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.
Today nurses practice in many arenas, from hospital bedsides to executive office suites to research laboratories to the halls of the United States Congress. Our Code of Ethics charges all of us to be involved in the political process to influence policies affecting the nursing profession and the health and well-being of all people. Our national professional organization, the American Nurses Association (ANA), encourages all nurses to be politically active to ensure safe and effective care for all patients, to elevate the profession, and to work to eliminate health disparities across our country.
Many early nursing leaders were suffragists and some even went to jail for advocating for women’s right to vote. As soon as the 19th Amendment passed in 1920, nurses were elected to local and state offices. Margaret Laird, a New Jersey nurse, was one of the first two women elected to the New Jersey Legislature in 1920. Between 1920 and 1992 nurses served in state legislatures in many states including North Carolina, Virginia, West Virginia, Massachusetts, Maine, and California. Iowa nurse JoAnn Zimmerman served as her state’s Lieutenant Governor from 1987 to 1991. While a nurse has yet to win a governorship, U.S. Senate seat, or Presidential election, eight nurses have served and/or are serving in the United States House of Representatives.
Texas nurse Eddie Bernice Johnson became the first nurse to win a national office in 1993 when she was elected to serve the 30th Congressional District of Texas in the United States House of Representatives. Twenty-six years later, Johnson continues to serve her district. In the intervening years she has been joined by seven other nurses from across the country. The group of Congressional nurses are African American and white, Democrat and Republican. They range in age from 32 to 84. As a group they represent all areas of the country and a cross section of race, age, and political affiliation. They have all brought their professional experiences, ethics, and commitment to caring with them into the political arena. To kick off Minority Nurse’s new Nurses in Congress series, I will share brief biographical sketches of each of the eight Congressional nurses starting with Congresswoman Johnson.
Eddie Bernice Johnson, RN, BSN, MPA
Democratic Representative, 30th Congressional District of Texas, 1993-present
“Whatever discussion I am a part of, I never miss the opportunity to talk about the value of professional nurses, the value of investment in the profession and the value of attempting to look at the full potential of nurse’s abilities.”
—Rep. Eddie Bernice Johnson, Nurse.com
Throughout her life, Congresswoman Eddie Bernice Johnson has been a pioneer. As an African American female growing up in rural Texas during the time of legal segregation, her future may have appeared limited. However, as Mr. James Daniels noted in an interview with Johnson:
Mrs. Johnson, your accomplishments are impressive and even astonishing. Your firsts set you apart as a genuine trailblazer. You are the first woman ever elected to represent Dallas in the U.S. Congress. You are the very first chief psychiatric nurse of Dallas; first African American elected to the Texas House of Representatives from Dallas; first woman in Texas history to lead a major committee of the Texas House of Representatives; first African American appointed regional director of U.S. Department of Health, Education, and Welfare; and the first female African American elected from the Dallas area as a Texas senator since Reconstruction. Your crowning accomplishment, however, is as the first nurse elected to the United States House of Representatives.
—James Daniels, MinorityNurse.com
Johnson was born on December 3, 1935 to Lee Edward and Lillie Mae White Johnson in rural McLennan County, Texas to a family of limited means, but with a reverence for education. Johnson graduated from A.J. Moore High School in Waco, Texas in 1952. She wanted to become a nurse, but no accredited nursing school in Texas would accept African American students, so she enrolled in St. Mary’s College in Notre Dame, Indiana. In 1956, she graduated with her nursing diploma. Johnson continued her education earning her BSN from Texas Christian University in 1967, and in 1976, she was awarded her master’s degree in public administration from Southern Methodist University.
Johnson’s early nursing career was spent as a psychiatric/mental health nurse, psychotherapist, and nursing administrator for the Veteran’s Administration (VA). After ten years working for the VA, she achieved the rank of chief psychiatric nurse at the VA Hospital in Dallas. In 1977, Johnson was promoted and became a regional director of the U.S. Department of Health, Education, and Welfare.
In 1972, while working at the VA, Johnson was elected to the Texas House of Representatives, making her the first African American woman to ever win an election in Dallas. Johnson waged a successful campaign for a seat in the Texas Senate in 1986, which she gave up in 1992 to run for the U.S. Congress. She won in a landslide and became the first nurse to serve in Congress. She has retained her seat for twenty-seven years.
