Abstract
Despite broader changes in the health care industry and gender dynamics in the United States, men continue to be a minority in the traditionally female occupation of nursing. As a caring profession, nursing emphasizes empathy, emotional engagement, and helping others—behaviors and skills characterized as antithetical to hegemonic notions of a tough, detached, and independent masculine self. The current study examines how nursing and related organizations “mobilize masculinities” in their efforts to recruit men to nursing. Analyzing recruitment materials, I assess the mobilization and construction of masculinities in the context of textual, spoken, and visual content. Results reveal how organizations simultaneously mobilize aspects of hegemonic and nonhegemonic masculinities through ideological gendering practices. I identify three distinct types of mediated mobilization: full hegemonic co-option, partial hegemonic co-option, and alternative construction of masculinities. Empirically, the study illustrates the content of nursing recruitment material aimed at men and the ongoing contradictions endemic to men’s entry into caring professions. Complementing existing structural and interactional approaches, the study advances theory on how the mobilization of masculinities operates as an ideological gendering practice at the organizational level.
As a historic and contemporary issue, occupational gender segregation is an important topic for scholars interested in understanding the devaluation of work typed as female (Baron and Newman 1990; England 1992) and the barriers women face when entering traditionally male jobs (Acker 1990; J. C. Williams 2000). Controlling for labor market variation, researchers argue that women’s work is devalued and women in traditionally female occupations suffer from lower wages than men in traditionally male jobs (Cohen and Huffman 2003; England 1992). As a result, recruiting men to traditionally female occupations has been a difficult task, despite the fact that service sector jobs—with an increasing number of “affective requirements”— have been on the rise since the latter part of the twentieth century (Bulan, Erickson, and Wharton 1997). As greater occupational gender integration benefits women through increased gender pay equity, decreasing occupational segregation is a worthy aim for feminists invested in bettering the economic standing of women (Cohen and Huffman 2003; Cotter et al. 1997).
Occupational gender segregation is particularly evident in nursing, where men make up a small minority even as the profession highlights projected staffing shortages and concern for diversity (Bureau of Labor Statistics 2012; Institute of Medicine 2010). Thirty years ago, an early advocate for the recruitment of men to nursing criticized the profession for failing to recruit more men (Christman 1980). Since then, the number of men in nursing has increased from the modest 2-3 percent when Christman wrote to about 7 percent today (Institute of Medicine 2010)—an increase of over 100 percent, but far from the gender parity for which he had hoped. Over the last 10 years, nursing organizations such as the American Assembly for Men in Nursing (AAMN), health care systems, hospitals, and corporations have attempted to address the number of men in the field through recruitment posters, videos, and brochures.
Drawing on recent scholarship on gendering practices (Martin 2001, 2003) and masculinities (Connell 2005; Connell and Messerschmidt 2005), this study advances theoretical and empirical understanding of how health care organizations in the United States mobilize masculinities as an ideological gendering practice to recruit men to nursing. In analyzing recruitment materials, two primary themes emerge: (1) across content, both hegemonic and nonhegemonic masculinities are mobilized, with (2) each item (video, poster, and brochure) employing a mobilization strategy of full hegemonic co-option, partial hegemonic co-option, or alternative construction of masculinities. Results suggest a portrait of men in nursing that is neither wholly hegemonic nor wholly alternative. The study extends the gendering practices approach and advances our theoretical understanding of how ideologies of masculinity are simultaneously reproduced and reconstructed through mediated materials that work to reconcile the cultural contradictions of the male nurse.
Literature Review and Theoretical Framework
The Contradictory Male Nurse
The male nurse is characterized as “a contradiction in terms” (Bradley 1989, 195). The current structure of health care in the United States is predicated on gender distinctions that stretch back to nursing’s formation as a profession (Gordon 2005). Florence Nightingale’s efforts to professionalize nursing as a white, middle-class, and feminine occupation exaggerated the disconnect between “caring” and “curing” in order to mirror Victorian sex roles (Bradley 1989, 193-95; Evans 2004). Women were and continue to be seen as naturally adept at caring (Lewis 2005), while men, with their technical skill and knowledge, are assumed to be better suited for curing. Nursing’s distinct “care” component emphasizes a nurse’s ability to nurture others and provide emotional support (O’Lynn 2007), with nursing rated high on a scale of nurturance (England et al. 1994) and associated with femininity (O’Lynn 2007).
