They make up significantly less than 1% of the registered nurse population, but their numbers are increasing and the demand for them is growing. “They” are Hispanic nurses who happen to be men.

Even though they are one of the most underrepresented populations in nursing, that hasn’t deterred them from contributing to the profession by carving out leadership roles and serving as mentors to other Hispanic men who may want to pursue a nursing career but are unaware that it’s a viable option for males. Nor do their small numbers diminish their desire to provide quality health care, especially to Hispanics, who are one of America’s most medically underserved populations.

In 1996 there were an estimated 5,064 Hispanic men in nursing, according to the National Sample Survey of Registered Nurses, issued approximately every four years by the Health Resources and Services Administration (HRSA), Bureau of Health Professions, Division of Nursing. The most recent (2000) survey places the number of nurses who are Hispanic men at 6,227 (out of a total Hispanic RN population of 54,861). Although that’s a nearly 23% increase from 1996, Hispanic men still make up less than a quarter of 1% of the approximately 2.7 million total RN population in the United States.

“There has been an increase in male Hispanic nurses, and males [in nursing] in general, over the past 30 years,” agrees Hector Hugo Gonzalez, PhD, RN, a past president of the National Association of Hispanic Nurses (NAHN) and current chief executive officer of NAHN’s San Antonio, Texas chapter. When Gonzalez first graduated from nursing school in 1962, male students were so rare that the school he attended didn’t even have a restroom for men.

Things have improved a bit since then, of course. Today nearly 14% of the graduating class at the nursing school at San Antonio College, where Gonzalez serves as professor and chairman emeritus, is male. Of those, approximately 40% are Hispanic, he adds.

Hispanic First, Male Second

A primary reason for the increase in Hispanic nurses who are men is that health care facilities are now required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to provide culturally and linguistically competent care that is sensitive to the needs of America’s ethnically diverse population. For many health care employers, hiring bilingual Hispanic nurses who have firsthand knowledge of Hispanic culture is a move in that direction—and the gender of those nurses is not an issue.

“Hospitals want me because I can speak Spanish and I know the medical jargon,” says Felipe Gutierrez, MSN, RN, FNP, an advanced practice nurse at Scripps Mercy Hospital in San Diego, who estimates that at least half of the patient population he cares for is Hispanic. When people are sick, they tend to revert back to the language with which they are most comfortable, Gutierrez explains. Furthermore, even though many of his Hispanic patients can understand and speak English, they prefer speaking Spanish, he says.

Gutierrez also understands the importance of family in Hispanic culture and the need to have many relatives nearby when someone is ill. “Every time my great grandmother went to the hospital, five of us would sit around her bed,” he recalls. But he also remembers that when he was working as a tech in the emergency room, only one family member, if any, was allowed to accompany the patient. That was a difficult rule to enforce with Hispanic patients, knowing the emphasis they place on family, he says.

Similarly, many hospitals allow only two visitors at a time in a patient’s room. Although Salvador Alonso, BSN, RN, house supervisor at Yuma Regional Medical Center in Arizona, doesn’t suggest breaking the rules, he does sometimes bend them. When two patients are sharing a room, Alonso always asks if the other patient minds if more than two visitors stay. “If [they say yes], then I just allow two visitors at a time,” he says. “Otherwise, there may be four or five people.”

 

This Hispanic cultural tradition of having many family members present is something that many Caucasian nurses complain about, he adds. Not long ago, Alonso’s grandfather passed away and approximately 35 relatives were in the hospital waiting room. “Fortunately, I worked there, so they gave us a private room,” he says.

Nurses like Alonso and Gutierrez are also highly attuned to other Hispanic cultural practices relating to health and illness, such as the use of home remedies or hanging up a cross on the wall. Alonso usually lets patients tape the cross on the wall or affix it to a bulletin board. “I try to accommodate these and other customs,” he says, “but some nurses don’t.”

Alonso has found that understanding the importance of cultural identity in the Hispanic community has given him an appreciation for other cultures and languages. “Knowing my culture makes me appreciate others,” he says. “[For example], we get some female Muslim patients who don’t want to be cared for by a male nurse. I’m not offended. You have to respect their beliefs.”

Perceived Authority

While both male and female Hispanic nurses are equally skilled at establishing culturally knowledgeable relationships with Hispanic patients and their families, there are some areas where Hispanic nurses who also happen to be men do seem to have an advantage. For example, when speaking with Hispanic patients, male nurses may be perceived as more authoritative than their female counterparts.

Alonso has noticed that when he talks to Hispanic patients about Do Not Resuscitate (DNR) orders or palliative care, they seem to accept the information more readily than if a female nurse talks to them. He cites several occasions when, after a female nurse discussed DNR orders, the family was opposed. But when Alonso explained it to them afterwards, they changed their minds.

Rudy Valenzuela, MSN, RN, FNP, director of clinical services and health promotion at the Regional Center for Border Health in San Luis, Ariz., often discusses the impact of diabetes with male Hispanic patients. He notices that the patients are not only more willing to discuss certain aspects of the disease process with another man, they are also more likely to follow his advice.

 

“The reception of my teaching to a male Hispanic patient is more effective,” explains Valenzuela, who is also the newly elected president of NAHN. “They perceive the information coming from a male nurse more as an order. When it comes from a female nurse, [they see it as] more of a suggestion.”
The same goes for discussions about sexually transmitted diseases or hypertension with Hispanic male adolescents, he adds. “[In those situations], that paternalistic machismo pervasive in the Hispanic culture has something to do with your relationship with the patient.”

