Men in Nursing paper (part 3)

[Thunderwolf, MSN, RN]

A Male Nurse in a Psychiatric Hospital

'I applied for mental nursing once I was demobbed after the War'. This respondent had made the decision to take up nursing based on gossip he had heard during his time in the ranks that to seek work in the police, the prison service or the mental hospitals was a good career move after being in the army. Ex-service men and women were highly regarded in these services for which they would be considered already trained. The respondent freely admitted that he had not gone into psychiatric nursing primarily to care for sick people. 'What I most relished when I started were the company of ex-soldiers and the sporting facilities...Working with patients was boring, but once I could escape to the sportsfield, I was in my element.' He had been thrilled to find the facilities for playing sport were much better at the hospital than he could have expected elsewhere.

The respondent noted that many of the staff at the mental hospital were indeed ex-military and much of the culture of the hospital was overtly militaristic with a strong emphasis on uniforms and the correct wearing of them. Ex-soldiers were valued for their strength and fitness, making them well able to control difficult patients. Staff without a service background often disliked the hospital's regimentation during the 1950s and 1960s. Those favouring regimentation sometimes despised patients, thinking them 'to lack spine.' Talk amongst male staff often centred on tales of the War, violence and aggression. Male nurses were frequently trying to work through their own difficult and distressing experiences as soldiers whilst carrying out their duties on the wards. They tended to dismiss depressed patients as malingerers especially if they had never seen active service, and attention was given to those who were good company and good workers.

This distinction recollects a dilemma that had existed in military circles for forty years previous to this informant's experiences. Concerns over shell shock, cowardice and malingering had bedevilled psychiatry in the first World War. The patients, like disorientated soldiers in the trenches, had somehow suffered the loss of some important masculine feature. The concern that shell-shocked soldiers had lost courage or suffered from 'funk' (35) finds its echoes in the 1950s where these ex-military personnel found a lack of 'spine' in their patients. In either case, the objects of this militaristic gaze, be they malingering soldiers or patients had been disenfranchised from the company of men and had to be disposed of within the framework of military discipline or behind the shield of hospital routines.

Controlling patients in order to maintain a pristine establishment was the major task of the nursing staff and one to which ex-soldiers were well suited. 'Floors were polished twice a day and patients were forbidden to walk on them before a visit from the Superintendent or the Chief Male Nurse. The appearance of the ward was far more important than the comfort of patients. Staff were complimented on their clean and orderly wards, not on how compassionate they were to patients.' There was occasional violence when patients were restrained or secluded. Nursing staff might be guilty of using too much force, but were rarely held to account for what they did or said to patients as medical staff always accepted their account of incidents even when contradicted by the patients.

Although the atmosphere in the male wards was generally one of staff dominance and patient subservience, the respondent noted instances where friendships flourished between nurses and patients. Some staff would offer patients extra tobacco and help them write letters to their families and friends. As more nurses without a service background came onto the wards the atmosphere began to change. In the 1960s, talking to patients and providing companionship became an expected part of nursing. These new nurses were no longer satisfied with a controlling and supervisory role; they wished to be involved in therapy and treatment. The respondent noted how his own attitudes had changed: 'Towards the end of the 1960s, I attained the position of Charge Nurse and became convinced that the majority of patients in the hospital in which I worked led miserable, unhappy lives.' He had become interested in occupational therapy and sought to improve patients' lives, campaigning for them to receive payment for their work in the Occupational Therapy Department, even if this was only sufficient for them to buy cigarettes and sweets. He encouraged patients to get away from the hospital at week-ends and to cultivate enjoyable hobbies.

Discussion: Military metaphors in the caring professions

These two nurses' accounts of their working lives offer some interesting insights into nursing history. Both men came into nursing after previous experience of large organisations: the general nurse had worked with the Red Cross, and the psychiatric nurse had served with the armed forces. It seemed a natural progression to move from these organisations into nursing, which offered an institutionalised life with strict routines and codes of practice with which they could feel at ease. The uniform offered them a security which they valued; it represented a regimented way of life and signalled where they and others fitted into a particular hierarchy. Their accounts suggest that they were welcome recruits because of their strength as males, rather than for their personalities. They were able to fit in because they were doers who got on with the job and derived security from the structured organisation rather than reflecting on their position. Neither perceived his work as being in any way women's work. The general hospital nurse was not worried by being one man amongst many women and did not rebel when treated differently from his female colleagues. Perhaps both nurses flourished precisely because, at the time, they did not reflect on their position within nursing or the type of work in which they were employed.

The military atmosphere noticed by the nurse in the psychiatric hospital deserves further comment. It has some parallels with Theweleit's exposition of the nature of 'soldier-males' who are strongly bound to men and male organisations (36). Even though, as we have noted, general nursing became feminised, we still have the ambivalence of continuing machismo in a 'feminine' domain. Theweleit unearths in the 'soldier-male' personality a distrust of everything feminine. The soldier-male wraps himself up in a fiercely masculine rigidity or destructive hardness: 'The more lifeless, regimented, and monumental reality appears to be, the more secure the men feel. The danger is being-alive itself' (37). He has 'the hard, organised, phallic body devoid of all internal viscera which finds its apotheosis in the machine' (38). This is a rather extreme formulation, but it suffices to caricature the mind-set of military men in the early twentieth century. Nevertheless, these military ideologies perhaps make sense of the soldierly atmosphere discussed in our second oral history. Yet as we can also see from this informant's account, 'soldier-male' voices have been interrogated or 'dialogized' (39) by feminine voices. Certainly, the respondent seemed pleased that the soldierly atmosphere retracted with the influx of non-military workers.

Conclusion: The changing culture of gender in nursing

There is a danger of romanticising the reminiscences of these men. Whilst they have detailed, complex recollections of their working lives, they never intended to be gender pioneers. Nevertheless, their reasons for becoming nurses, however mundane, differed from those which are found nowadays. Modern male nurses cite the desire to care for others, job security and empowerment as a professional (40). Moreover we do not see, in the early careers of either of our informants, the rapid drift into managerial positions common with contemporary men in nursing (41). This highlights how the pattern of men in nursing is a highly differentiated picture where patterns of employment shift with the passage of time and the influx of more men into the profession.

As men have found their way into nursing so too the training curriculum has become more academic and educational. Equally, there has always been concern that education is not necessarily good for nursing. As Young put it, 'The aim of nursing education should be to produce a good nurse, not necessarily a well educated young woman.' (42) Indeed, in the present, a number of increasingly strong voices are demanding a return to nurse training which is vocational rather than academic, and based on 'competencies' (43).

Thus we can point again to the long history of ambivalence about the education and training of nurses. Perhaps one clue about the role of training in nursing is given by our two informants. A great deal of what it means to be a nurse is transmitted via the experience of doing the job - the ceremonies of trying on uniforms, taking blood pressure and blanket bathing patients. This process is remarkably sensitive to shifts in social attitudes. In studies of some occupations, researchers have drawn attention to a cynical, reactionary 'canteen culture' which resists innovation. This is suggested in our second informant's reminiscences of the post war culture of psychiatric nursing. Conversely, our informants show that far from being a sclerotised mass of tradition, the local cultures of their hospitals enabled them to recognise a shift in the ethos of care as patients became more central to the organisation of hospital routines. They developed awareness of patients' needs, and their security in the hospital's organisational structure was superseded by an appreciation of their relationship with patients. For these men, the caring aspect of nursing grew in importance, as their original motives for entering the profession transmuted into something Florence Nightingale might have approved of, even if she might still have reservations about their gender.