Unsurprisingly, then, men have a small presence in the field of nursing, making up only 7 percent of the U.S. workforce (Institute of Medicine 2010). With an aging population, increasing rates of chronic disease, and implementation of health care reform, the Bureau of Labor Statistics (2012) projects the demand for registered nurses to grow much faster than most occupations, and employment in nursing to increase by 26 percent through 2020. Furthermore, health care organizations emphasize efforts to increase workforce diversity (American Association of Colleges of Nursing 2012), making nursing an attractive occupational choice to a more diverse group than the white, middle-class women who have traditionally entered the profession.
Previous research on men in nursing has investigated men’s reasons for entering traditionally female jobs, their financial and promotion outcomes (i.e., the “glass escalator,” Snyder and Green 2008; C. Williams 1992), and the racial dimensions of these outcomes (Harvey Wingfield 2009). This work has shown that men in female-concentrated occupations are acutely aware of the problems posed for constructing a masculine self (Cross and Bagilhole 2002; Heikes 1991). For example, Simpson explores how men in caring professions negotiate masculinity (2007), finding that men emphasize technical competence and rationality. Despite the benefits men gain, they must negotiate contradictions between hegemonic masculinity and their work in a caring profession, often segregating work and nonwork presentations as well as deemphasizing caring aspects of their job.
Research focused on the individual-level experience of men in nursing has been important for understanding gendered outcomes in traditionally female professions, but studies have not gone beyond the individual to address how organizational processes reconcile the cultural contradictions between the demands of nursing and the ideals of masculinity. By shifting from micro- to meso-levels of media representations, the current study provides theoretical insight into how gendering practices circulate within the sociocultural milieu as fluid combinations of cultural and ideological practices with the potential to contest and/or reproduce gendered structures of inequality (Howson 2006).
Hegemonic Masculinity and Gendering Practices Theoretical Framework
Conventional masculinity, or hegemonic masculinity, refers to the culturally dominant form of masculinity to which most men aspire but rarely achieve (Connell 2005; Connell and Messerschmidt 2005). Its Western contemporary form entails hyper-heterosexuality, control, technical/physical competence, autonomy, and rationality (Connell 2005; Lutz 1988; Pascoe 2005; Trujillo 1991). Hegemonic masculinity operates within a broader gendered system (or “gender regime”; see Connell 1987) as the norm against which alternatives, including femininities and alternative masculinities, are measured (Hanke 1992). Using normative cultural schemas, hegemonic masculinity assigns unequal value to such characteristics as technical/rational aptitude versus nurturance and, in so doing, provides an ideological basis for justifying the subordination of (primarily) women. Given its role in maintaining the gendered system, hegemonic masculinity can be viewed as both foundational for understanding gendered processes and a point from which to critique the current system (Howson 2006). To accomplish such critique, however, change must be seen “as a dialectic arising within gender relations themselves” (Connell 1985, 263). In the case of the current study, this dialectic emerges from the circulating, mediated representations of men found in nursing recruitment materials.
Recruitment materials seek to reconcile the seemingly contradictory demands of nursing (e.g., giving physical and emotional care to others) with the hegemonic ideals of emotional detachment, hyperrationality, and toughness. Held to different emotion expectations, boys are socialized to experience and express emotion differently than girls (Chaplin, Cole, and Zahn-Waxler 2005; Garside and Klimes-Dougan 2002). A detached, unemotional demeanor that conveys control reflects the dominant masculine ideal (Connell 2005; Lewis 2005; Lively 2000), while being supportive and congenial and showing empathy is considered feminine (Connell 1987; Lewis 2005). In and outside of work, it is often women who are relied on to provide practical and emotional support to men (Fletcher 1999; Martin 2001, 2003). Reconciling masculinity with the notion of care, then, is a formidable task for recruiting men to caring professions.
Beyond viewing gender as interactional and performative (West and Zimmerman 1987), scholars have increasingly conceptualized gender as an institution with its own, often rigid, practices that maintain structures of power (Lorber 1994; Martin 2004; Risman 1998, 2004). While interpretive work on the perceptions and meanings held by individuals is important for understanding the gendered work experience of men and women (Blumer 1969; Sayman 2010), a gendering practices approach embeds these meanings within the organizational level, illuminating the role of organizations in shaping subjectivities. Gender influences individuals, but its reach extends beyond them as it affects cultural norms and institutional policies (Risman 2004). Gendering practices operate as guidelines for performing gender at the interactional level, including the “plethora of meanings, expectations, actions/behaviors, resources, identities, and discourses that are fluid and shifting yet robust and persisting” (Martin 2003, 344). Studies of gender within organizations have largely emphasized the level of interaction, with less attention to how organizations themselves—through discourse and policy—engage in gendering practices (cf. Acker 1990; Sasson-Levy 2007).