Johnson is widely recognized as one of the most effective legislators in Congress. She is credited with authoring and co-authoring more than 120 bills that were passed by the House and Senate and signed into law. Over the decades Johnson has served on and chaired many committees and subcommittees in Congress, including as a senior member of the Transportation and Infrastructure Committee and Chairwoman of the Science, Space, and Technology Committee. Her subcommittee appointments include: the Subcommittee on Water Resources and Environment, which has jurisdiction over water conservation, pollution control, infrastructure, and hazardous waste cleanup as well as reauthorization of the Clean Water Act; the Subcommittee on Aviation; the Subcommittee on Railroad, Pipelines, and Hazardous Materials; the Subcommittee of Research and Science Education; and the Subcommittee on Energy and the Environment. She has also been a Senior Democratic Deputy Whip and Chair of the Texas Democratic Delegation. As chair of the Congressional Black Caucus from 2001 to 2003, Johnson was praised for her ability to build coalitions with business interest group as well as labor unions and civil rights organizations.
Johnson introduced the National Nurse Act of 2011, which would elevate the importance of the Chief Nurse Officer of the United States Public Health Service and appoint a National Nurse to work with the Surgeon General to promote wellness and health literacy. She is also passionate about improving mental health and increasing federal funding for women pursuing science, technology, engineering, and math education.
Teaching in the field of nursing is a rewarding experience and an opportunity to give back to nursing. Education in the faculty role allows for providing insight into current practices based on lived experience and present evidence-based guidelines. Overall, Caucasians and Asians are overrepresented in nursing in comparison to African American and Hispanic nurses, according to a study published in the Journal of Cultural Diversity. As a result of this disparity, there are also problems with equal representation of minority nurse faculty. Those considered faculty of color have continued to represent less than 13% of nursing faculty. As a nurse educator, I have a direct impact on one’s future practice when caring for patients. I am concerned about these known truths and have a few questions for one to consider:
- Why is there not an equal representation of minority faculty when compared to the majority?
- Are individuals given a fair chance?
It is a tedious process to complete applications for faculty roles and often discouraging to obtain feedback from an automated email generated message about qualifications not matching. I encourage all minority potential faculty candidates to increase their visibility in becoming part of a nursing faculty and continue to be persistent. There does need to be interest in nursing research to be considered competitive for some positions. There are overwhelming amounts of candidates with clinical experience as registered nurses or nurse practitioners. Students more than ever need to see someone who “looks like me” at some point in their curriculum with whom they identify with. This is important in ensuring self-efficacy is present throughout their program.
Often, the hiring process is screened by human resources and not nursing departments. Specific to nursing may be the change of having administrative involvement with applications submitted for faculty roles. Anyone who knows me both personally and professionally understands my passion for nursing education. A majority of my close friends have been convinced to give back to nursing in becoming professors. As an African American female, I disproportionately represent a minority faculty. I am grateful for my opportunities. However, we have more work to do in the recruitment and retention of minority nurse faculty.
Colleges and universities must consider diversity within the workplace, particularly for nursing. This is an initiative for the American Association of College of Nursing (AACN). Their initiative involved the inclusion of a diversity of both students and faculty in schools of nursing across the country. An inclusive learning environment can be shaped by the active recruitment of minority faculty. Should there be a representation of diversity in the hiring process, such as within a search committee? This endorsement by AACN is a step in the right direction in the solution to improving a diverse workplace and learning environment for students. Recognition is the first step in making strides to consider those who are minorities from diverse backgrounds.
Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, has spent her career working hard, and as a result, she’s been a standout.
But she recently received an outstanding honor when she was elected to the National Academy of Medicine (NAM)—and she’s only one of two nurses selected this year.
“It is a tremendous honor to be selected as a member of NAM,” says Taylor. “Membership in NAM is one of the highest honors you can achieve in science and medicine.”
In order to be elected to NAM, Taylor explains that you must be nominated by a current member, as nominees are not involved in the nomination process. When you are elected to NAM, it means that you have been elected by a group of experts who see you as a premiere expert in your particular field.
