Introduction

The nurse workforce deficit is a difficulty for many countries’ healthcare systems. Based on the present situation, the World Health Organization (WHO) predicts 32.3 million nurses/midwives by 2030, with a needs-based figure of 40 million.1 The WHO designates 2020 as “the Year of the Nurse and Midwife” to recognize nursing practitioners’ contributions to society.2 It also recommends measures to alleviate the potential risks associated with a nurse workforce deficit.2 Male recruiting into nursing is being prioritized, a previously ignored topic.

Nursing has been presented as a feminine career since the introduction of the Nightingale nursing curriculum in the mid-nineteenth century, which promoted women over males to become nurses.3 Equal education for men and women and attempts to promote equality in society beyond the healthcare arena have resulted in women entering men-dominated jobs and vice versa during the last half-century.4,5 Despite reduced gender imbalance in other professions, such as medicine, law, and business, nursing remains a female-dominated field. In the United States, male nurses comprised 12% of nursing employment in 2019, compared to 2.7% in 1970.6 In Canada, the proportion of male nurses in the nursing population gradually climbed from 5.7% in 2007 to 7.8% in 2016.7

Confucianism has had a significant impact on East Asian social customs. Caring work is historically considered a woman’s domain in the Eastern world, while males are considered the family’s breadwinners, undertaking adequately paid work outside the house. Because of the prevalent social attitudes about gender-related caring employment, men who provide nursing care have been sidelined. As a result, fewer males enter nursing in Eastern countries than in Western nations. In Japan, for example, male nurses comprise around 6.2% of the nursing profession, but men account for only 2.1% of the nurse population in mainland China.8,9 Male nurses in China are so scarce that they are referred to as “national treasures” and are often employed by significant health institutes.10

Nurses are represented as modest, mild, subservient, and empathic, while male characteristics such as being proactive and assertive are inappropriate for nursing.11,12 This stereotypical perception has pressured men to start or continue nursing.13 Conversely, a need for more male nurses might make female nurses awkward during patient care.14 A recent research focused on the experiences of female nurses in giving genitalia-related care to male patients.15 Both nurses and patients were unhappy with their care experiences. Patients appreciate the services of identical-sex nurses, according to other research.16

Men’s reluctance to join nursing is a prevalent problem in many nations, but their motives to do so are affected by gender-based ideas in a specific social-cultural environment. It is also essential to investigate the experiences of males already in the nursing profession in various social-cultural circumstances. Such understanding will affect nursing growth in the society where men reside and the worldwide nursing community. In addition, it has been reported that nursing students’ gender and class levels influence their perceptions of gender and professional ideals.17 Therefore; this study explored the feelings, thoughts, and opinions of male nursing students (first to fourth years) and male nursing professionals about their perception of the nursing profession.

Methods Study Design

The descriptive research used qualitative methodologies.18 The focus group interview (FGI) method was used purposely to get detailed information regarding male nursing students’ gender opinions regarding the nursing profession and their underlying thoughts, opinions, and perceptions.

Participant and Setting

This study aimed to recruit male nursing students enrolled in a bachelor’s degree program, as a bachelor’s degree is required for professional registration as a nurse in Mainland China. In addition, interventional nurses who had completed a bachelor’s degree program and had at least one year of work experience were also eligible. To ensure a diverse pool of participants, the researchers used a heterogeneous purposive sampling strategy. Researchers welcomed volunteers from various backgrounds, such as years of education or job experience, interventional departments, and growing origins (mainland China).

The study had 22 male participants, including 11 male nursing students and 11 interventional nurses. Three of the 11 male nursing students were in their first year, two in their second, three in their third, and the remaining three in their fourth year. All of the students who participated were from mainland China. The 11 interventional nurses all worked as frontline nurses, providing direct health care to patients. They had worked for one to nine years, with an average tenure of four years. Five worked in emergency departments, three in intensive care units, and the other three in operating rooms.

Data Collection

The most popular data-gathering techniques in qualitative research projects are semi-structured, in-depth interviews.19 Our study followed this strategy, and we created an interview protocol based on our literature analysis and vast experience as intervention nurses and nursing teachers. The guideline focused on issues relevant to the study’s purpose and enabled interviewers to explore developing thoughts during the interview. Field notes and the interviewer’s overall assessments of the participant’s thoughts, feelings, and perceptions about male nursing were gathered immediately following the interview. Figure 1 represents the interview guidelines for participants.

Figure 1 The interview format.

