Surviving as a Male in the World of Nursing

I knew when I entered nursing I would be a distinct minority. As an Emergency Medical Technician in the ambulance service I had seen very few male RNs in the ER department and virtually none anywhere else in the health system; our humble rural hospital in Northern Alberta certainly did not have any. As I mentioned in an earlier blog, we can thank Florence Nightingale for that - her view was that only women had the capacity for caring, which was ironic given men had been part of healthcare delivery and caring long before nursing became a recognized profession. Little did I know that I would run into a number of challenges being a male, beginning in my diploma training 35+ years ago right up to my current place of employment where I have felt unsafe as a white, gay male. Perhaps some people may be surprised about that lack of feeling safe in what should be a bastion of caring but then nursing is renowned for horizontal and vertical violence that, I believe, is reinforced in academic institutions. More about that later.

When I started the nursing program there were seven other male students that made up about 7% of the class. Not bad, given the national percentage of males in nursing was 5% back in 1987. And looking at the class photos in the hallowed halls of the Misericordia there had only been one other male graduate before us in, I think, 1980 or so. But there were no males on faculty and, in the time I trained, I only knew of two other male nurses working in the entire hospital. We were fortunate that the majority of faculty were kind and supportive of all students, regardless of gender, although there were a few strict authoritarians and a couple wolves in sheep clothing, as we were to discover. But I and the other male students would learn by the end of the first year a personality or two in the instructor and nursing ranks who treated us quite differently from our female peers; at least three of us almost packed it in by the end of the first year. Two others, for different reasons, did leave.

An example was the pattern of one instructor towards three of us males in one clinical group that started out fairly innocuously - a few more questions probing our knowledge level than our female counterparts would get and more insistence in being chaperoned for procedures. But then this evolved to confrontational behaviour and assertions that were belittling and/or humiliating. And, often, somewhat open and public. For me, the tipping point was when that instructor started questioning me in front of my patient in a four-person ward; the focus being about the drip rate of a bladder irrigation post-prostate surgery. To the uninitiated, the concept for a bladder irrigation is that flushing occurs to prevent clotting - there is a variable rate but as long as things are flowing nothing will plug and, definitely, no one is at risk. I had done my assessment, calibrated both the irrigation drip rate and the IV drip rate while also assessing my patient. The instructor came along and double-checked my assessment asking many questions and then, when she found the irrigation drip rate was not exactly what I had calculated, she proceeded to berate me in front of my patient. To the point that she accused me of lying about having done an assessment at all. I was devastated and could barely contain my embarrassment or composure, deciding to leave the environment to regain myself. Apparently, the patient came to my defense after I left and verified that my account of my assessment was, indeed, correct. I went to the nursing desk only to be asked by the charge nurse, when she registered my apparent distress, whether I was OK - the damage was complete and I fell to pieces. 

The long and the short of this situation was that I ended up going to the first year coordinator to discuss this situation. The coordinator was empathetic and supportive, at first trying to justify the instructor’s actions as a result of just coming off maternity leave and having a 6-month old baby at home - I think my response was “How is that my problem?” I discovered later that the patient confronted the instructor for her assertions and that my female peers later went of their own accord to the coordinator with concerns about the instructor’s treatment of the male students. As we three males started to share our experiences and considerations dropping out I was starting to realize how challenging it might be to remain in the profession of nursing. In second year we would learn of a unit manager who forbade male nursing students from her gynecology ward (but not male medical students or residents) feeling it was not appropriate for us to be there. We would encounter preceptors who were resigned to have us because of our patient assignment but who clearly not comfortable with men - one in postpartum made a comment to two of us linking men in the area to being pedophiles 😳

One has to ask why this animosity towards men in nursing, especially given that the profession has become large and diverse. And in light of females making such strides in male dominated professions such as medicine, law, commercial pilots, military roles, and the like. While I cannot make a comment as a white male, lest I risk being labeled a misogynist, I will repeat what many of my female colleagues say - it is the reality of women working for women in a female dominated vocation. Colleagues have often described (and I have witnessed) the nasty cattiness, the cliqueyness, the micro-aggressions, and other dynamic characteristics of many nursing environments - dynamics that are well-described as horizontal and vertical violence in nursing literature. Academics have opined that much of this is due to years of the profession’s oppression to medicine and the healthcare system, often evoking Paulo Friere’s Pedagogy of the Oppressed. I call BS on this…as well-educated professionals, with so much taught about professional behaviour and conflict in baccalaureate programs, there really is no excuse for this. My position, after 35 years of nursing, is that this pattern of behaviour is socialized into nursing and at the heart of this are many academics and the educational systems that perpetuate the issue. Furthermore, it is not just perpetualization of internalized oppression and vertical/horizontal violence, but also reinforcement of stereotyping and targeting men in the profession.

