Men in Nursing paper (part 1)

Men in Nursing: Ambivalence in care, gender and masculinity

B. Brown, PhD, BSc (Hons).*

(Senior Lecturer, Department of Human Comunication, De Montfort University, Kents Hill, Milton Keynes, MK7 6HP)

Peter W. Nolan, PhD, MEd, BA(Hons), BEd (Hons) RMN, RGN, DN (Lond.), RNT, Cert. Ed,

(Professor, The Medical School, University of Birmingham and the Foundation NHS Trust, Stafford)

Paul Crawford, PhD, BA(Hons), DPSN, RMN,

(Research Fellow, The Medical School, University of Birmingham and the Foundation NHS Trust, Stafford)

*Author for correspondence

Abstract

This paper briefly reviews some aspects of the history of men in nursing and suggests that, for centuries, men have been at the forefront of caring work, and it was in the mid-nineteenth century when shifts in the nature of masculinity and femininity occurred, spearheaded by Florence Nightingale, which resulted in nursing becoming feminised. Drawing on techniques of oral history, this paper presents the experiences of two men who pioneered the return of men into nursing, and how their work changed in the course of their working lives. Both men saw a shift away from institutional hierarchies towards a more patient centred model, which accompanied comparable developments in their own thinking in different fields of nursing. There were differences in the work they did and how they constructed their pasts, yet there were also similarities in the way they developed their philosophy of caring for patients.

Introduction

This paper examines some of the changes which occurred as men entered nursing in the late twentieth century. Nursing is unique in that during the late nineteenth century it became an almost completely 'feminised' occupation, following what Theweleit calls a 'new female assault' on medical and caring work. Before this, women did little more than midwifery (1). During the late twentieth century men have increasingly found their way back into nursing. In this paper we shall contextualise the experiences of two of the men who pioneered this influx. This shift in gender ratios in nursing has proceeded in tandem with a variety of other tensions concerning nursing and gender, and the training and education which was deemed to be appropriate. Nursing represents a sign of the times, within which dramas concerning the nature of medical knowledge, and indeed the nature of men and women themselves, are performed in particularly graphic detail.

For this reason, the experiences of men in an occupation that is predominantly female are worthy of investigation. Examining the motivation and experience of men in nursing challenges traditional concepts of 'nursing' and 'masculinity'. Moreover, it illuminates the shifts between different ideologies of nursing. Let us begin by placing the mid-twentieth century experience of men in nursing in some historical context. Much modern nursing can be dated to Florence Nightingale, who promoted the idea that to be a 'good nurse' was also to be a 'good woman' (2). Klaus Theweleit describes this ideal vision of the female nurse as the 'white nurse' (3), a pure 'caring mother figure, who transcends sensuousness' (4).

Florence Nightingale was a strong advocate for both women and nursing, and considered traits such as nurturance, gentleness, empathy, compassion, tenderness and unselfishness to be essentially feminine and essentially nurse-like. Not surprisingly, in the present, this position has been increasingly challenged by those who argue that these attributes exist also in men, and might not necessarily be found in all female nurses! (5).

Nightingale herself believed that men's 'hard and horny' hands were not fitted 'to touch, bathe, and dress wounded limbs, however gentle their hearts may be' (6). Her opposition to men in nursing caused her to denounce male asylum nurses especially, because she considered their duties more akin to those of prison warders than to nurses in general hospitals. Her hostility, allied to that of her fellow-campaigner, Mrs. Bedford Fenwick, was partly responsible for the increasing divergence in training, philosophy and sex ratios between psychiatric and general nursing during the late nineteenth and early twentieth centuries.

Following Nightingale's experiences at Scutari, she devoted forty years of her life to the development of nurse education, hospital design and sanitary reform (7). Carpenter has pointed out there 'are different ways of being a nurse' (8) as a brief study of the history of caring suggests. Before Nightingale began the formal education of nurses at St. Thomas's Hospital in 1860, 'nursing' encompassed a far broader range of activities, and involved a much wider variety of people.

Men in the history of health care

In one of the few existing reviews of men in nursing, Wright and Hearn (9) suggest that the earliest nurses were men. There are references in Hippocratic writings to male slaves performing therapeutic activities with clients in their work as bath attendants. These slaves were trained by doctors to assist with and undertake treatments (10). Care in the public sphere in Ancient Greece was predominantly provided by men, whereas in the home, the sick were cared for by women (11). Later, the Romans were one of the first cultures to practice battlefield medicine in mobile tent hospitals (12) and these skills were later applied to civilian patients.

