For more than a century, nursing has been thought of as the domain of women. But that has fluctuated over the last few centuries. Men actually dominated nursing through the mid-19th century. During the Industrial Revolution, men began leaving nursing for factory jobs. Florence Nightingale led the advancement of women in nursing, targeting upper and middle class women for nurse training. In fact, men were not allowed to serve in the Army Nurse Corps during World Wars I and II. Today, as workplaces evolve, more men are entering the profession again amidst a nursing shortage.
About 13% of nurses in the U.S. today are men, compared with 2% in 1960, according to the Washington Center for Equitable Growth. However, in the high-paying specialty of nurse anesthetist, there is an equal number of men and women.
The United States is leading the way in the increase in the number of male nurses. While the U.S. rate of men in nursing was not much higher than in Switzerland and Brazil in 1970, it rose rapidly over the next several decades and far surpassed these countries in addition to Portugal and Puerto Rico.
The rise of men in nursing is due in part to a shift in available jobs, especially as traditionally male-dominated jobs in manufacturing jobs like automakers have been taken over by automation or moved overseas for cheaper labor. A recent study published in the journal Social Science Research reviewed eight years of Census data. The study found that of men who had worked in male-dominated industries and then became unemployed, 14% decided to enter industries dominated by women, such as nursing. Eighty-four percent of men who didn’t lose jobs moved onto traditionally female jobs. Unemployed men who got jobs in female industries received a pay increase of 3.80% when making the move.
Where the Jobs Are
Another reason propelling more men into nursing is a shortage of nurses. According to the Bureau of Labor Statistics (BLS), employment for registered nurses will grow 12% between 2018 and 2028, much quicker than the average of other professions. There will be a need for 3.19 million nurses by 2024.
California is expected to have the highest shortage of nurses, and Alaska will have the most job vacancies. Other states that will face shortages of nurses in the next few years include Texas, New Jersey, South Carolina, Georgia, and South Dakota.
One driver of the need for more nurses is the growth of the aging population, who will require more medical care. Job growth is expected in long-term care facilities, especially for the care of stroke and Alzheimer’s patients. The need for nurses treating patients at home or in retirement communities will continue to grow. The rise in chronic conditions such as diabetes and obesity also means more nurses will be needed.
Pay and Training
The median annual wage for registered nurses was $71,730 in 2018, according to the BLS. The lowest 10% earned less than $50,800, and the highest 10% earned more than $106,530. Those working for the government and hospitals earned the most.
But like many other professions, men are outpacing women in pay. Male RNs make an average of $5,000 more per year than their female counterparts, according to a study published in the Journal of the American Medical Association. This salary gap hasn’t improved since the first year the salary survey was done in 1988. The difference in pay ranges from $7,678 per year for ambulatory care to $3,873 for work in hospitals. The largest gap, $17,290 for nurse anesthetists, may explain why so many men enter that specialty.
The researchers note that increasing transparency in how much employees are paid could help narrow the gap. In addition, part of the pay gap may be due to women taking more time out of the workforce for raising their children. FiscalTiger.com suggests that offering adequate leave to both mothers and fathers after the birth of a child could have a role in making pay more equitable.
The Washington Center for Equitable Growth’s report suggests that the amount of formal training required to become a registered nurse may bring men into nursing from other occupations later in their careers. The minimum training for registered nurses is an Associate Degree in Nursing. Increasingly, employers are demanding more education, however. That includes earning a Bachelor of Science in Nursing (BSN) degree. RNs in the U.S. military must have a BSN, and the Veteran’s Administration, which employs the most RNs in the country, requires a BSN for promotion.
While men are still a minority in nursing, various programs offer support and networking. The American Association for Men in Nursing was founded in 1971 but shuttered in a few years. In 1980 it was reformed and now has thousands of members. It encourages men of all ages to become nurses and supports their professional growth.
Some nursing schools also have groups to support male nursing students. New York University, for example, has Men Entering Nursing (MEN), open to all nursing students at the Rory Meyers College of Nursing to discuss the concerns and perceptions that affect men and what it means to be a male in the field of nursing.
Sometimes nurses know they are destined for a lifelong nursing career; for other nurses, it’s as if the career chooses them.