All the participants and researchers preferred the tranquil environment of the nursing school classrooms. The interviews lasted between 20 to 45 minutes, averaging 35 minutes. The data collected from subsequent participants showed repeated information, indicating data saturation. This suggests that further interviews and recruiting efforts should be stopped as no new information is expected to emerge from the data.20

Data Analysis

The study used classical theme analysis, which entailed an inductive approach using the following four steps:21 (a) Read the interview transcripts several times to comprehend the data thoroughly. (b) Analyse the data line by line, dividing text portions into meaningful units and marking them with the appropriate code. (c) Determine the links between the codes, organize related codes into subthemes, and then group subthemes into themes. (d) Expressing themes as manifestations of the text’s hidden substance.

Data was processed using the NVivo11 Plus qualitative research application, with two team members each coding three interviews. After that, they compared and debated the coding results to create a coding framework. This framework established codes to assure agreement among scholars. The first author, an experienced qualitative researcher, used this approach to code the remaining interviews. The framework was prescriptive yet adaptable if new codes and concepts surfaced during data analysis. Finally, all team members agreed on the analytic results.

Ethical Consideration

The ethics committee of the Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital) approved this study (reference no: 2021-ZSH-03). The participants’ identities and replies to study questions would not be disclosed to anybody outside the research team. The participants were informed that they could withdraw from the research without obligation. Before the interview began, the participants signed a consent form.

Rigour and Trustworthiness

The study achieved rigour and trustworthiness by following Lincoln and Guba’s qualitative research guidelines.22 It was carried out by a group of registered nurses, including a male nurse who had previously been on the front lines. The researchers and participants had comparable professional backgrounds, which aided the interviews and data processing. The study team was aware of the possible detrimental effects of analogies and made steps to mitigate them. The researchers employed reflexivity to actively and critically reflect on their beliefs, attitudes, and biases, which might influence the study process and analytic conclusions.23 Another way to boost study credibility is to return the analytic data to three participants for feedback. The three participant reviewers recommended no changes.

Results

There are significantly fewer male nursing practitioners than female counterparts. Despite their employment’s numerous advantages and disadvantages, they seek to appear as equals to their female colleagues. Three shared identities impact the participants’ professional development: male, nurse, and ethnic minority. The nurse’s identity is essential since professional behaviour is required to preserve patient and healthcare provider confidence and attention. Being a male or a minority can be both a barrier and a facilitator in nursing career development.

Various factors can affect male nurses’ career development, and these factors may have different effects based on their individual circumstances and understanding. Based on these factors, three concepts were identified: “perceiving gender varieties”, “taking apparent advantage of masculine characteristics”, and “taking an equal perspective” (Figure 2).

Figure 2 The advantages and disadvantages of professional growth as considered by male nurses.

Perceiving Gender Varieties (Concept I)

Male nurses, as a minority, faced pressure and challenges at nursing schools and health institutions. The concept I was subdivided into “nursing education possibilities are scarce”, “nursing employment opportunities are scarce”, and “female patients refuse care”.

Nursing Education Possibilities are Scarce

Male students at a nursing school reported feeling ignored during group work. One male student had just finished his first year of nursing school and said female team members tended to sideline male students:

each team comprises four or five student members, including one or two male students. However, due to their numerical advantage, the girls would often dominate the conversation without giving male students a chance to participate. Although male students had opinions, the girls controlled the direction of the discussion….said the second male student.

It was perceived that junior male students tended to show this behaviour more frequently. As students advanced to higher classes, they became more discriminating about whom they desired to work with in-group assignments and asked only those eager to participate fully. Male students often struggled to find friends similarly committed to laboratory techniques. On the other hand, senior male students were unaffected since they had undergone considerable clinical skill laboratory training throughout their first two years.

Nursing Employment Opportunities are Scarce

Male nurses faced several hurdles, including limited employment prospects in interventional departments. This problem was more common in private hospitals with insufficient nurse personnel than in public health facilities. Male nurses could only work in certain sections, including the emergency department, operating room, critical care unit, and haemodialysis units. They were often forbidden from working in healthcare settings with only one nurse assigned to the night shift. One participant raised worry, saying, “It is inappropriate to have only one male nurse on night duty”, according to the sixth male nurse.

The majority of male nurses were indifferent about their employment constraints. They appreciated the limits imposed on them. They typically preferred to work on interventional wards manned by male nurses. One nurse, who graduated a year ago and has been working in the emergency department since, said why he enjoys working in this sort of environment: “After graduation, I applied to the interventional department first, then the intensive care unit, and finally the soothing care ward”. I was particularly interested in the first two areas since the job was tough, and I love complex assignments. “I believe young nurses should begin in these departments to gain experience”, remarked the tenth male nurse.

Several interventional wards guaranteed male nurses permanent employment and the possibility of pursuing speciality-nursing education. Some individuals who had previously worked in the critical care unit stated that they loved it because of the complex technology and opportunities for specialized nursing. The first male nurse stated that the interventional care unit requires specialist nursing due to the presence of complex devices.