 

Because of the culture’s emphasis on male authority, Hispanic nurses who are men are often mistaken for being the doctor, even after they identify themselves as the nurse.

“When I was an emergency room nurse and often the first person the patient saw, they automatically assumed I was the doctor,” recalls Rick Martinez, BSN, RN, president of San Antonio-based MedTrust, a healthcare staffing company that specializes in placing nurses. “When I told the patient I was the nurse, the dynamics in the room suddenly changed.”

Education Comes First

Some young Hispanic men who want to go to nursing school must do so over the objections of their fathers, who perceive their career choice as “woman’s work.” But because their culture values the importance of education, many other male Hispanic nursing students receive full support from their families to obtain a college degree as a means to entering a respected occupation.

 

“[In many Hispanic families], the fact that you’re going to college is more important than the fact that you’re choosing what may be considered a non-traditional career for males,” explains Valenzuela, who graduated from nursing school in 1991. “You would think because [ours] is a paternalistic, macho culture that a nursing career would not be seen as desirable , but often that’s not the case.”

 

Gonzalez concurs. “I received a lot of support from my family because education is so highly valued within the culture,” he says. Unfortunately, he adds, the number of Hispanic college graduates in the U.S. currently doesn’t reflect that commitment because too many Hispanics still live in poverty or lack the economic resources to send their children to college.

Martinez says that in his family’s eyes, getting a degree after fours years of college added a sense of professionalism to his chosen career. But even though he wasn’t questioned about going into a female-dominated profession, he was often asked when he was going to become a doctor, as were many of his male nursing colleagues. “Nursing was almost seen as a stepping stone to medical school,” he relates.

Today, Martinez notices more nurse recruitment ads that feature men, many coming from the military. “They’re trying to let the public know that it’s an acceptable career for men,” he says.

Family Pressures

Ironically, while relatives may offer support and encouragement, Hispanic culture’s deep-rooted emphasis on family can add extra stress in the life of a Hispanic nursing student who is often too busy studying to maintain those close family ties.

Alonso, who graduated with his BSN in 2000, recalls that nursing school was a struggle because he was married with a three-year-old and holding down a full-time job. One day, his son told him that he wasn’t his best friend anymore because best friends are supposed to play together. “It broke my heart,” says Alonso. That prompted him to settle for some Bs instead of pushing for all As, in order to spend more time with his family. “They knew I was in school and working, but they still demanded my time,” he says of well-meaning relatives. “They don’t realize they’re doing it.”

When he was an assistant professor in the nursing program at San Diego City College (he is now an adjunct professor), Gutierrez received positive feedback from Hispanic students grateful for a male Hispanic teacher. “They would tell me, ‘You understand that we have family issues.’” That was true not only for male students but also for female students, whose relatives would tell them that they don’t need to go to school and should be at home taking care of their kids, Gutierrez adds.

“The culture does put a lot of emphasis on family responsibilities,” Valenzuela agrees, “but out of that comes the push to improve your life.” Most wives or relatives of male Hispanic nursing students are willing to accept the temporary disruption in family life for a few years because a nursing career will allow the men to better support the family, he says.

In recent years, the nationwide nursing shortage has created more job security and higher wages for nurses, making the profession more appealing to men. “It’s important to relay that information to Hispanic males, because they’re predominantly the breadwinners,” says Gutierrez.

Building Up the Numbers

All of the nurses interviewed for this article would like to see more recruiting efforts aimed at bringing young Hispanic men into the nursing profession. “Nursing schools are paying a lot of lip service about recruiting minorities and males, but [to a large extent] it hasn’t happened,” believes Gonzalez. He points to the example of medical schools, whose student population now consists of 50% women as a result of aggressive efforts to recruit more female students.

 

“I think nursing schools mean to do it, they’re just not sure how,” Gonzalez continues. He suggests such strategies as conducting public awareness campaigns to publicize the fact that men can be sensitive caregivers, and tapping into the pool of individuals pursuing second careers.
Increasing the number of male faculty in nursing schools would help as well, by providing role models and mentors. “[Men who want to go into nursing] don’t have that many role models in academics,” says Valenzuela. “Nursing schools and hospitals need to target the male population at large, especially Hispanics, to portray nursing as a career that improves your life, academically and financially.”

 

Meanwhile, many Hispanic men in nursing have become involved in grass roots efforts, such as career fairs at local colleges, as a means to get the word out to young Hispanic males. As President of NAHN’s San Diego chapter, Gutierrez makes it a point to go out into the community with the recruitment and retention committee. “I try to encourage male students to go into nursing,” he says. “Many of them have never seen a man who is a nurse.” He hopes to coordinate a program between his hospital and local schools that will enable students to shadow the nurses at work.

What advice do these veteran nurses have for other Hispanic men who are interested in pursuing a nursing career? Get yourself into a nursing education program and ask about financial aid, Gonzalez recommends. “Hispanics are very reluctant to ask for money,” he says. “They feel ashamed to be poor. But I tell them the government gives financial aid to students because the government considers it an investment. Payback time will come.”

If you need to get into the workforce right away, he adds, you should attend a two-year program and continue your education while working. If you can attend a four-year program, then go for it and get the BSN degree. While in school, concentrate on your education, Gonzalez suggests, even if that means postponing getting married or having children if you’re already married.

NAHN President Valenzuela has the last word. “I would encourage any male Latino to join the nursing field,” he says, “because it will allow him to take care of his personal needs and the needs of the population at large, by improving the health of the communities where he lives and works.”

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