That’s how Jonathan Llamas DNP (c), BSN, RN-BC, PHN, found his way to nursing. Knowing the career would be a good fit for his compassionate nature and his innate ability to have empathy for others, Llamas applied for nursing school right out of high school.
“I knew the work was selfless and inspiring,” he says, “but I went into nursing school with some naiveté. I knew I had the qualities to be a successful nurse, but I didn’t understand the amount of hard work and dedication required for me to excel in the heavily science-based coursework.”
Llamas was unprepared and struggled with the demands of the course load. Looking back, Llamas sees how his path started to become rockier, even as he wanted to succeed. He lacked the mindset to focus on his work. “I didn’t commit the time necessary for me to be successful,” he says.
Transferring to community college, Llamas finished his prereq courses, but says his lackluster GPA set him up for a cycle of rejections from other nursing programs. Determined, Llamas pressed on but struggled with setbacks that would have had other students choosing another path.
“Based on my GPA, my community college counselor said, ‘You don’t have what it takes to be a nurse,’” says Llamas. Feeling demoralized by the comment, Llamas still felt that nursing was his calling. He just had to find a way to get there. “I had to prove to myself I could do it,” he says, “and that I could do well under pressure.”
The toll from the rejection was growing though. As a first-generation college student from a supportive Filipino family, Llamas recalls his mother’s upset at all the rejection for him and it struck a nerve.
“I looked in the mirror and thought, ‘How do I want to be remembered? Do I want to be a father who inspires his kid to rise above adversity or fold under pressure?’” Llamas says. “I didn’t want to be the latter. I wanted to make something of myself.”
Determined to succeed, Llamas applied to West Coast University’s nursing program, and they gave him another chance. He didn’t throw it away and graduated in 2013. I learned that if I wanted to be successful, I have to apply myself,” he says. “I carry that now. If you want something, you have to work for what you want. We are all different in terms of the resources we have initially. We are not all starting at the same starting line.”
“Hopefully my story will inspire others,” says Llamas. He wants students to be academically and mentally ready at the outset so they aren’t surprised by the intensity and high expectations of nursing school. “You have to sacrifice to be successful,” he says. “It’s hard, but it’s temporary. Do your research, and know why you want to be a nurse. Have a vision for yourself and your future.”
As Llamas has learned, there is a level of commitment to nursing that is necessary to be an exceptional nurse. “There’s a difference between your passion and your purpose,” he says. Having the inherent ability to be a successful nurse often makes one’s passion for nursing grow stronger, he says. “I understand that nursing requires sacrifice, but the most rewarding thing you can do is provide such incredible care to a patient.”
For Llamas, persistence has paid off. He is set to graduate this spring with his DNP from Loma Linda University and juggles his academic load with a full-time schedule as a psychiatric mental-health nurse. “I am fortunate to have hit this stride in my career,” he says. The advanced degree will help him reach his future goals of influencing change in nursing by providing a different form of influence beyond the bedside. He envisions working as an NP, becoming an educator to help future nurses, and using his platform to help other nurses.
“If you had said to me 10 years ago that I would accomplish this, I would have said you were crazy,” he says. “If I have impacted someone’s life for the better, then I have lived a life worth living. I feel blessed, humbled, and grateful for the opportunities that have come my way.”
On January 1, 2019, Ernest Grant, PhD, RN, FAAN, became president of the American Nurses Association (ANA), the first man ever to hold the position. As a minority nurse trailblazer with more than 30 years of clinical and leadership experience, he was well equipped to break one of the remaining glass ceilings in nursing.
Grant, who holds a PhD in nursing, headed North Carolina’s nationally renowned Jaycee Burn Center at UNC Hospitals in Chapel Hill, where he started as a staff nurse in 1982. He has deep roots in the area, having earned his bachelor’s from North Carolina Central University and his master’s and doctoral degrees from UNC-Greensboro.
An internationally recognized expert on burn care and fire safety, Grant was presented with a Nurse of the Year Award in 2002 by former President George W. Bush for his work treating burn victims from the World Trade Center site of the 9/11 terrorist attack.
Grant won the election by an overwhelming majority of votes from his colleagues after having served as vice president of the ANA and being an active member for decades. The organization has served nurses for 122 years, and now represents more than four million registered nurses nationwide.