To support my position, I shall highlight a few observations and experiences. First off, in all of the programs I have been employed in, there are so many faculty (mainly academic professors) who literally have no or very little real nursing practice experience; many have been so far removed from actual clinical practice and real life nursing practice there is a disconnect. Many of these people are elevated to “leadership” positions, with only the socialization they obtained through academia, to perpetuate (sometimes magnify) negative hegemonic power-over dominance and control through petty politics, usually exclusion and favoritism. Rare have I seen true leadership qualities at this level, especially in nursing academia, where talent is nurtured, people are supported, and there is a spirit of inspiration. Usually it is top-down transactional micro-management and taking the opportunity to suppress people who do not drink the Kool Aid, think differently, or dare to express themselves. I will say that I saw and experienced more of this at research intensive universities (McGill, Queen’s, uOttawa and University of Manitoba) than at the community college and comprehensive university levels (Douglas College, St. Francis Xavier, and University of New Brunswick Saint John).

Second, I have also seen and experienced more of the dysfunctional top-down hegemonic and nastiness where the entire “leadership” team is female. In my last place of employment, of approximately 10 - 12 management positions, none are male - the exception is the office manager, a non-nursing position, who assumed the position to fill a maternity leave. And, with my departure, there were no male RNs left in a tenure track role there…I had been the only one. Being, essentially, railroaded out of the department with lack of support for the vision I brought or any of the ideas I expressed (I will share more about this in upcoming posts) I cannot help but believe this was by design. As I mentioned earlier, I have felt unsafe and unwelcome by the department’s “leadership” as a gay, white male and, while I expressed this concern to some leaders and the union, nothing was ever taken seriously or done about it. The irony is the big effort to promote EDI, yet I seem to be viewed more as a white privileged male (you know, the main problem in the dominant culture) and not as a true minority in my own profession. There was an overt situation of homophobia that I was witness to, where anti-2SLGBTQ+ graffiti was written on the whiteboards of a classroom, a situation that was quietly swept under the rug with no acknowledgment within the department and no check in with me - this added to my discomfort in the work environment.

A third event that happened in my career related to what should have been my PhD focus, and that was the attrition of males from nursing programs. Literature in the early 2000s identified that male students were disproportionately leaving nursing programs, not due to academic performance but more in response to subjective evaluations in lab and clinical practice. In fact, through some investigative work at the first academic institution I was hired, we discovered males who left the program seemed to do well in academics but either failed where instructors subjectively evaluated them or just withdrew from the program. As it happened, I went to a nurse educator conference and a group of us in BC decided to pursue a more formal research study of this phenomenon. However, one female academic professor known for her radical feminist views stated “That is an interesting finding, but I would hate that nursing, the last bastion of feminism, would need to change to address that [attrition of men from nursing].” A number of us were shocked by the comment, especially as it underscored a reason why nursing needed to change. But as I have since discovered in my academic career, nursing academia really has no desire or capacity to change - for all the evidence and supposed intellect, it continues to safeguard the status quo. Proof of this is that, in the 35+ years since I was a student, curriculum structure, content, and implementation (content dumping and hegemony) is fundamentally the same. And, I predict, this will essentially erode the nursing profession into its own demise.

And does this need to be the case? No, because I have seen where nursing has flourished in very positive environments and where they tend to be inspired to grow professionally and personally. Sadly, not in academia and often not in acute care settings, although I reflect fondly on a couple units at the Misericordia Hospital Edmonton where the nurses were a supportive and cohesive group. Rather, my best experience as a practicing nurse has been in community settings where the team tends to be interprofessional and not a predominant nursing culture. And while men still tend to be in the minority, the mix of disciplines and diversity of people makes for a much more inspirational and supportive milieu. I think that the other facilitator in this is more autonomy in the nursing role, given the flexibility in scope of practice and less restrictive (oppressive) parameters compared to the rigidity of healthcare and academic institutions - this tends to make the work more fulfilling, an important ingredient to a positive, vibrant workspace. Community is also where I have seen and experienced real leaders who inspire, rather that crap upon, their team members. And, I have seen in nursing education programs that educators and researchers with real clinical practice in community health tend to have a better understanding of true leadership grounded in practicality and reality, and a more cohesive approach given real experience with interdisciplinary and community work. They also tend to be more receptive of diversity in the academic ranks.

After 35 years of nursing practice plus my original three years of nursing education and starting out with such optimism for the nursing profession, I find myself trying to balance the highlights of my career with the continuous battle with mysandry in the profession - especially in the nursing world of academia. I had expressed my concerns to the highest levels of the insitution I last worked at with absolutely no response. For this reason and others I opted to resign this last position…leaving became more than just a matter of survival but of self-preservation and personal well-being after, essentially, having been excluded, unvalued, and feeling targeted. But this is what nursing historically done and it is well-documented - it eats it young and many nurses in power, particularly in academia, perpetually suppress and crap upon those they do not favour. And some of them seem to take great delight in exercising mysandry, possibly seeing this as an excusable response to the misogyny that nursing has experienced in relation to medicine and male-dominated healthcare institutions.

My resignation and an intentional decision to take a time out after a catastrophic dead end in my career path will allow me the time to reflect. I can proudly point to all that I have achieved - the great opportunities to work across Canada, my work in community health, successful completion of my PhD, practical research and publications, and international invitations as visiting scholar to Brazil, China and Macau. More importantly, I have achieved this in spite of the challenges and barriers presented to me from within the nursing profession. So, while I contemplate hanging up my stethoscope and walking away from the dysfunctional worlds of nursing, particularly nursing academia, at least I can say I survived. And I now start my PATTernity (Post-Academic Trauma Therapy) leave to reflect, recover, and refocus with a view to a new path ahead.