According to a statement from NYU Rory Meyers College of Nursing, Taylor has been recognized for her “bench-to-community research in gene-environment interaction studies on blood pressure among African-Americans that has provided novel contributions on SDoH and omic underpinnings of hypertension.”
“These newly elected members represent the most exceptional scholars and leaders whose remarkable work had advanced science, medicine, and health in the U.S. and around the globe,” NAM President Victor J. Dzau said in a statement. “Their expertise will be vital to addressing today’s most pressing health and scientific challenges and informing the future of health and medicine for the benefit of us all. I am honored to welcome these esteemed individuals to the National Academy of Medicine.”
While Taylor now works as a Professor and Vernice D. Ferguson Professor in Health Equity at the NYU Rory Meyers College of Nursing, she began her academic career working as an Assistant Professor and Director of the Pediatric Nurse Practitioner Program at the School of Nursing at the University of Michigan. Taylor then worked for nine years at Yale, and became the first African American woman to go through the tenure track ranks. In 2014, she earned tenure. Later, Taylor was named the first Associate Dean of Diversity at the Yale School of Nursing where she remained until going to NYU Rory Meyers College of Nursing. She then came to NYU to serve as the first Vernice D. Ferguson Endowed Chair. She also is the Director of the Meyers Biological Laboratory and Co-PI and Co-Director of the P20 Exploratory Center on Precision Health in Diverse Populations.
“Nurses have been members of NAM for a very long time. It is very important to have a membership that is diverse across health disciplines such as Nursing, Dentistry, and Medicine because all work together for the greater good of patients,” says Taylor. “I believe that my membership in NAM will add a greater voice and representation of nursing as an integral part of scientific research and practice.”
Taylor also hopes that this membership will open up opportunities so that she can “move the science forward in a more robust way and at an even larger scale.”
As a minority nurse, you know diversity and inclusion means much more than what the people in your organization look like and where they have come from.
Diversity and inclusion is absolutely focused on creating a nursing workforce that more closely mirrors the different populations in a given area. But diversity and inclusion also means more because the culture of a workplace needs to feel comfortable to the people who work there.
If you’re a nursing leader you hold a responsibility for hiring the right people, and also for creating an environment where employees feel like they can be their authentic selves. When employees feel like they are able to bring the things that make them different to work—whether that’s their affinity for studying languages or for making cat toys for shelters or for four-wheeling in their spare time—it’s up to the organization to honor what they bring to your organization.
The Society of Human Resources Management (SHRM) offers resources for making sure your workplace is not just diverse on the surface, but also goes deeper to be welcoming to employees.
What can you do to make sure your working environment is inclusive to all your employees?
Find the Right People
Make hiring high-quality workers who are similar to the populations you serve a priority. The more diversity you have, the more perspectives you’ll have. That only results in better care for your patients.
Understand the Concerns
Assess the culture of your workplace with open forums and anonymous comment boxes and bring your talent management team in on the results. Ask your employees for feedback about what feels right and what makes the workplace uncomfortable or unproductive for them.
Listen and Respond
Your team wants to be heard. They have voices and experiences that can make your unit stronger, more efficient, more effective, and more in tune to the needs of your patients. Make sure what they say matters, so listen to their concerns and work with them to develop meaningful solutions.
Keep It in the Open
Whatever changes you make probably won’t make everyone happy, but they should address an identified problem that will move your organization toward its goal of inclusivity. Each solution might look different. Sometimes, education about how different cultures make healthcare decisions will dispel misunderstandings. Sometimes it might be a direct policy that will address blatant mircroaggressions against people on your team. Many times, it is an open and honest celebration of they differences among your team members that will make them feel like they have found a place where they can flourish.
Look at the Outcome
In the end, a diverse workforce is essential and will meet many or your organization’s goals. But being an inclusive team is what makes employees committed to where they work and focused on the job at hand.
The outcome is better patient care, longer employee retention, an increased reputation as a fair employer in the community and the industry, and nurses who become ambassadors for your organization.