Female Patients Refuse Care

Female caregivers denied care services to many male patients, particularly those involving personal regions of the body such as the perineum or breast. While some were dismayed by the refusals, others did not consider them an issue. According to a male nurse, these refusals occur six to seven times yearly. A male nurse who worked in a haemodialysis unit stated that excellent communication between male and female patients would prevent humiliation. For example, after implanting a catheter for haemodialysis, some young female patients must remove their bras. The nurse would explain the process and ask them to remove their bras. The nurse would not remove the bra for them as they should, but clear explanations were essential. The fifth male nurse explained, “they now understand why they must expose the chest. There would be no humiliation”.

Taking Apparent Advantage of Masculine Characteristics (Concept II)

Male participants perceived certain advantages as men despite limitations in healthcare services. Two sub-concepts relate to concept II: “assessed physical and mechanical control strength” and “as predicted, pursue professional development”.

Assessed Physical and Mechanical Control Strength

During interviews, male nurses stated that their physical strength gave them an edge in patient lifting. They said that their female colleagues frequently request assistance carrying heavier patients. A third-year student who recently finished a year of clinical practice emphasized the importance of having male nurses on staff for patient lifting. He says, “Female nurses have difficulty handling heavier patients, which is where male nurses can help”. One male nurse stated that assistance with patient lifting helped him maintain a positive connection with his female supervisor throughout the clinical study.

Men assumed they were more skilled than women at interacting with machines were. A man who was a nurse who worked in the haemodialysis unit stated that there were many machines in the unit and that

I was quicker to get familiar with the machines than those females who joined the unit at the same time as me. In the operating room, males were skilled at working with equipment. I am trying to understand why. That is human nature, …said the fifteenth male nurse.

Other male volunteers who worked in the emergency department and intensive care unit agreed with him.

As Predicted, Pursue Professional Development

Four of the eleven male interventional nurse participants had finished postgraduate studies, including masters or postgraduate diploma degrees. At the same time, the remaining five were enrolled in or applying for postgraduate programs. Those with a postgraduate degree were considering or pursuing higher education, such as PhD programs. The new nurses with only one year of work experience were the only two who had yet to contemplate additional study.

Male nurses are reported to have higher expectations of their superiors and the community than female nurses. A male nurse working in the haemodialysis unit showed an interest in obtaining a postgraduate degree in cardiac, renal, or psychological nursing. He stated that “male nurses are more motivated to advance their careers due to internal and external pressures”. According to him, female nurses emphasize family above professional development, giving male nurses an advantage in career advancement. He further added that all male nurses at his hospital attend advanced nursing programs as advised by their superiors, even if they do not use them. The thirteenth male nurse added that people have always believed that males should advance in their occupations, and the higher, the better”.

Taking an Equal Perspective (Concept III)

The male volunteers emphasized that nurses are professionals and that patients and society demand quality service regardless of their gender. The third concept is divided into two related sub-concepts: “gender versus personality” and “improved acceptance”.

Gender versus Personality

According to junior nursing students, females have attributes such as kindness, caution, and empathy, which can aid in communication between nurses and patients. Their attentiveness can also help avoid blunders and deliver safe health treatment. However, senior nursing students and clinical nurses have questioned the concept that women are superior to men in nursing based on their own experiences. A graduate nursing student who had finished her fourth year indicated that gender had no bearing on the quality of healthcare services. He believes that “healthcare quality is determined not by whether the nurse is diligent or careless, but by whether they are passionate about their work”. He also stated, “being careful does not come naturally, but is cultivated through learning and guidance”. The seventh male nurse shared this perspective.

Improved Acceptance

The nursing community’s greater acceptance of male nurses altered their views on gender equality. Female nurses continue to make up the vast majority of the nursing workforce in Mainland China, and the phrase “female nurse” is frequently used to designate male nurses as well. However, male nurses who have been in the field for a long time are increasingly called “nurses” or “sir” by patients, showing a growing appreciation for nursing.

Male nurses are gaining popularity and are seen as an integral component of the nursing profession.

Critics may argue that men should work harder to support their families, yet nursing is now a respected profession with well-paying and stable salaries that demand a bachelor’s degree. Nurses have particular knowledge and talents and are more than just doers who follow doctors’ directions. Following the SARS pandemic in 2003, extensive media promotion and increasing public understanding of the nursing profession helped considerably boost nurses’ social status in Mainland China. Male nurses are now more accepted in the profession, and a comfortable social environment has emerged to improve their retention”, …said the twelfth male nurse.