In the Middle Ages in Europe, health care was largely provided by the various religious orders. Indeed, a major manifestation of the Christian beliefs of these monks and nuns was the care they provided for the sick and outcast (13). It is partly through these religious movements that nursing became feminised as the middle ages progressed (14).

Rubin (15), in an analysis of medieval monasticism, is suspicious of the 'masculinity' of the monks because they had 'renounced' their heterosexual role. Yet Barber (16) notes that 'the charge of homosexuality was an obvious accusation to direct against an all-male celibate Order' and considers it irrelevant to the nursing work which the monks undertook. There are nevertheless intriguing parallels between these questions of sexuality and the recent role of gay men in caring for those suffering from HIV and AIDS (17). It is in this sphere, especially, that men's nurturant activities can be exercised without incurring suspicions.

A comparable climate of suspicion explains why, during the middle ages and Renaissance, care was increasingly relocated into religious institutions. These were the only places where mediaeval women could practice healing arts without the risk of being accused of witchcraft. At this time also we can see a profound ambivalence to knowledge in women, whose alignment with witchcraft meant that their knowledge and care-giving was regarded with suspicion by theologians and inquisitors (18). Indeed, as the middle ages led into the Renaissance, the reformation and the counter reformation, the climate for women became more hazardous as religious authorities rooted out such cases with increasing zeal (19).

The purpose of this argument, then, is to show that the feminised nature of nursing emerged through historical struggle and was never 'naturally feminine'. The ideological hard labour of Nightingale served to bridge the gap between women serving in the workplace as nurses and the Victorian concern that well-bred women should remain in the home developing ladylike behaviour (20). Nursing then was about bringing the private sphere of nurturance into the public domain of the hospital (21).

A further strand of history which helps to explain the way in which nursing became increasingly a woman's sphere is the shift which took place in masculinity through the nineteenth century. Early in the nineteenth century men had a more physically intimate attitude to friendship and caring than is the case nowadays (22). As the nineteenth century wore on, masculinity was re-worked so as to emphasise the qualities we see in it today. There were the beginnings of a studied avoidance of sensitivity, nurturance and emotion. A particularly prominent sign of the times can be seen in the writings of Thomas Carlyle. As Clarke (23) describes, the young Carlyle was especially disgusted with the idleness, foppishness, slovenliness and self indulgence displayed by the poet Coleridge. Equally, he was revolted by his friend Edward Irving nursing and playing with his baby. Carlyle's writings then, valorised a form of masculinity which had no time for idleness, affection or chatter. A man, if he was to be a worthy example of his sex, should be silent, steadfast and have little to do with women and children.

The reformulation of masculinity and femininity which was taking place more generally in 19th century society set the stage for the likes of Nightingale and Carlyle to be heard by a wider audience. In Nightingale's case, her friends in government such as Sidney Herbert and Lord Stanley enabled her ideas to become policies. By being directly asked to go to the Crimea to care for soldiers by Sidney Herbert in his role as War Minister, she was in a powerful position to assert her vision of the female nurse.

There are particularly interesting implications here for scientific knowledge, gender and the nature of care. Knowledge was increasingly being defined away from the human contexts where care took place. Education for nurses was planned so as to originate in university medical schools, colleges, or within training courses. This kind of knowledge involved a one way path of transmission from the academy to the ward. The autonomous features of working life unique to nursing on the other hand were to do with the high moral character which was to be developed in nurses. Nurses needed to be scientifically trained so that they could become the skilled servants of medicine, rather than autonomous scientific minds in their own right.

Before Nightingale's expedition to the Crimea, British soldiers were mainly nursed by male orderlies. They had no training, except through experience and by working closely with surgeons (24). It was thus during the late nineteenth and twentieth centuries that a shift took place in the Armed Forces, the Religious Orders and the Hospitals so that caring became predominantly women's work. Indeed, 'nursing was lauded as a domestic art that fulfilled the calling of true womanhood' (25).

Meanwhile, as the late nineteenth century developed, medicine itself was reforming as a discipline that originated not in the surgeon's craft but in the laboratory. The engine house of scientific medicine was increasingly seen as residing in the newly-developing sciences of bacteriology, neurology and biochemistry. It is significant in this regard that Nightingale herself never believed in germs. Thus, because of its rudimentary intellectual and scientific content, the Nightingale formulation of nursing could coexist quite comfortably with Victorian beliefs that education was bad for women and harmed their reproductive organs.

It is particularly important, from our point of view, that echoes of this vision of nursing can be found in the reminiscences of nurses and ex-nurses who undertook training at mid-century, and it is this issue which brings us on to the importance of oral history.