Grant intends for his appointment to help unravel stereotypes about men in nursing. He plans to use his term to address some of the most pressing issues in the field, such as a looming nursing shortage that more inclusionary educational recruiting practices could alleviate.
We interviewed Dr. Ernest Grant to learn more about his historic election as ANA president and what the future holds for the association under his leadership.
ANA President Ernest Grant
Photo credit: Max Englund/UNC Health Care
What are your top priorities as far as encouraging more diversity in nursing?
Increasing gender and ethnic diversity in nursing is one of my top priorities. A nursing shortage is expected as the general population is aging, and experienced baby boomer nurses are retiring. (Projections are that 500,000 seasoned RN’s will retire by 2022, and 1.1 million new nurses will be required to replace them.) There are ways we can avoid this [predicated shortage], which include recruiting more men into nursing and increasing diversity across the profession.
How will you encourage greater diversity in the nursing profession?
There should be more people of different backgrounds entering the profession so that it reflects society. One way to achieve this is through better access to scholarships and other educational and community resources. People of all ages, genders, and ethnic backgrounds must know what’s available—that there are federal loans geared to nurses, for instance.
A nursing assistant may not be aware that taking courses at a community college is possible or that an employer may offer tuition assistance. But the stumbling block is not always money; it could be having young children or home responsibilities. Online training or resources in the community that pay for child care would be the solution then.
What would encourage more men to pursue the nursing profession?
Men are joining the profession. Seeing someone who resembles them in the health care system has helped empower them to become nurses. Promoting images of men in nursing needs to begin early, starting at the grade school level and letting boys see men who are nurses. “Here’s somebody who I can identify with,” they will think. Then at the high school level, it gets reemphasized by a guidance counselor or health occupation program. In those programs, they can get certified as a nursing associate, and obtain more exposure to nursing.
Currently, 9 to 13 percent of nurses are men, but when I started it was much less. (Probably it was only 3 to 4 percent.) Several things are contributing to the increased interest, including increased representation in advertising and the media. Another is men who served as medics in the military but then unfortunately don’t [immediately] qualify for any nursing jobs. There are some accelerated nursing courses nationwide for former medics. In my state, they can choose nursing school, PA school, or medical school—all are good options for our military folks.
How did you get interested in nursing and decide to make it your career?
I grew up in a very poor community, as the youngest of seven, and my father died young. It took a village. Everyone knew everybody and people made sure you studied and didn’t misbehave. They said they knew I was going to successful.
When I got into nursing—I started as an LPN—I intended to go on to medical school. I got exposed to men in nursing and was fortunate enough to have multiple mentors to go to for advice. These are still my mentors. Thanks to Dr. Gene Tranbarger and others, who paved the pathway for me. When I started my studies in the mid-70’s and early 80’s, there were many stereotypes about men in nursing, but you don’t hear them as much anymore.
People know: Men are just as capable of providing care as women. You can be masculine and still care. I’m 6’6” and very large, so a lot of people may think “this guy is going to hurt me” but I’m really a gentle giant. They would soon realize that and ask for me as their nurse.
How has being a racial minority impacted your career as a nurse?
It has impacted my career, especially in the early years. (I grew up during time when segregation was ending.) Once in a while, you may meet someone who doesn’t want you to care for them because of your sex or color or both. Now it doesn’t happen as often. You have to prove yourself to be just as competent of a nurse as your white counterpart.
Have there been other minority nurse presidents in ANA’s history?
Yes, ANA has had two African American presidents, Barbara Nichols (served 1978-1982) and Beverly Malone (served 1996-2000).
I would like to be judged by my capabilities, not by my race or gender. My leadership skills are what got me here. I’ve worked very hard to win the respect of my colleagues. Men ran before for ANA president but faced a lot of obstacles. I’m looking forward to this challenge and endeavor.
What do you want MinorityNurse.com readers to know?
Consider joining ANA and your state nurses association if you’re not already a member. As you begin your career, I want to encourage you to be more politically savvy at the legislative level. You need to be more aware of how decisions in the house or senate may hurt your ability to practice to your full license and educational level. Or it may limit your ability to treat patients—if they can’t get to us to access care [due to political efforts to replace or end the ACA]. If we’re not smart enough to advocate for our patients, then we’re doing a disservice to them.
