GENDER DISCRIMINATION AND

NURSING: Α LITERATURE REVIEW

CHRISTIANA KOUTA, PHD∗ AND CHARIS P. KAITE, MSC†

This article aims to examine gender stereotypes in relation to men in nursing, discuss gender
discrimination cases in nursing, and explore methods used for promoting equal educational
opportunities during nursing studies. The literature review was based on related databases, such
as CINAHL, Science Direct, MEDLINE, and EBSCO. Legal case studies are included in order to
provide a more practical example of those barriers existing for men pursuing nursing, as well as
statistical data concerning gender discrimination and male attrition to nursing schools in relation
to those barriers. These strengthen the validity of the manuscript. Literature review showed
that gender discrimination is still prevalent within nursing profession. Nursing faculty should
prepare male nursing students to interact effectively with female clients as well. Role modeling
the therapeutic relationship with clients is one strategy that may help male students. In general,
the faculty should provide equal learning opportunities to nursing students. (Index words:
Νursing; Male nurses; Gender stereotypes; Gender roles; Educational strategies) J Prof Nurs
27:59–63, 2011. © 2011 Elsevier Inc. All rights reserved.

O FTEN MEN DECIDE to become nurses for self-

actualization or survival needs or because they
were not accepted by a medical school (Zyberg & Berry,
2005). Some men decide to become nurses and start their
studies with the goal of embarking on a nursing career;
others start a general career and then decide to become
nurses. The latter may indicate that their previous career
failed (Heubner, 2007; Inoue, Chapman, & Wynaden,
2006). Furthermore, men resign from nursing during the
first 4 years after graduation more frequently than women
(Sochalski, 2002).
Men entering the nursing profession encounter
barriers that limit their choice of specialty and risk
being labeled and stereotyped (Genua, 2005). In England,
9:10 nurses are women, 98:8 of the midwives are women,
3:4 supervisors are men, and only 10% of the surgeons are
women (Equal Opportunities Committee, 2006). Al-
though men choose to become nurses for the same
reasons as women do (e.g., caring for people), often they
are represented by media as “male nurses” and women as
nurses (Meadus, 2000).
∗Lecturer, School of Health Sciences, Cyprus University of Technology,
Nicosia, Cyprus.
†Postgraduate Associate, School of Health Sciences, Cyprus University
of Technology, Latsia, Nicosia, Cyprus.
Address correspondence to Dr. Kouta: Lecturer, Department of
Nursing, School of Health Sciences, Cyprus University of Technology,
P.O. Box 12715, 2252 Latsia, Nicosia, Cyprus.
E-mails: christiana.kouta@cut.ac.cy, nikolaou@cytanet.com.cy
8755-7223/10/$ - see front matter
Journal of Professional Nursing, Vol 27, No. 1 (January–February), 2011: pp 59–63
© 2011 Elsevier Inc. All rights reserved.
“Gender discrimination is any distinction, exclusion
or restriction made on the basis of socially constructed
gender roles and norms which prevents a person from
enjoying full human rights” (Cottingham et al., 2001,
p. 49). Men are excluded from several forms of training
and from certain positions. For example, the criteria
for accessing certain senior positions in nursing (e.g.,
director of nursing) may include midwifery qualifi-
cations, but several countries exclude men from mid-
wifery training, thus barring them from these posts
(Burth, 1998).
It is not so common to have a male lactation consultant
or a male nurse midwife. This might be due to rejection
during maternity rotations in the nursing school, gender
discrimination, poor networking, or just a lack of interest
in this area. Male nurses have been practicing for a long
time in neonatal intensive care units, but when they want
to practice in obstetrics and gynecology, even if they are
qualified, they are barred due to gender bias (Cudé &
Winfrey, 2007).
Gender bias and role stereotyping do exist in nursing
educational programs because nursing faculties are often
composed mainly of women (Anthony, 2004). Nursing
has been identified with feminine ways of caring. In
Florence Nightingale's time, men were considered to lack
the capacity to provide mothering and caring because
“their horny hands were detrimental to caring,” so they
were excluded from nursing (Cudé & Winfrey, 2007).
Therefore, male and female nursing students have
different learning experiences in nursing faculties
59
doi:10.1016/j.profnurs.2010.10.006
60
(Cudé & Winfrey, 2007). Furthermore, they are rarely
assigned to female patients in clinical rotations (Emmons,
Sells, & Eiff, 2002).
