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Code XY: Nursing Toxic Masculinity

Picture this: Monica and Chandler from Friends are having a lover’s quarrel while at the hospital. Monica begins a flirtatious conversation with an attractive male nurse. Chandler interrupts. 

“A nurse not a doctor, huh? Kinda girly, isn’t?” The laugh track roars. 

Monica admonishes him, but the nurse raises his hand. “Nah, that’s okay. I’m just doing this to put myself through medical school. Plus, it didn’t feel so girly during the Gulf War.” 

Chandler mumbles, “Thanks for doing that for us, by the way.” He turns on his heel and scurries out the door. 

Sigh. There’s a lot to unpack here.

Threatened by this nurse’s rugged good looks and obvious interest in his girlfriend, Chandler hopes to undermine him by feminizing him. His attack backfires. Not only does this nurse clarify that Nursing is “just” a stepping stone on his way to becoming a doctor, he also drops that he was a soldier, who saw war. Of course Chandler runs.

Chandler is not cowed because the nurse challenges his toxic masculinity. Chandler flees because he is out-manned. This nurse is both a hyper-masculine soldier and in training to be a physician – the 'masculine' role in healthcare. The 'feminine' role of the nurse is merely a stepping stone toward a higher goal.

Media reflects the assumptions and beliefs of society. Chandler thinks Nursing is for girls. And he’s not the only one. Someone wrote this. The studio audience cackled. More importantly, the at-home television audience gets the joke. Each step reinforces the message: "Doctoring is for men. Nursing is for women."

Nursing began as ‘women’s work’. Nurses have been fighting prejudice and patriarchy to be recognized as professionals ever since. Granted, the number of male nurses is on the rise. But this rise has been slow, and men are still underrepresented in Nursing. Today, there are nearly 3 million Registered Nurses in the United States; 2.7 million of these are women.

For millennia, women have looked after the young, the infirm, and the elderly. They have been and continue to be the caretakers of the family. In the Middle Ages, sick wards exploited the labor of poor women - and some men - to care for patients. These early nurses had no training and were often ill themselves. Over the centuries as medical knowledge increased, nurses began to receive some standardized training. Nevertheless, nurses remained poor, mostly uneducated woman who were available for exploitation.

Florence legitimized Nursing by saving the lives of those in power - men.  

Modern Nursing began in the mid-19th century.  Florence Nightingale, an educated woman from a wealthy family, trained as a nurse and went abroad to care for soldiers during the Crimean War. Under her direction, she transformed the hospital environment, initiating strict sanitation requirements reinforced by thorough, deliberate documentation of data.

The mortality rates of soldiers dropped dramatically.  The British government took notice. In a system dominated by men, Florence took the first step in legitimizing the profession of Nursing by saving the lives of those in power - men.  

Florence and women like her were barred from studying medicine.  But these women were crafty. They capitalized on their status in the private sphere. They made the most of their supposed ‘woman’s touch’. They recognized Nursing as the traditional women’s space in healthcare, and made the most of a slim opportunity.

Nursing’s development as the feminine healthcare profession in the late 19th and earlier 20th centuries served hospital budgets well. Women were a much cheaper source of labor than men. Hospitals recruited women who were unmarried and childless. By employing women, hospitals could pay them the lowest possible wage.

Additionally, early nurses faced significant barriers to accessing higher education. Nursing itself was not designated a curricula until the turn of the 20th century. Nursing programs struggled to acquire funding or even to find physical spaces to instruct upcoming nurses. They faced significant animosity from physicians, who feared nurses would threaten their status, power, and control of the medical domain.

This foundation lacked status and power, and over and against the patriarchy of medicine, has shaped Nursing into what it is today. Nurses have fought an uphill battle to be recognized as healthcare professionals. Had the first wave of nurses been male, we would have seen a very different valuation of our profession today.

Our society continues to value conventionally ‘masculine’ characteristics over ‘feminine’ characteristics. In healthcare, these characteristics fall under two umbrellas: Care and Cure. Care is associated with the ‘feminine’: nurturing, empathy, gentleness. Cure is associated with the ‘masculine’: intelligence, assertiveness, dominance over the disease. Cure is the role of the physician. Care is the role of the nurse.

We readily find fault with this social construct:  There is no Cure without Care. The theoretical bits of medicine are meaningless without the practical aspects of care. As Florence helped point out, a physician can prescribe as many antibiotics as he wants, but without a nurse to administer them and keep the wound clean, what's the point?

There is no Cure without Care. The theoretical bits of medicine are meaningless without the practical aspects of care.

We have made progress elevating the status of women and offering equal access to education and various professions. But society’s historically constructed complementary gender roles persist. How did this artificial division between Care and Cure come to be?

The answer lies in Social Role Theory. Long ago, men had sole reign over the ‘public sphere’: government, industry, trade. Women were confined to the ‘private sphere’: the home and the family. Society’s historic division of labor by gender leads to stereotypes about the roles men and women typically do and should occupy. We have inherited a Gender Narrative that gives men and women distinct paths.

