in survey said they thought men were overlooked in the profession. Men might be more likely than women to leave a job if they don't feel respected and valued, Lucas said.

Studies also show a greater percentage of men in management, which some men say is because men are pushed away from bedside care. Nursing schools have few or no male faculty members. Some men report harassment at work or in school by female colleagues or professors. Male and female nurses tell stories about men not being allowed in labor and delivery rooms, not because patients objected but because staff nurses or instructors disapproved.

But many male and female nurses say that although they have encountered or heard about gender discrimination against men, they believe it is the fault of a few individuals rather than a pervasive problem. Most nurses, they say, don't care who you are as long as you can do the job. Most patients don't care either.

"Decades ago, there was a bias against men in nursing," said Polly Bednash, Ph.D., RN, FAAN, executive director of the American Association of Colleges of Nursing. "I would be surprised to see any of those biases continue to exist" as more men move into the profession. "I see strong respect and sharing between men and women."

Nurses also admit they need to work to overcome the gender bias that became automatic in the 1900s. Burton said she still forgets sometimes and refers to all nurses as "she," even though she makes a conscious effort not to. Textbooks with pictures of all female nurses need to be updated.

"If nursing wants to become diverse, it needs to portray itself as a diverse profession," Wilson said. "In its language, in its textbooks, in its journals." For the first time, he said, he is starting to see a change. "I'm starting to see articles in some of the major journals saying perhaps we should let men into nursing."

Burton said that in her region at least, she's hearing fewer horror stories about men facing discrimination in nursing. Her next campaign, which begins in the fall, will focus on bringing minorities of both sexes into the profession.

When she's walking around the campus of the University of Portland, a private school, Burton sometimes comes across young men visiting the campus with their parents. They usually are lost and need directions. While helping them, she asks where they are from, what the son plans to study. If the student says he doesn't know, she asks if he's ever considered nursing.

The responses are as regular as clockwork, Burton said. The father laughs. The mother says, "I don't think so."

The boy thinks for a moment and says, "I don't know, why not?"

Like a sign on a bathroom door, it's a small thing, but it could mean a great deal to the future of nursing.

Contact Cathryn Domrose at kaguilar@well.com