Literature Review
Expression of feelings and empathy are considered to
be a female “privilege” (Grady, Stewardson, & Hall,
2008). Sherrod (2003) argued that nursing faculty is
functioning with an educational system that has been
designed to educate women.
The Association of Women's Health, Obstetric and
Neonatal Nurses conducted a survey within its male
members. The survey was sent to 51 available e-mail
addresses of male members to find out, among others,
if they had ever experienced gender discrimination,
either within their work or in the nursing school. The
results showed that 58% of the respondents had not
experienced gender bias during nursing school,
whereas 42% reported gender bias from the faculty
and the nursing staff, but not from patients. As
professionals, 75% reported bias from the nursing staff
and 8% from the female physicians (as cited by Cudé
& Winfrey, 2007).
Furthermore, in 2005, the American Assembly for
Men in Nursing, several other nursing groups, and
Bernard Hodes Group (a marketing firm) conducted a
survey to explain why there were so few men in
nursing. Of the 498 male nurses who responded, 73%
referred to negative stereotypes, 50% identified nursing
as a women-dominated profession, and 42% reported
lack of male models and mentors. Despite this, 83%
reported that they would encourage a male friend to
become a nurse, mainly because of profession stability
and job security, and 80% reported that they would
choose nursing again if they had to (as cited by
Weber, 2008).
Studies conducted concerning male students' percep-
tions of obstacles that perpetuate gender bias and
stereotyping in nursing studies reported that (a) there
is no male faculty in nursing, (b) educators refer to
nurses using the word she, (c) there are limited
opportunities to work with male nurses in clinical
settings, and (d) during the presentation of the history of
nursing, there is no presentation of the history of men in
nursing (Grady et al., 2008). In addition, faculty does
not give any guidance for appropriate use of touch, there
are antimale remarks made by faculty in the classroom,
and male nursing students report inequitable treatment
by nursing faculty (Grady et al., 2008). In addition, lack
of awareness by nurse educators of the unique needs of
male learners (Scriber, 2008) and a lack of gender
neutrality in nursing textbooks were also discussed in
the literature (Scriber, 2008).
Keogh and O' Lynn (2007) conducted a survey in
2005, with 250 male nurses who had completed general
nursing training from 1995 to 2005 in Ireland. The
findings showed that barriers such as “no history of men
in nursing,” “no guidance on the appropriate use of
touch,” and “different requirements/limitations for male
KOUTA AND KAITE
students during obstetric placements” were highly rated
as being present during preregistration education pro-
grams for men (Keogh & O' Lynn, 2007).
The above strengthens the argument that nursing
students’ textbooks show the absence of the historical
contributions of male nurses from nursing texts and
the lack of male professors and clinical instructors
(Smith, 2006).
Stott (2007) conducted a qualitative research with
eight male nursing students enrolled internally in the
bachelor of nursing course at a regional university in
Australia. Data were collected using in-depth interviews
and written narratives in the form of a diary. Findings
revealed that male nursing students face barriers from an
academic and clinical practice perspective during their
university experience. A central theme to emerge was the
sense of feeling isolated or excluded from the academic
and clinical setting, meaning that nursing students were
treated differently from educators, within clinical set-
tings, and were not prepared to provide intimate care to
women clients (Stott, 2007).
Patterson and Morin (2002) and Kelly, Shoemaker, and
Steele (1994) highlighted the different learning experi-
ences in clinical settings for male and female nurses.
Learning health assessment, providing care to clients of
both genders, and participating in postpartum care were
different for male nursing students (Patterson & Morin
2002; Kelly et al., 1994).
Several studies have shown that female clients
experience stress when male nurses physically or
intimately touch their genital area and breast (Inoue
et al., 2006).
Patient's attitudes vary regarding the use of chaper-
ones during intimate examinations, with the majority of
patients not indicating if they want a chaperone or not,
despite the patient's age or the gender of the physician
(Cudé & Winfrey, 2007). Providing intimate care for
women clients is challenging for male nurses because
men are not educationally prepared for it. Thus,
nursing education should deal with gender issues
(Inoue et al., 2006).
Patients have the right to decline care provided by a
male nurse; however, gender discrimination should be
considered an ethical issue, similar to ethnic discrimina-
tion. The client is the one to decide if the gender of the
nurse is an issue. If male nurses ask female patients about
their preference of the gender of the nurse who is going to
provide care for them, most of the time, patients seem to
be open and nondiscriminatory toward men (Cudé &
Winfrey, 2007).