Shifting the level of analysis from individual to organizational practice, the current study examines how recruitment efforts illustrate the gendering practice of “mobilizing masculinity” (Martin 2001). Originally conceptualized, mobilizing masculinity refers to men’s use of practices in the workplace that implicate, or “bring to bear,” masculinities in a given situation (Martin 2001, 588). Extending this concept, I suggest that individual men are not the only ones who utilize masculinities, but that organizations themselves also mobilize a plurality of masculinities through mediated representations. In the present study, the representation of men in nursing recruitment material is framed as a site for the organizationally based, gendering practice of mobilizing masculinities—meso-level ideologies that bridge performative and structural gender inequalities.
Media serve to circulate gender beliefs through cultural representations of men and women, including hegemonic and alternative constructions (Hanke 1992; Ridgeway 2006). Empirical work analyzing media and gender centers largely on women, as is the case in studies of women’s body image (Hesse-Biber 2006; Zhang, Dixon, and Conrad 2010) and the portrayal of women who “opt out” of careers in favor of motherhood (Kuperberg and Stone 2008). However, media studies focused specifically on men and hegemonic masculinity are not without precedent (Morrison and Halton 2009; Vigorito and Curry 1998).
Nursing recruitment materials may expand upon or perpetuate definitions of masculinity centered on the ideals of emotional detachment, rationality, and autonomy. However, the ideals of hegemonic masculinity are heavily scripted within the current sociohistorical context (Trujillo 1991), and nursing materials are embedded within that context even as they confront the contradictions of men in nursing. In analyzing nursing recruitment content aimed at men, the current research was guided by the following questions: How do organizations recruiting men to nursing reconcile the qualities of dominant masculinity that seem at odds with the requirement that nurses provide physical and emotional care to others? More specifically, what qualities of hegemonic masculinities and nonhegemonic masculinities are represented in the recruitment material? Finally, using each recruitment item as a separate case, what type of mobilization strategy does each poster, video, and brochure utilize in an effort to attract men to the profession?
By answering these questions, the current study advances our understanding of gendering practices by extending the “mobilization of masculinity” process to include multiple masculinities utilized as ideologies at the organizational level. In doing so, the study’s findings illuminate three distinct mobilization strategies aimed at recruiting men to nursing: full hegemonic co-option, partial hegemonic co-option, and alternative masculine constructions. Theoretically, mediated representations of men serve as an important link between macro-level structures of gender inequality and the interactional/interpersonal level of gendering practices, with constructions of masculinity reproduced and reconstructed simultaneously within a hegemonic gender system.
Data and Method
To answer these research questions, I analyzed U.S. nursing recruitment materials targeted at men. Content analysis is particularly appropriate given the study’s focus beyond an individual level of analysis (Prior 1997, 61) in order to address the gendering practices of organizations. As cultural texts, recruitment materials can mirror and reconstruct social reality, representing a pivotal site where “hegemony is enacted, contested, resisted, and challenged” (Hesse-Biber and Leavy 2004, 305). By analyzing recruitment materials, I assess the common values that content creators hold concerning what it means to be a man and a nurse.
Recruitment materials were collected over the course of fall 2011 through summer 2012. The data include two brochures, 12 posters, and 18 videos, ranging in length from 31 seconds to over 10 minutes, for a total of 32 items. The total video footage is 68 minutes and 56 seconds (see the online appendix at gas.sagepub.com/supplemental for content details). I also analyzed relevant campaign reports, nursing web pages, and newsletters, totaling 39 items with 286 pages of text. These were located through organization websites and nursing newsletters and journals as supporting documents for understanding the goals of content creators, their intended audience, and the professional context in which the materials were produced. Individual men featured in the recruitment materials totaled 124.
I learned of nursing recruitment efforts aimed at men through the AAMN’s “20 x 20 Choose Nursing Campaign” (AAMN 2011), which aims to increase the number of men enrolled in nursing programs to 20 percent by the year 2020. It produced four posters and two videos. More recruitment materials were located through organizational websites, an online search engine (www.google.com), and EBSCOhost. I also used an online search engine and EBSCOhost to seek out professional newsletters, briefs, and reports that dealt with the issue of recruiting men to nursing.