Social Role Theory illuminates why these prejudices exist. Why do we expect men to be strong, assertive leaders who prioritize logic over emotion and earn the primary income for their family? Why do we assume that women are caring, sensitive nurturers who are led by their emotions rather than logic? Societal norms have been drilled into our heads. We are raised to believe these socially constructed realities are inherent to who we are at birth.

Now a quick intro to Gender Theory: The term for the biological categorization of people into males or females is 'sex'. 'Gender' refers to the sociocultural categorization of people into men or women. Sex is determined by biology. Gender is determined by society.

Research shows that there is some biological component to gender expression in humans, mostly due to hormone levels. However, males and females are much more alike biologically than they are different. There is no biological imperative for men and women to have disparate skills and personality traits. This gender binary is socially constructed. That's just how we read - and write - history.

The Gender Narrative obscures a more accurate picture of reality. Some men are more tender, sensitive, and nurturing than other men. Some women are more logical, assertive, and directive than other women. Likewise, some women are more “masculine” than some men, and some men are more “feminine” than some women. Such traits are not a function of gender. To categorize a person's capabilities based on gender is limiting for both the individual and the community who could benefit from a more natural expression of who each is without forcing people into artificially gender-defined social roles.

Plus, as we separate people into groups, power dynamics develop. We have seen this with race, social class, and yes, gender. 'Separate but Equal' has never worked. This was true in Florence Nightingale's time, and it is true today.

The history and development of Nursing perceived through the lens of Social Role Theory helps us understand why society views Nursing as a job for women. Our culture reinforces specific rules about the circumstances under which it is acceptable for men to be nurses. 

Society's Nursing Narrative includes a Gender Narrative that has been developed and reinforced through time. In it are two myths. First, feminine traits are less valuable than masculine traits. Second, femininity is a prerequisite for nursing.

The answer to challenging the Nursing Gender Narrative is not to claim, “Nurses aren’t feminine!” 'Feminine’ traits are no less important than ‘masculine' traits. Denying this undermines every position that is predominantly filled by women! There is nothing wrong with being 'feminine'. 

In truth, being an effective, professional nurse requires both ‘masculine’ and ‘feminine’ traits - as does, I would argue, any other profession. A logical, empathetic, assertive, and nurturing nurse is not hard to imagine. I work with such nurses every shift.

Being an effective, professional nurse requires both ‘masculine’ and ‘feminine’ traits.

The terms ‘masculine’ and ‘feminine’ are just labels for two distinct clusters of characteristics that are in no way inherently linked to male and female genitalia. Nor does any trait require association with another trait in the cluster. Nothing about being assertive requires you to be logical. Nothing about being demure demands that you be empathetic. Such traits are distinct qualities that rise out of the human experience having no real association to either gender or even to one another.

There is nothing wrong with thinking that most nurses are women. That is a fact. The issue is how society’s complementary views of gender - and the resulting gendered division of labor - has led to stereotypes about women and Nursing. Many believe that something about being a woman is a prerequisite to being a nurse.

These views of Nursing start young. We know that school-aged children have already learned stereotypes about who can and should be a nurse. We also know that these children actively discourage other children who express interest in cross-gender activities.

Female nurses outnumber male nurses 10 to 1. And the men that do enter nursing school will likely neve hear about the many contributions that men have made to the history of Nursing.

Male contributions have been left out of nursing textbooks. Erasing history - especially in order to perpetuate a ‘respectable’ narrative about gender and nursing - is dangerous and destructive. When we encounter evidence that does not fit with this understanding, we toss it out, rather than amend our Narrative. It's easier to label men in nursing as the 'exception' and discount them than it is to do the work to include them.

Until we actively challenge the myth that Nursing is for girls, we lose out on 50% of our talent pool. We also let people make sexist assumptions about the work that we do and the talent that we DO have. As we face a major nursing shortage, re-writing the Nursing Narrative is absolutely critical.

As we face a major nursing shortage, re-writing the Nursing Narrative is absolutely critical.

I'm a woman in Nursing, but that doesn't mean that I can't stand up for my male colleagues. That doesn't mean that I can't recruit men to our profession. That doesn't mean that I can't call out sexism and misogyny in the way that people discuss the work that I do. That doesn't mean that I can't call out a beloved television series for its problematic reinforcement of the Nursing Gender Narrative.

Suppose one day you turn on the TV and see a Friends episode playing.

Monica and Chandler are having a lover’s quarrel while at the hospital. Monica begins a flirtatious conversation with an attractive male nurse. Chandler interrupts. 

“A nurse not a doctor, huh? Kinda girly, isn’t?” There's a beat of uncomfortable silence. Then, the boo track plays.

Monica admonishes him, but the nurse raises his hand. "Nah, that's okay. Help me understand what makes you uncomfortable with my role as a healthcare professional?"

Chandler smirks. "Well, it's just... Isn't nursing for girls?"

The nurse's eyes widen. He grabs his work phone from its holster and shouts into it, "Code XY! Code XY!" An alarm sounds. Men and women dressed in scrubs storm into the room. Chandler is pushed onto a gurney and wheeled down the hall.

Alarmed, Monica cries, "What's a Code XY?!" The nurse solemnly replies, "We've got a case of Toxic Masculinity." Monica gasps. The screen goes black.

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