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Odd man out: weighing up the profession’s gender balance problem

Recent recruitment ads sparked a backlash, so how can the profession attract more men into nursing?

Recent recruitment attempts sparked a backlash, so how can the profession attract more men into nursing?

  • Only 11% of registered nurses are men, making nursing one of the most gender-segregated jobs in the UK
  • Outdated impressions persist around nursing being womens work and not highly skilled and varied roles
  • Reviewing the general appeal of nursing as a profession including pay and career progression could attract a more diverse workforce

When pupils in England received their A-level results in August, an NHS advertising campaign on social media urged them to consider applying for nursing.

But the tone of the adverts particularly one Twitter message clearly

...

Recent recruitment attempts sparked a backlash, so how can the profession attract more men into nursing?

  • Only 11% of registered nurses are men, making nursing one of the most gender-segregated jobs in the UK
  • Outdated impressions persist around nursing being ‘women’s work’ and not highly skilled and varied roles
  • Reviewing the general appeal of nursing as a profession – including pay and career progression – could attract a more diverse workforce
Illustration showing a group of game player pieces, all grey,  with a single orange piece to one side
Picture: iStock

When pupils in England received their A-level results in August, an NHS advertising campaign on social media urged them to consider applying for nursing.

But the tone of the adverts – particularly one Twitter message clearly targeting male applicants – caused some heated debate in the profession, with some suggesting it positioned nursing as a ‘fallback’ career and reinforced gender stereotypes.

The controversial NHS careers ad video

The controversy began when NHS England and NHS Improvement tweeted a 14-second video clip below the wording: ‘If your grades have changed, or you’re still considering your next steps – why not consider a future in the NHS?’

The accompanying video clip shows a young man working out, finishing a football match and looking after patients as a male voice says: ‘We are not who you think we are. We’re not embarrassed by what we do. We’re proud of our work.’

London South Bank University’s chair of healthcare and workforce modelling Alison Leary was not impressed with the campaign’s approach. ‘Saying that you’re not embarrassed to be a nurse – why would you even think that?’ she asks.

Gender stereotypes promoted, not challenged

She says the advert, which remains on social media, plays on gender stereotypes.

Alison Leary, London South Bank University chair of healthcare and workforce modelling
Alison Leary: NHS recruitment ad targeting men ’played to male stereotypes’ Picture: Nathan Clarke

‘If you compare the adverts in that campaign, you’ll see the ones that feature women are much more virtuous and the male ones are much more action-packed.

‘It was about working in emergency departments, even the tune they laid on top of it – “I’m a Man” – was manly.

‘I reported it to the Advertising Standards Authority because it was a gendered advert. Essentially, the issue is that not only is it playing to male stereotypes but, in trying to make nursing more appealing, it picked up on a lot of the negative things.

‘They shot themselves in the foot a bit.’

A profession with a serious gender imbalance

Whether the campaign was successful in attracting more men into nursing remains to be seen. But what is clear is that, despite a number of initiatives, nursing in 2020 remains a female-dominated profession.

In March 2020, 11% of registered nurses were men, according to Nursing and Midwifery Council data, making nursing one of the most gender-segregated jobs in the UK.

That figure has hardly changed for years, with only fractional changes in the gender split occurring within a 1% swing.

It appears no different for incoming nurses in training. The latest Universities and Colleges Admissions Service figures show that only 9% (3,150) of the 34,190 people accepted onto nursing degree courses in 2020 were male.

The Men are Nurses Too campaign

Glasgow Caledonian University launched its Men are Nurses Too campaign last year in an attempt to breakdown stereotypes and encourage more men to apply to study nursing.

Senior lecturer Gordon Hill describes the campaign as a response to a Scotland-wide target to increase male nursing student numbers to 25% of overall numbers by 2030.

Senior lecturer Gordon Hill
Senior lecturer Gordon Hill: ‘It’s about planting the seed for anyone who wants to be a nurse’ Picture: Twitter

The university also realised it had men within the nursing department who made good role models, including lecturer Stevie Morrison.

‘He was a Commonwealth boxer for Scotland and got into nursing, so his story was quite unique,’ says Dr Hill.

‘We felt this would be a useful way of raising the profile of men in nursing. It provided a focus to go out to schools and plant the seed for more boys to consider nursing as a profession.’

Measures include a Twitter campaign and school visits, although the latter have been on hold due to the coronavirus pandemic.

The intention is to start with the youngest children, as part of a Scotland-wide plan to change cultures over time, for example, by encouraging pupils to dress up in gender neutral mini-uniforms.

‘There’s probably not one solution; it’s multiple things,’ says Dr Hill.

‘It’s having role models in the media and role models in real life. It’s about attending recruitment fairs and usually what we try to do there is have at least one male member of staff go along so that lads going round can identify that there’s actually a man and he’s a nurse.

‘It’s about encouraging and planting the seed for anyone who wants to be a nurse and making sure that the nursing workforce reflects society.

‘Part of that is attracting more men into nursing, but it’s also about thinking of other under-represented groups and also not thinking about gender as a binary.

‘It’s about thinking about reflecting society in a more general way and giving anyone the confidence to go into nursing because it is a fantastic profession.’

Creating a representative nursing workforce

So why do low numbers of men in nursing represent a problem?

Lancashire and South Cumbria NHS Foundation Trust associate director of nursing and engagement Paul Jebb says we need more nurses overall, so ‘we have to look at what makes nursing attractive to everybody, and why nursing should be a career of choice’.

‘Some of that is around pay, some of that is in relation to how nurses feel valued, whether that’s male or female, or however people want to identify themselves.