The twelfth male nurse cited a number of variables that contributed to this good trend, including growing acknowledgement of nursing as a profession, nurses’ specialized knowledge and talents, and well-paying and stable salaries.

Discussion

As nursing becomes more generally recognized as a profession, society’s perception of nurses improves, resulting in a good attitude toward male nurses and a positive self-image among male nurses. However, nurses confront obstacles and possibilities as they shape their professional identities in nursing school and practice.24,25 This study discovered that male nurses overcome obstacles by leveraging their perceived masculinity and utilizing their expertise to further their careers.

Previous studies have found that male nursing students have had negative experiences, such as being neglected by female coworkers.12,16 Our research shows that male students still have similar negative experiences. Junior and senior students, as well as interventional nurses, have slightly different viewpoints on gender-related nurse identities. Junior students feel that femininity is superior to masculinity in nursing; however, senior students and interventional nurses have opposite perspectives. Previous research revealed that male nursing students have a negative self-image.12,16,24 Our research suggests that when men learn more about nursing, they become more hopeful. However, further qualitative and quantitative research is necessary to confirm these findings due to the study’s small sample size.

Several studies have found that patients are uncomfortable when nurses of the opposite gender care for them in intimate regions.3,26–28 In this study, male nurses showed an awareness of their patients’ issues and used various tactics to foster collaboration. Male nurses’ ability to manage patient contacts in various scenarios demonstrates their flexible and diverse approach to patient care.

The male nurses were allocated to a restricted number of interventional wards due to a nursing staffing shortage. However, this work restriction was advantageous for confident men since these wards gave greater possibilities for masculine trait usage.29 The male nurses in our study, in particular, rejected the traditional concept that so-called feminine attributes, such as gentleness, empathy, and care, were optimal for the nursing profession and that females naturally possessed these traits. It means that males refuse to admit that they are innately inferior to women in the nursing profession.

Several studies have found that male nurses typically feel lonely as a minority in a mostly female-dominated sector.16,26,27 However, our research reported that male nurses appreciate working well with their female counterparts. Men with typically masculine physiological and psychological attributes are more willing to work in female-dominated nursing teams. This is corroborated by research performed on Japanese male nurses. It was reported that male nurses received support and admiration from their female colleagues for aiding in physically challenging chores such as transporting heavyweight patients.30 Women in nursing often welcome males into the profession, and men can employ coalition strategies to make ties.29,31 Furthermore, our research found that male nurses were sometimes better prepared to handle situations in the interventional lab when nurse-patient disagreements emerged.

Policy Implications

Our research reveals that nursing students experience academic hurdles. To overcome these difficulties, nursing educators can give more support to their students and include them in the teaching process. This would increase the likelihood of male and female students accepting the teaching approaches. To foster diversity in the nursing profession, nursing schools should also target male students or nurses in their recruiting efforts. Additionally, the social perception of nurses affects the choice of nursing as a major among high school graduates. Therefore, nursing schools should promote information about nurses’ qualifications and roles in the healthcare system to high school students.32

Limitations

The qualitative research method adopted in this study has limitations. The small sample size in qualitative research could restrict the application of study findings to different circumstances.31 There are two additional limitations to the research. First, despite the researchers’ efforts to recruit a diverse sample, all study participants attended the same nursing school, limiting the findings’ generalizability. Second, member checks have limitations.33 We recruited three volunteers to evaluate the research findings. This strategy can increase the trustworthiness of study results, but it also has its challenges. The researchers may have overlooked different opinions from individuals other than the three invited. The absence of corrective recommendations from the three participants might imply that they provided the information they believed the researchers wanted to hear.

Conclusion

This qualitative research was conducted on the thoughts, feelings and perceptions of male nursing students and professionals about the nursing profession in China. In our study revealed that male nursing professionals and students believe that anyone can excel in the nursing profession by utilizing their skills and attributes, regardless of gender. The study’s findings support the International Nursing Association’s33 call for nurses’ involvement in policymaking. Due to the care-centred nature of the nursing profession, further qualitative studies are recommended to explore gender roles among male nurses in both student and working contexts.

Ethics Approval and Consent to Participate

The ethics committee of the Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital) approved this study (reference no: 2021-ZSH-03). A written consent form was obtained from each participant regarding the publication of anonymized responses before interviewing.

Funding

This study was supported by (1) Pudong New Area Health Commission Summit Discipline Construction PWYgf2021-04; (2) Pudong New Area Health Commission Key Discipline Group PWZxq2022-11; (3) Pudong New Area Science and Technology Commission Project PKJ2023-Y13; (4) Pudong New Area Health Commission General Project PW2022A-01; and (5) Internal research topic ZPRC-2023B-20.

Disclosure

The authors report no conflicts of interest in this work.

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