Case Studies
The following cases present types of gender discrimina-
tion within the nursing profession, especially when
providing intimate care.
Case 1: Moyhing v. Barts and London NHS Trust (2006).
Moyhing was a student studying for a bachelor of science
degree in nursing who has been undertaking clinical
GENDER DISCRIMINATION AND NURSING
placement at the respondent hospital. Moyhing claimed
that they asked him not to participate or watch intimate
examinations, while this was not asked from a female
fellow student. He supported that during his duty, there
was a culture of confrontation that male nurses were
second-quality citizens (U.K. Employment Appeal Tri-
bunal, 2006).
Furthermore, there was a widespread assumption that
women nurses are considered to be suitable to provide
care to anyone, but it is inappropriate for male nurses to
provide care to female patients especially in intimate
cases, such as urinary catheterization. Moyhing's appeal
was supported by the Equal Opportunities Committee of
London (U.K. Employment Appeal Tribunal, Moyhing v.
Barts and London, 2006).
The appellant referred to three incidences where he
had been treated differently from his female classmates:
1. In the first case, the student was required to
perform an ECG on an Asian female patient
who had been having breathing difficulties. The
procedure involved touching the patient's chest,
which was considered to be an intimate
procedure and required him to be accompanied
by a female nurse. However, female nurses
performing ECGs to males were not required to
be accompanied by anyone. The appellant felt
like a rapist and a criminal and not trustworthy
enough to fulfill this process (U.K. Employ-
ment Appeal Tribunal, Moyhing v. Barts and
London, 2006).
2. In the second case, he claimed that he was told
that he was not allowed to perform catheteriza-
tion on female patients. In contrast, his female
fellow students could perform catheterization
on a male patient (U.K. Employment Appeal
Tribunal, Moyhing v. Barts and London, 2006).
3. In the third case, he was asked to leave the
room while a Papanicolaou smear was per-
formed on an Asian woman (U.K. Employ-
ment Appeal Tribunal, Moyhing v. Barts and
London, 2006).
Several questions arise from the above case studies. In
the case of the ECG, was the student accompanied by the
chaperone because he needed a chaperone or because of
stereotypes against male nurses? Does this mean that the
procedure can be considered as intimate and therefore
female clients would feel better if the procedure was done
by a female nurse?
In the second incidence, when he was not allowed to
perform catheterization on female patients, was he not
allowed to do it in an effort to respect the woman's
privacy? If this was the case, why is the same procedure
not being followed by the female nurses as well?
The institution's policy for male nurses to be
accompanied by female chaperones could be character-
ized as sexist and a form of violation of human rights,
since it does not promote equal educational opportunities
for both female and male nurses.
61
In an effort to counteract the gender barrier in clinical
settings, (a) all institutional nondiscrimination policies
must include gender issues and all employees must
understand that such policies prohibit discrimination
against men and (b) male students need to have access to
male nurse role models in the classroom and clinical
settings (Keogh & O' Lynn, 2007).
Case 2. This U.S. case refers to the employment of
only female nurses in the obstetric ward of Camden-
Clark Memorial Hospital. The question before the court
was whether a gender requirement was a bona fide
occupational qualification, within the statutory excep-
tion to the West Virginia Human Rights Acts general
prohibition of discrimination in hiring practices. Mi-
chael Silvka was a registered male nurse with experience
in various fields including obstetric duties. Silvka sued
the aforementioned hospital for discrimination when
they announced that they do not hire men in the
obstetric ward due to concerns for patient privacy,
staffing, and quality of care (Legal Eagle Eye Newsletter
for the Nursing Profession, 2004). The U.S. Supreme
Court (2004) decided that it is unlawful to discriminate
on the basis of gender unless the employer can show
that gender is a bona fide occupational qualification for
the job in question, but the health-care facility has the
obligation to protect the rights of the patient and argued
that the intimate and intrusive procedures that are
routinely performed in the obstetrics department may
raise privacy concerns in patients (Legal Eagle Eye
Newsletter for the Nursing Profession, 2004).
One could argue that the above case is a discrimina-
tion against men since excluding men from obstetric
settings is like undermining their capabilities of being a
nurse. Instead of excluding men from obstetric wards,
men and women should be trained equally by the
nursing faculty to have the mechanisms to deal with
intimate cases. Hospitals should also develop antidiscri-
mination gender policies.
