I do not trust history, “it is a pack of lies played by the living upon the dead” (Brennan & Renear, 1991) as Voltaire is said to have said, but that may be a lie also. I don’t know, I wasn’t there; so when given the task of listing three events in the history of nursing that have impacted the profession, I will do so with this in mind, also trying to give a tip of the hat to that which has been left out because history, if it is anything, is a chronicle written by fallible human beings with agendas and biases. History is a study of power: those who write it represent the dominant culture and the dominant culture in nursing history is feminine.
Florence Nightingale is the singular person credited with beginning the art and science of nursing as we know it today. I do not wish to detract from her achievements because she is the person who initiated nursing as an independent evidence based profession. She may have been the first to collect data as evidence for nursing practice (Black, 2014) and using this information to fight for reform in the British Army’s medical system (Black, 2014). She also founded the first nurses’ training school in 1860 (Black, 2014), “which would become a model for nursing education in the United States” (Black, 2014, p. 25). Nightingale, though, “largely ignored the historical contributions of men. The male role as she saw it was confined to supplying physical strength, such as lifting, moving, or controlling patients, when needed” (Black, 2014, p. 37).
I do not blame Nightingale for this. We are all the victims of the constructions of the societies in which we were born and brought up. In her time, gender roles were a lot more fixed than they are today; but they are social constructions (Black, 2014) and, as such, should be questioned because social constructions don’t represent truth. The history of men in nursing reaches very far back in time. The earliest recorded accounts of men in nursing are during the fourth and fifth centuries (Evans, 2004) as members of religious orders such as The Order of St. John of Jerusalem “who defended Jerusalem during the crusades, later provided protection to travelling pilgrims and also built hospitals and castles across Europe that served as both lodgings for pilgrims and places to nurse the sick” (Evans, 2004, p. 322). There were many other such orders such as the Knights of St. Lazarus, Knights Templars, and Teutonic Knights which ministered to the sick (Evans, 2004). These points suggest that men didn’t and don’t deserve to be confined to gender roles in the profession yet it should be mentioned that gender roles attached by men to women at this time in history was unfortunately not unheard of:
Even in medieval accounts, however, there is the suggestion that nursing work in these orders was considered to be of low value and hence more appropriately carried out by people of low status. In 1264, in The Rule and Statues of the Teutonic Knights, Book of the Order, the Knights entered into their rules that women were to do the nursing because service to livestock and sick persons was better performed by women. (Evans, 2004, p. 322)
The second historical event that had an impact on nursing as a profession took place in 1472 with the founding of the Alexian Brothers as a religious order (Evans, 2004). I say this because, even before Nightingale, the advent of the Alexians relegated male nurses to a role within the profession that had everything to do with the construct of gender and nothing to do with natural abilities: psychiatric nursing. According to Evans (2004), when the plague disappeared in the 1700’s, the Alexian Brothers “became well known for their ministry to the mentally ill” (Evans, 2004, p. 322) though it is questionable to me whether this ministry had less to do with actually helping the mentally ill as it did with controlling them because, as written in Black (2014), psychiatric nursing “often required physical stamina and strength and was therefore considered an appropriate setting for men in nursing” (p. 37). The Alexian Brothers may have actually helped perpetuate the idea that male nurses are more suited for psychiatric nursing due to the fact that they established training schools in the United States for men in the field (Evans, 2004). This might help to explain Nightingale’s attitude towards men in nursing cited earlier in this article.
The third historical movement which has impacted and continues to impact nursing is the so-called “feminization of nursing” (Black, 2014, p. 26) which took place in 19th century England and the United States. When the first schools for nursing were founded in these countries men were forbidden admission based on “The Victorian belief in women’s innate sensitivity and high morals” (Black, 2014, p. 26). Indeed, according to Evans (2004), Nightingale brought the relationship between men and nursing to a close in the 19th century because “To her, every woman was a nurse, and women who entered nurse training were doing only what came naturally to them as women” (pp. 322-323). Evans further states that a “family” (2004, p. 323) model of nursing prevailed at the time where:
The dominant role of father was assumed by men physicians. Nurses as women and patients as children completed the institutional family and reflected general social values regarding the division of labor based on gender. The notion of men as nurses was subsequently incompatible with the prevailing institutional family ideology of the time.
Anecdotally, as a man who has been in the nursing profession (starting out as a nurse’s aide and becoming a psychiatric nurse), I can attest that these gender stereotypes in the profession continue. I was the one often come to for help lifting a patient or helping to control a violent patient. As a nurse’s aide and as a nurse, I was more likely to be given assignments containing the heavy or violence prone patients. When I became a psychiatric nurse this last September, I remember my colleagues commenting that it would be nice to have another man on the staff and I know that I was scheduled so as to make it possible that there was always a man with a woman nurse on the floor because it was explained to me that way when it happened. Interestingly, aside from my academic interest in psychiatric nursing, I remember thinking as I applied for the job that I would probably be more likely to be hired because I am a man.
In closing, as of this writing, 8% of students enrolled in undergraduate nursing programs are men (Black, 2014). This is a very small number compared to women in this so-called enlightened age. This can’t help but to be an effect of the social construct of gender roles assigned irrationally to both women and men throughout history, a history which has been written by women who also inadvertently share these same values. It is interesting to note that of the 26 pages Black writes about the history of nursing in her Professional Nursing Concepts & Challenges, less than three are dedicated to the topic of men in nursing. Perhaps this is due to the paucity of information about this subject due to the aforementioned forces of history or maybe it is due to the subjective but probably unconscious selective process of a woman. I suspect it’s probably both. If more men are going to enter the profession of nursing history must be rewritten to reflect the contributions men have made and gender stereotypes must be challenged on every front.
References
Black, B. P. (2014). Professional nursing concepts & challenges (7th ed.). St. Louis, MO: Elsevier Saunders.
Brennan, E. & Renear, A. (1991, January 10). 4.0879 responses: Voltaire; on humanist (3/43). Message posted to http://dhhumanist.org/Archives/Virginia/v04/0876.html
Evans, J. (2004). Men nurses: A historical and feminist perspective. Journal of advanced nursing 47(3), 321-328.
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