The Honor Society of Nursing embraces diversity in the broadest sense of the word, including diversity in career paths, educational backgrounds, gender, race, geographic borders and culture.

As the nursing shortage escalates, the importance of reaching out to underrepresented groups continues to be imperative.

Nursing and the Challenge of Gender Inequity

By Tim Porter-O'Grady

From the process of breast-feeding to the expression of caring, the visual image that appears regarding nursing has always been a "picture" of the woman. This is as it should be. A challenge to this image arises; however, when the nurse is a man, for nursing has always been associated with women.

All kinds of images emerge when conflicting mental pictures roll out and create perceptual and experiential dissonance between what "should be" and what is. Interestingly enough, when the man is the nurse, many frames of reference emerge that would not be applied in reference to a woman who is a nurse. Comments related to competence ("What's wrong, couldn't you get into medical school?"); intelligence ("You're a bright guy, why'd you become a nurse?"); sexual identity ("Are you gay or something?"); and a host of others indicate the prevalent disparity in perception between being a man and a nurse. All indicate that there must be something not quite right with a man's choice of nursing as a career.

This discriminatory conflict does not end with choice. The role expectations in practice around the ability to lift more, the affinity for "tinkering" leading to more mechanistic role choices (like intensive care or surgery), or ultimately moving into management are prime examples of actualized expectations for the role when the nurse is a man.

Professionally, the challenges are equally apparent. When seeking nurses for elected office, leadership positions or representation of the profession in a wide variety of forums, men are generally grossly underrepresented or are simply not present, and the contribution they might be able to make is just not evidenced. A leadership colleague once indicated that while she didn't consciously intend to discriminate against her qualified male nurse colleagues, when she thought about whom she might suggest or appoint to a key position in nursing leadership, the image of a man did not come to mind. She never did call upon them during her tenure in office, because she associated nurse, woman and leader all in one.

Further creating difficulty in the issue of gender equity is the reality that nursing is one profession where women have a real opportunity to grow, contribute, lead and advance. This opportunity provides a chance for women to achieve the power and privilege that should come with the ability and accomplishment. Superficially, at least, it would defeat the purpose, in this scenario, if men were to ascend to the very positions that women historically have been denied, and to do so within the context of women's own turf. If men actually did embrace nursing as a more legitimate career pursuit, there is a real potential danger that the same loss of opportunity for power and position would occur in nursing as it has occurred in more other roles where women have struggled to find a place.

This dynamic certainly creates the classic "Catch 22" for both women and men in nursing. However, in the current state of the profession it would be easy to overstate the case and perpetuate the very circumstances organized nursing says it objects to. It is quite clear that men will, for the foreseeable future, comprise less than five percent of the roles the profession in the United States. There is not the risk in the United States that there is in the United Kingdom of men subsuming many leadership roles in nursing out of context to their numbers. There are just not enough men in the profession and certainly there are not enough that see it in their career trajectory to assume major leadership roles. Any fear that might be expressed that men might take leadership opportunities from women in significant enough numbers and in a concentrated-enough period of time is clearly unjustified. There simply is no foundation for concern about gender threat or the compromise of leadership opportunities for women.

What might be of considerable interest would be the response and public reaction to a man holding a key leadership role in nursing at the political or policy level. There may be a real appreciation of interest and visibility if the president of the American Nurses Association or Sigma Theta Tau, or the director of the National Institute of nursing Research was a man. The perceptual challenge and uniqueness that would engender could actually increase the visibility of the profession and advance the opportunity for women and the agenda for equity. Furthermore, it would indicate to all, the openness of the nursing profession to gender equity and equal opportunity for all.

Diversity is always healthy for a profession, just as it is for society at large. In fact, diversity is the key requisite for sustainable solutions and continuous growth. As nursing increases its diversity, it extends the potential of its contribution to those whom nurses serve and to society. The dialogue between women and men in nursing is central to increasing the viability of nursing as a social mandate. The times certainly create the demand for a focused dialogue on the state of relationship between men and women in nursing and the impact gender has on the opportunities in nursing and the exercise of nursing leadership. The commitment and public posture of organized nursing around the issue of gender equality should operate at the same level as racial and sexual equality.

There certainly are policy positions regarding discrimination in organized nursing. There has, however, never been a specific forum related to the state of gender integration and equity within the discipline that in any way informs the current circumstances of gender relations in nursing. It is duplicitous at best to call for equity with regard to women's roles in society and give no evidence of the place for dialogue and a formal position on minority gender equity within the profession.

There are many issues that nursing will need to address as nurses move toward the millennium. The roles and expectations for practice are shifting into a broader frame of reference toward a stronger community- and health-driven script. Nothing could be more important to the profession than the pursuit of the mandate to assure the health of the nation. Healthy communities, however, require healthy provider relationships that reflect the ideals and goals of the greater society. Contribution of the profession to this health mission will demand the full capacity of its diverse membership. It would be a shame if the male members of the profession were not at the table of dialogue and decision-making evidencing the gender diversity of nursing. And what would others think of nursing's commitment to community and diversity if there were little sign of it with its own leadership? Now is the time to change all that and to show to the world the engagement of the full resources of nursing in assuring a truly healthy future.

This article originally appeared in the second quarter 1998 issue of Reflections on Nursing Leadership. Tim Porter-O'Grady, RN, EdD, PhD, FAAN, an international health care consultant, is a senior partner in Tim Porter-O'Grady Associates in Atlanta. A dual citizen of the U.S. and Canada, he is an advanced practice nurse in gerontology and an assistant professor at Emory University.