Case 3: Evans v. Prinicipi, 2005 WL 485743, D.D.C.,
February 17, 2005. The case concerned a female
supervisor exercising gender discrimination when she
was supervising a male nurse. In the United States, a male
nurse who is working with a female supervisor is
protected by gender discrimination laws. The particular
male nursing student was treated with discrimination by
his female supervisor. From the beginning, the supervisor
told him that he did not belong to the unit; he was treated
differently from female nurses and was more closely
audited; he was even given a janitor's closet as his office
and his former office was redone and given to a female
nurse. The court also found that the supervisor was using
abusive language, threats, false accusations, and was
generally violating the gender discrimination law (Evans
v. Principi cited in Legal Eagle Eye Newsletter for the
Nursing Profession, 2005, p. 8).
To counteract this kind of gender bias, any staff who
gives misandric comments and discriminates against
gender could be given disciplinary action similar to the
62
ones meted out to those who give racist comments and
racially discriminates.
(Keogh & O' Lynn, 2007). A form of strategy to coun-
teract gender discrimination in nursing students is the
development of peer support (Roth & Coleman, 2008).
Limitations
Case studies are by their nature subjective and give
weight to only one side of the argument, and literature
review is limited to collecting information about what has
happened in the past; thus, it cannot provide data about
actual current behavior. However, case studies provide
examples that may help in challenging, analyzing, and/or
forming a gender-equality strategy.
Counteracting Gender Discrimination in
Nursing Studies
Nursing educational programs need to be reviewed and
provide equal opportunities for all nursing students.
Faculty should create a climate of acceptance for
student's differences and empower male nurses in
providing intimate care for women clients. One method
of empowering male nursing students could be sharing
stories about caring instances involving male nurses
providing intimate care and role modeling (Grady et al.,
2008). The National Health Service has already initiated
educational programs and recruitment techniques, such
as the “nurse explorer” program, with high school
students, who are invited to spend one evening a week
for 5 weeks touring different patient care areas in hospital
in an effort to equally represent male nurses in all of these
programs (Meyer, 2003).
Nursing faculty should give accurate information
about some origins of nursing stereotypes and the effects
of those stereotypes on nursing students in practice
(Jinks & Bradley, 2003).
Another method for counteracting gender discrimina-
tion in nursing studies is counseling. Faculty should
provide counselors for discussing problems that emerge
during educational experiences (Brady & Sherrod, 2003).
Counseling male students is more effective when the
counselor is a male nurse who can relate to the student's
issues (Brady & Sherrod 2003).
Using humor and giving a full-detailed guidance for
intimate procedures to women clients could help both
male nurses and women clients overcome their stress
related to the procedure (Inoue et al., 2006).
Nursing students should be trained to handle sensitive
situations despite gender and be prepared to suppress
feelings and concentrate on the task they are given to do.
In addition, male nurses should be supported by their
colleagues when providing intimate care to women
clients and be able to talk freely about their experiences
of providing intimate care (Inoue et al., 2006).
Nursing associations could also help by removing the
she bias from their standards. The American Nurses
Association has made a strong commitment to remove
the she bias from its standards of practice and code of
KOUTA AND KAITE
ethics in an effort to include both men and women in
health practices (Weber, 2008).
Conclusion
According to the Charter of Fundamental Rights of the
European Union (2000/C 364/01, Article 14), “Εvery-
one has the right to education and to have access to
vocational and continuing training.” Thus, nursing
education should not be different for men and
women. The policy of supervision of students should
be the same, despite gender differences (2000/C 364/01,
Article 14).
Nevertheless, gender stereotypes still exist within the
nursing profession. Nursing faculty should prepare
nursing students to interact with female clients and
provide counselors to discuss problems that emerge
during their training and experience (Brady & Sherrod,
2003). The use of cooperative learning activities could
increase collaboration and decrease competition among
male and female nursing students (Anthony, 2004).
Role modeling the therapeutic relationship with clients
is another strategy to help male nursing students prepare
for intimate cases. The use of humor by male nurses when
providing intimate care for female clients might help as
well (Grady et al., 2008; Inoue et al., 2006).
There is a need to revise nursing educational programs,
at least those that seem gender-biased, in order to provide
equal training opportunities to all nursing students,
develop a climate of acceptance and empower male
nursing students both in the nursing school and clinical
field, and thus empower the career development of male
nurses (Inoue et al., 2006).
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