‘We need to get the retention of nurses right and make sure it’s a profession that’s attractive to everybody.’

Mr Jebb believes that recruitment needs to be fit for purpose and cover all communities to ensure that nursing reflects society.

‘If that means more men, then that means more men,’ he says.

‘If that means more women, more mature people, more school-leavers, or if that means more people from a black, Asian or minority ethnic community, then we need to do that.’

A nursing recruitment fair, with people chatting and handing out leaflets at a stand
Take opportunities to influence potential recruits and promote the profession
Picture: John Houlihan

What nurses can do to promote a more diverse workforce

  • Be enthusiastic about your job and the career opportunities for nurses of all genders
  • Take opportunities to influence future nurses, for instance, by talking at school and other careers fairs (when COVID-19 restrictions allow) or through social media
  • Try not to stereotype A Scottish study found male students felt female clinical staff assumed they would prioritise career aspirations and ambition
  • Avoid using gendered terms such as ‘male nurse’ or ‘female doctor’, which suggest such individuals are anomalies

Source: University of the West of Scotland

Appealing to the right people

Mr Jebb, who has been a nurse for 24 years, was inspired to follow his career path when he witnessed the care his father received after being involved in a road traffic accident. His family and friends were supportive of his choice, he says.

‘There was the odd one or two comments which weren’t reflective of what I was doing or seeing day to day – that you were just there to mop up after people,’ he says. ‘There were also questions around the gender mix and around sexuality.

‘There were scathing comments but they were in the minority.’

‘The adverts were aimed at people joining the profession who are quite often still facing peer pressure around masculinity – it’s still there for some’

Paul Jebb, associate director of nursing and engagement, Lancashire and South Cumbria NHS Foundation Trust

The NHS advert was aimed at a particular group, he believes.

‘The messaging around nursing that “if you don’t meet the grades, think of nursing as an option” was wrong.

‘But the adverts relating to “masculinity”, for want of a better word, were aimed at 16 to 17-year-old boys. I shared it with my 16-year-old son, who thought it was a good advert.

‘Lots of people who were criticising it were 30 years-plus, so we need to look at who the advert was aimed at and who the communication was aimed at before we started throwing the baby out with the bath water and criticising it too much.

‘It wasn’t aimed at long-standing registered nurses; it was aimed at people joining the profession who are quite often still facing peer pressure around masculinity – it’s still there for some.’

A male nurse on the ward
Potential students need to see positive representations of men in nursing in the media and real life Picture: iStock

Mr Jebb believes it is worth revisiting job titles, such as matron and sister, which reflect nursing’s feminine history and in some areas are no longer used, for example, in Scotland.

‘Having been a matron, it was never a problem for me, but it was quite interesting when I would go to see families and I’d walk in and they’d say “Oh, I wasn’t expecting a man”.

‘It’s about the role that people do, rather than the title, but maybe you need to look at the role and make sure that the title is reflective of what is done, rather than the history behind it.’

Solving structural inequalities for everyone

For Professor Leary, the number of men in nursing is a red herring.

‘The issue is that they out-perform women in terms of pay and progression,’ she says. ‘It’s not so much that the men are out-performing but that the women are held back, as they are in many predominantly female professions.

‘What we have is structural inequality in society, and because nursing is associated as women’s work, not knowledge-intensive, not particularly valued, and thought about only [in terms of] its virtue – the kind of person you are, the kind of character you have – that has tended to put men off.

‘So even though men out-perform women in terms of pay and progression, it’s still seen as female work. It’s less attractive to men in that sense, even though the men that do come into it do better.’

Professor Leary’s view is that, if nursing was a more attractive profession to everyone, more people – of all genders – would be interested in doing it.

‘Deal with structural inequality, so that everyone – regardless of gender, ethnicity, disability, sexuality – has a better experience of working in the profession,’ she says.

The nursing student’s view: ‘I want to make a big impact’

Alex Richardson is in his final year of a mental health nursing degree at Canterbury Christchurch University, a career path he started on eight years ago when he began working as a healthcare assistant aged 18.

Mental health nursing student Alex Richardson
Mental health nursing student Alex Richardson

He is one of four men in his cohort of sixteen, reflecting the fact that mental health nursing has a higher proportion of men than other branches, but admits his old school friends ‘don’t get’ his choice of career.

‘All of my mates would literally say the same thing, all the time – “absolute credit to you Alex for doing what you do, but you wouldn’t catch me doing that”.’

His friends – mostly plumbers, electricians, or construction workers – do not understand what he does, he adds.

‘If you asked any of my friends if they would help change someone who was incontinent, they would almost laugh about that,’ he says.

‘Is this the role of a man?’

‘There’s something of an idea of “is this the role of a man?”. It’s about breaking down that barrier of sexism.’

Mr Richardson decided to train to be a nurse because, as a senior healthcare assistant, he felt he could not progress further.

‘I thought I don’t just want to change the life of one person; I want to change the service.

‘I’ve said from day dot that I want to go into management and keep climbing as much as I can, because I want to try and make a big impact.’

However, he believes there are some disadvantages to being male in mental health nursing, including the need to be accompanied when treating female patients, the expectation that – as a man – he will be called on to help with restrictive practices, and the risk of complaints of inappropriate behaviour.

‘There have been many scenarios where I’ve built a rapport with someone and they’re opening up, but I’ve been told I can’t work with her on my own in case she makes an allegation. That frightens a lot of people.’

Some people still think nursing is a woman’s job, Mr Richardson adds. ‘I have no idea why people in this century still think that,’ he says.

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