With their state-of-the-art medical technologies and outstanding nursing programs, the United States has long been one of the most desirable destinations for international nursing students to enroll. As an international nursing student studying in the U.S., you’ll have the opportunity to receive a top-notch education that provides hands-on experience under the guidance of world-class nurse faculty members.
But before you can begin learning from leading experts in the field, there are a few important things that all international nursing students should know. Below, you can find out the crucial skills you need before enrolling in a U.S. nursing school, and how to set yourself up for career success.
1. Strong English skills are a must.
One of the most frequently asked questions of any international nursing student is, “Do I need to have good English to succeed in my program?” To put it simply: Yes, you need to have a good grasp of the English language to enroll in a U.S. nursing school.
Most nursing school programs will require you to take the Test of English as a Foreign Language (TOEFL) to ensure that you understand the language well enough to complete the coursework. This is true whether you’re a first-year nursing student or an experienced RN enrolling in graduate-level studies in the United States.
2. You need to complete prerequisite coursework first.
Before you can apply to nursing schools in the United States, you need to show proof that you have completed the necessary prerequisites for the program. International nursing students must fulfill these prerequisites in order to obtain an F-1 visa, which allows you to take up foreign residence in the United States for the duration of your program.
Once you’re accepted into a nursing program, your school admissions office will issue you an I-20 application form. The next step is to fill out this form and take it to the U.S. Embassy or Consulate, where you will pay a fee to submit your application for a student visa.
3. Take advantage of scholarships and financial aid programs.
Even for in-state students, the cost of nursing school in the U.S. can be steep. In-state nursing students can expect to pay anywhere from $3,000-$8,000 per year, depending on the type of education, location and the type of school (i.e., public vs. private).
As an international nursing student, you can expect to pay more than an in-state American student. Don’t forget to factor in the cost of housing, food, and all the basic nursing supplies you’ll need for nursing school. To help ease the financial strain, be sure to apply for financial aid and scholarships that are available to international nursing students. You can find out which financial aid opportunities are available to you by getting in touch with the admissions office of any nursing school you’re considering.
4. Buy everything you need in advance.
Studying in the United States for the first time can be overwhelming. With so much to take in, it’s easy to forget all the supplies you need before your first day.
Depending on when you arrive, you’ll want to figure out which medical supplies for nursing students in advance and order them sooner rather than later. This includes at least a few sets of scrubs, a good pair of slip resistant shoes and compression socks, note-taking supplies, a stethoscope, and a clipboard, just to name a few.
5. Study groups are key to your success.
Though you may prefer to study solo, don’t immediately dismiss the idea of joining a study group. As an international student, being part of a study group can make all the difference in your success. Studying in a group can help you retain more information from class, improve your test scores, and provide you with moral support from your fellow classmates. Additionally, working with a group builds teamwork and social skills, which are highly valued in the field of nursing.
6. Don’t be afraid to ask for help.
Nursing school is challenging even for those who are accustomed to U.S. teaching styles. If you’re struggling to keep up with the coursework or to understand a certain concept, don’t hesitate to reach out to your nurse educators. After all, they were once nursing students as well and have been in your shoes.
Though they may not know the exact challenges of being an international nursing student, they can help make your life a lot easier in several ways. Be sure to make use of their office hours and let them know what you’re struggling with. They may post their lecture slides online to help you study or work with you one-on-one to help you better understand the lesson.
7. Get comfortable with NCLEX-style testing.
Don’t wait to begin preparing for the NCLEX test. Instead, start studying for it while you’re enrolled in nursing school. This challenging test—which is required to become a nurse in the United States—can throw many students off with its different styles of questions. The format ranges from multiple-choice, order response, calculation questions, and select-all-that-apply questions, which can take some getting used to.
Fortunately, there are ways for international nursing students to prepare for the NCLEX test early. In addition to challenging yourself with a daily NCLEX-style question, you can also invest in practice resources offered by Kaplan, NRSNG and UWorld.
Being an international nursing student can be challenging. On top of social and cultural barriers, you’re also faced with undergoing a rigorous program that will put your skills to the test. Don’t let this dissuade you from pursuing your dream of studying nursing in the United States. By keeping the above things in mind, you can ace your nursing school program and go on to become a successful nurse.