Gender bias in Critical Care nursing

Rosie Baruah

I’ve written a blog on implicit gender bias for WICM, focusing on the problems female doctors can face as a result of the implicit bias that doctor = man, I thought it might be interesting to look at nursing, where there is a strong implicit assumption that nurse = female…

In contrast to the medical workforce, the UK nursing workforce is overwhelmingly female, with only 11.4% of nurses on the 2017-18 Nursing and Midwifery Council register identifying as male.[i] Membership of the British Association of Critical Care Nursing is 85% female.[ii] Nursing has only relatively recently been seen as the preserve of women. There is historical evidence that nursing was a majority male, or equal male/female role from ancient times, albeit one associated with relatively low social status. During the Crimean War, Florence Nightingale originated the role of the professional nurse and centred it around the female gender role, claiming that men were not capable of functioning in the nursing role as “their horny hands were detrimental to caring.”[iii] Modern nursing is very much a female dominated profession, centred around the expression of communal qualities in the act of caring for patients.

Men may face multiple barriers to a career in nursing due to explicit and implicit gender bias. The small number of men in the profession leads to a limited number of role models for men considering becoming a nurse. Once admitted to training, nursing students may find themselves in university departments where the vast majority of students and teaching staff are female, and teaching materials may use “she” and “her” as default descriptors of nurses. Male nursing students on placement may find themselves disproportionately allocated to potentially violent and aggressive patients and given an excess of physical jobs such as moving and handling of patients and equipment, compared to their female student colleagues. Their placement mentors are likely to be female, and male students may feel inadequately guided in the appropriate use of touch and may fear their use of touch in acts of care may be misinterpreted as sexualised touching, especially with female or paediatric patients. They may express caring behaviours differently from their female colleagues and may receive less positive placement evaluations as a result.[iv]

Men in nursing seem to be disproportionately represented in senior clinical, leadership and management roles, and the disadvantages experienced by men in nursing as a result of explicit or implicit gender bias does not impede career advancement. This has been described as a ‘glass escalator’ which allows men to experience an advantage over their female colleagues in terms of promotion to senior roles. In England, men make up 11.7& of the nursing workforce but 17% of nurses at Band 8a, a pay band associated with senior management roles. [v]

The ’glass escalator’ may be the result of gender bias where men are more readily perceived as leaders. Senior leadership and management roles are likely to be associated with so-called ‘agentic’ character traits. These traits – competitiveness, aggression, determination, ambition – are stereotypically associated with men. Men are expected to demonstrate these behaviours and if they do not, they may be negatively perceived. In female senior nurses, agentic behaviours are associated with negative perceptions (‘the battle-axe matron’).

A man who wants to be a nurse should feel that his gender is no barrier. He should not feel like an outsider, the nurse prefaced with ‘male.’ We as a society need to be more comfortable with allowing men to demonstrate caring behaviours, without this being seen as unmanly. A nurse who is male possibly gravitates to ‘techy’ specialties like theatre and ICU, and more senior leadership roles not because this is intrinsically more interesting to men, but because they have been bombarded since childhood with subtle messages that caring isn’t a man’s job.

WICM aims to remove barriers to women in intensive care medicine – but it’s important to realise that gender disparity and gender bias occurs in other professions too and by shining a light on it, we can take the first steps to addressing it.

Rosie is the Chair of the WICM group. She is a consultant in critical care and anaesthesia at the Western General Hospital in Edinburgh.

[i] Accessed 1st April 2019

[ii] R Scott,  BACCN, personal communication

[iii] Kouta CK, Kaite CP. Gender discrimination and nursing: a literature review. J Prof Nurs 2011; 27: 59-63

[iv] Meadus RjJ Twomey JC. Men student nurses: the nursing education experience. Nurs Forum 2011; 46: 269-279

[v] Pushton G, Maclaine K, Trevitt P et al. Nursing pay by gender distribution in the UK – does the glass escalator still exist? Int J Nurs Stud 2019; 93: 21-29