The gender imbalance in nursing

The gender imbalance in nursing, our nation’s largest profession, is a slow-to-change and complex problem steeped in stereotypes, economics, unconscious bias, power, and privilege in health care and society. Along with other diversity gaps in the nursing workforce, gender imbalance is another missing piece to achieving the highest quality patient care. Solving the gender imbalance could accelerate the profession in reaching its full potential.

Diversity improves quality

Addressing the gender gap represents a positive change that honors the dedicated and diverse nurses in today’s workforce. We gain more by recruiting, developing, and supporting men in nursing because the result will be a health care profession that authentically represents the patient population itself.

When any population group is underrepresented, for whatever reason, organizations do not get the best possible job candidates, so they likely won’t be able to hire or promote the best talent. Ensuring the largest possible talent pool is essential to quality — in health care or any endeavor.

The fact that only 13 percent of nurses are male shows there are many potentially excellent nurses who are not entering the profession. Increasing gender and other types of diversity to proportions reflecting the patient population will improve the quality of the nursing profession and the care it delivers.

Enhancing the influence of nursing

With consumer demand for health care services projected to far outweigh the supply of nurses, there are other important reasons why the profession needs to increase the number of male nurses. As part of a long-range solution to the nursing shortage, greater numbers of men pursuing careers in nursing could provide some relief.

In the short-term, the U.S. needs more than 200,000 new nurses a year to fill new jobs and replace retiring nurses. Increased numbers of male nurses won’t necessarily solve that problem, but every lever that can be pulled to increase the supply of nurses means downstream benefits for patient care.

An influx of male applicants could help create pressure to expand nursing programs. And if nursing becomes more diverse, it could become a greater force for social and public policy change, including greater investment in educating more nurses.

Gender-related health conditions

Though genders share many physical and behavioral conditions, they also experience gender-specific diseases, injuries, symptoms, and health determinants. And the gender of practitioners makes a difference in diagnoses and treatment.

Research based on nine years of data from Florida hospitals found that female heart attack patients experienced better outcomes in emergency departments that had a higher percentage of female physicians. The same study also found that male physicians are more effective in treating female heart attack patients when they work with more female colleagues and treat more female patients.

Although this research is not about nurses, its implications are striking. Better gender equity and experience among practitioners has a beneficial effect on patient outcomes.

On a larger scale, the health of populations and communities could be improved if nurses, the occupation with the largest scale of hands-on patient care, better represent the people they serve. Care quality is dependent on the relationship between practitioner and patient; practitioner characteristics that match patient populations could be key to more effective treatment and successful outcomes.

Myths that devalue nursing

Nurses are scientists as well as caregivers — nursing requires complex knowledge and skills from many scientific fields. As a scientific profession, all genders have equal ability to excel in nursing. There is no gender predisposition to the profession. The emphasis on good relationships with patients is part of the science-based practice by those clinicians who spend the most time with patients and provide personalized care. More male nurses would help shift the focus on the nursing profession to a balanced view of science and caring.

According to the WHO Nursing Now report, the fact that nursing is majority female obscures the fact that nursing is based on skills, knowledge, science, and expertise. False stereotypes about women and nursing begin with the misleading beliefs that women are more nurturing than men and that the most important aspect of nursing is to comfort people.

These two misrepresentations continually reinforce each other. In searching for a reason why nursing is predominantly female, people fall back on the myth that women are more nurturing.

The gender, nurturing, and “soft science” myths about nursing are long-standing and deeply rooted. Increasing the percentage of male nurses would be very impactful in changing them.

Possible unintended consequences

In any change, there is always the possibility of untoward effects. Increasing the number of men in nursing could have negative effects on female counterparts due to the “glass ceiling” for women and “glass escalator” for men. It’s important to be aware that if nursing moves toward gender neutrality, it could increase the likelihood of a ceiling that prevents the advancement of women into leadership and an escalator that advances men faster than women.

This is a real risk. Common roadblocks to advancement are gender roles in childbearing and household management that place the highest burden on women, investing many women with a second full-time job that creates barriers to leadership roles. Also, gender-related socialization of self-confidence can render those with low self-confidence unlikely to enter leadership. That’s why we need leadership training for nurses, removing workplace discrimination based on childbearing status, creating workplaces with flexibility for child care, and increasing educational opportunities.

Increasing the number of male nurses has the potential to unravel many myths about nursing. But more importantly, society needs more male nurses, along with other increases in diversity in the profession, so that it will mirror the patient populations and potentially improve the quality of care and outcomes.

The contributions of women and men in nursing have been critical to the improvement in national and global health and life expectancy over the past century. The issue of gender diversity in nursing today is a next step forward in the progress of health and well-being, affirming that in health care and everywhere, diversity is a driver of quality.

Cole Edmonson is chief clinical officer and Paulette Anest is vice-president of clinical operations, AMN Healthcare.

Image credit: Shutterstock.com

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