Get out there and attend town hall meetings that your representatives are having, and volunteer to serve on their committees as a health care expert. Who else out there is more of a health care expert than a nurse? I would challenge all nurses to be more politically astute about how decisions at the state and national level affect the nursing profession.
There is a growing demand for more nurses in general and that the demand for male nurses is currently on the rise. Male nurses are increasing their presence at the bedside, hospital, clinic, and nursing home. The American Association for Men in Nursing (AAMN) profiles the progress of its campaign for a 20% increase in the number of male nurses in the workforce by 2020. We all know that the nursing profession would benefit from a more diverse representation of gender, age, and cultures within the workforce.
Male nurses are bringing balance to the profession, which benefits patients as a whole. Having male nurses ensures that male patients are well cared and represented. Sometimes patients prefer a nurse of a certain sex, particularly for procedures like inserting a catheter, serving a bedpan, or administering EKG. Male nurses have skills and care-giving strengths that can make nursing an excellent career for them. Importantly, the benefits of being a male nurse are the same benefits of being a nurse.
If you are male and thinking about becoming a nurse, don’t hesitate to explore the career and most importantly look into yourself to ensure that this is the right career for you. Nursing is a challenging job and one that requires hard work, integrity, and dedication. Nurses can treat every patient regardless of gender, but dealing with human sickness and patients who may be crabby and cranky is simply a fact of life for nurses. As nurse, you are able to help patients and give them a level of comfort and put them at ease. The world of nursing holds many possibilities. There are over 100 different nursing specialties available and there are plenty of ways to advance your career if you are willing to work hard. Since not everyone has what it takes to be a nurse, there are a lot of considerations when it comes to nursing and what your personality needs to be like in order to be a good nurse.
Here are four key questions to ask yourself.
1. How well do you cope with stress and emergency situations?
Nursing jobs can be stressful at times. If you are someone who can work well under pressure and copes well with stress, you will do well as a nurse.
2. Are you easily offended?
Nurses sometimes come in contact with patients who are hostile or unfriendly. Being easily offended can make your nursing job difficult and stressful quickly.
3. Do you consider yourself to never stop learning?
The field of health care is continuously changing, whether it is a new disease or recently discovered new treatment, nurses learn something new every day. Therefore, a good nurse is always ready to learn more.
4. Are you a team player?
Teamwork is essential in nursing to getting the job done right and improving the patient’s health. Nurses, who enjoy their job, work well with other team members.
Nine years ago, I was so happy to have my first article published in Minority Nurse. The article was a discussion on whether or not it’s OK to be out at work as a gay person. Looking back at the changes I’ve seen over this time period, I decided to put together a few thoughts.
The county hospital where I work is rolling out some new intake questions for our electronic health record system. The impetus is to better serve our LGBTQ patients. A transgender person with residual breast tissue did not know he could still get breast cancer. An MTF person developed prostate cancer. These patients slipped through the cracks because they lived their true self but had body parts susceptible to illness that the caregiver was not aware of. By next month, we hope to have 10% of our patients properly classified using our new Sexual Orientation and Gender Identity (SOGI) questions. As the program rolls out, we will capture more and more of our population so caregivers can better serve them.
As a gay man in my 50s, I have seen great changes in my lifetime on LGBTQ issues. There was a time when just being out was a danger. But we bring some unique perspectives to our job that shouldn’t be overlooked. We know what it’s like to be the underdog. We cherish family because we worked so hard to have our families recognized. Respect for minorities come easily to us because we have suffered discrimination. Fairness in treatment under the law was not free for us or other minorities so we always strive to protect our patients’ rights. We know that being gay does not give you AIDS, but we also know what those risk factors are and we are able to educate our patients on the facts without judgement.
Now that we are rolling out a campaign to identify our patients’ unique needs regarding sexual health, reproductive issues, and mental health, we are working to destigmatize these issues in our community. Just asking these questions can be a litmus test of our own feelings. When the program was being explained in an employee meeting, there was pushback. “Our patients will be insulted.” Or, “Our patients won’t understand the terms.”
It occurred to me that we might be projecting our own feelings and, in some cases ignorance, onto our patients. Of course, there are what seem like valid issues when trying to tease this information out of patients in the geriatric clinic. My feeling is that you just throw the questions out there and you get what you get. The elderly are just as much part of the world as the young (and in between).I can’t wait to get some real world experience in asking these questions:
- What is the sex on your original birth certificate?
- What is your gender identity?
- What is your sexual orientation?
Some explanation might be needed with some patients. Sexual identity is not your sexual orientation. Sexual identity cannot be inferred from your birth certificate. We are looking forward to the rollout but with a bit of trepidation because we are not used to asking such personal questions. But,if you want to better serve this population, you have to identify them. The FTM person who never got a breast cancer screening because his caregivers never informed him of the risk—that can be preventable with better understanding of our patients. More information is better than less.
I take away two points from the SOGI questions that excite me. The first is that caregivers are going to be more aware of the disparities in health care that can occur with our LGBTQ patients. We are charged with the care of all our patients, not just the ones that fit into neat boxes. Just being aware of the differences makes us stop to weigh implications that might have been missed in the past. The second is that by normalizing this conversation, both patients and caregivers can talk openly about a subject that was once taboo. It’s OK to be gay or lesbian, FTM, MTF, something in between, or nothing at all. We all have health care needs.
Annette Smith, a nurse and coworker with 35 years of experience, has insight into changes in practice like the new SOGI questions: “At the beginning, there is a lot of pushback. The sky is falling, the sky is falling. But after a while, the process becomes normalized and it’s not a big deal anymore. We end up wondering what all the fuss was about!”
There was a time when just talking about sexual orientation was not even considered. Now we are required to ask! This destigmatizes the whole subject. To revisit my first question: It should never be a question of whether it’s right or wrong to be out at work. It’s just a question of you being comfortable enough in your own skin to let other people know.
I’m orienting as a charge nurse at a clinic. A middle-aged gay man (well, late middle age), surrounded by young women. Something odd happened that I want to share. My clinical partner, a charge nurse with 35 years of experience, pulled me into a room. “I’m going to tell you something awkward. Some of the nurses have said they feel uncomfortable when you touch them on the shoulder.”
You could have knocked me over with a feather. I honestly didn’t remember ever touching anyone and said as much. However, later that same day I actually caught myself just as I was about to touch a coworker on the shoulder and say, “Thanks for helping me with that patient.” So I had touched someone….without their permission, without thinking about it. I really had to rethink my behavior toward the opposite sex in the current climate.
Women are finding their power. Things that might have slipped by in the past are no longer going to get a pass. Frankly, I think it was a long (centuries) time coming. I hope it continues. I know it will. I’m excited to live in a time where women’s rights and female empowerment is in ascendancy.
I guess I just thought that being gay somehow made me immune from charges of sexual harassment (from women at least). This is just not the case. Harassment is in the eye of the beholder. If someone is uncomfortable with something, he or she has a right to their feelings, even if, from the other side, he/she/we may feel that nothing was done wrong (or at least intended). It’s hard to grasp, but important. Harassment is whatever someone says it is.
I admit, my feelings were hurt. I did not intend to make a coworker uncomfortable. My being gay or straight has no bearing on the issue of someone else’s feelings. I won’t argue that I didn’t mean to. I won’t say that I’m a hugger, or come from an affectionate family. Whatever my reasons for touching someone without their permission are not pertinent. All I can do is identify the behavior that caused the problem and fix it going forward.
Some might argue that the pendulum of women’s rights has swung too far. Anyone can say they feel harassed about anything. Any innocent touch, a pat on the back, is harassment and it’s just too crazy. That’s not the way to look at it. The #MeToo movement did not happen in a vacuum. It takes place in the context of an entire human history of women being treated as property and all that entails. There was a time when gay-bashing was, if not a national past-time, at least a frequent diversion, and I’ve been the victim of it several times. Gay rights didn’t happen in a vacuum, either. The broken body of Mathew Sheppard brings to mind exactly why we are fighting. Now, women are fighting.
What I’m saying is that I understand that women have a right to be seen and heard, respected, and not touched in the workplace. They have a right to pick and choose how they will be interacted with and what is appropriate. They fought for that right and continue to do so.
I’m glad that someone thought enough about me to point out something I could improve upon in my work life. I’ll keep an open mind, and my hands to myself in the future.