The AAMN’s campaign to recruit men includes a distinct social media component, including a channel on the popular video sharing site YouTube (www.youtube.com). Using this site, videos were located through suggestions on the site and systematic searches for the keywords “male nurse,” “men in nursing,” and “recruiting men to nursing.” My sampling frame limited material to items endorsed or produced by an organization or institution such as the AAMN, or a specific nursing program or hospital (e.g., St. Francis, Emory Healthcare). All materials had to target men. Amateur videos and those portraying nursing students were excluded. Like other visual studies of “found materials,” I cannot assess the representativeness of these materials (Pauwels 2010, 550). However, by using a variety of search techniques across multiple sites, the search for materials within the parameters of the study was thoroughly exhausted and yielded a range of affiliations, including multinational and national corporations, urban hospital systems, national and state nursing organizations, and community colleges. Northeastern, Southern, Midwestern, and Western regions of the United States, as well as a multinational corporation, are represented in the material. To ensure access to the video content, I downloaded high-quality MP4 files of video and stored them as permanent electronic copies.
Analysis of the content included attention to the text, speech, and visual elements of the materials (Rose 2004). Visual elements included facial expressions, body posture, and objects. Drawing from the literature on masculinities, I looked for themes relevant to hegemonic and alternative masculinities. In total, the analysis included five rounds of screening the video content. In the first round, I assessed the appropriateness of the item for the study. During a second round of screening, I documented emerging themes relevant to hegemonic and nonhegemonic masculine qualities. I developed a list of codes and re-analyzed the content in a third round of screening, noting the frequency with which they occurred in each brochure, poster, and video, revealing, to a degree, the emphasis a code receives (Rose 2004, 362). Using a web-based video analysis program (www.dedoose.com) I was able to select clips and elements of posters and brochures and then attach relevant codes to each excerpt. The software tracked code frequencies as well as the number of co-occurrences of codes, that is, the number of times that two codes were applied to the same excerpt. In a fourth round of screening, I documented the number of men represented in the materials. Finally, I analyzed the content using each recruitment item as the level of analysis to determine the type of mobilization strategy used by each (for multiple levels of analysis in content studies, see Kuperberg and Stone 2008).
In analyzing the data sources, I focused on the contradictions between hegemonic masculinities and the demands of a caring profession, looking for themes related to the notion of both hegemonic and alternative masculinities. Emergent hegemonic themes included competition, risk-taking/adventure-seeking, athleticism/physicality, emotional detachment, technical/rational competence, autonomy/independence, emphasized heterosexuality, and breadwinner/provider. Focusing on the care component of nursing, I analyzed the content for emergent nonhegemonic themes, or those that conveyed alternative conceptions of masculinity, including caring for/helping others, teamwork/collaboration, feelings of self-efficacy/gratification, and sense of purpose/making a difference. Following Vigorito and Curry (1998), I analyzed the visual signifiers of masculinity, including facial expression, body posture, and use of objects as props. These included sports equipment, motorcycles and gear, tattoos, smiling or not, arm positioning (i.e., crossed, at side, etc.), and posture (i.e., leaning forward or backward).
Findings
Results of the analysis show a mix of hegemonic and nonhegemonic codes across the recruitment material, with three distinct, emergent strategies for recruiting men to nursing. The first strategy consists of mobilizing hegemonic masculine ideals within the profession and among the men represented in the content. A second strategy pairs hegemonic with nonhegemonic masculinities in a manner that polarizes these constructions. In a third strategy, alternative masculinities stand alone without recourse to hegemonic forms. This latter strategy focused predominantly on the value of caring for others and making a difference. Before discussing each strategy, I frame the context of recruitment efforts in terms of audience and goals. I then describe the most common hegemonic and nonhegemonic codes in the materials, providing examples for each. Finally, the three mobilization strategies are examined in detail.
The Context of Nursing Recruitment
Beyond meeting the projected need for nurses (Bureau of Labor Statistics 2012), recruiting men to the profession is motivated by broader workforce diversity interests (Institute of Medicine 2010). As echoed by professional reports and newsletters (Institute of Medicine 2010; Johnson & Johnson 2012; Robert Wood Johnson Foundation 2011), a diverse workforce that more closely mirrors the demographics of the patient population is expected to improve patient care. Materials are targeted at boys and young men likely to be in the process of choosing their career. Policymakers suggest that nursing be introduced to boys and youths early on as a viable career choice (LaRocco 2007; Meadus 2000). To reach this audience, materials are distributed to elementary and high schools, advising viewers to contact guidance counselors. Recruitment campaigns also aim to increase public awareness of men in nursing so as to lessen the stigma and stereotypes held by the public at large (Trossman 2003). To accomplish this, press releases announcing organizational recruitment efforts were aimed at the public and local communities (American Nurses Association 2007; Anderson 2011; Virginia Partnership for Nursing 2002). For example, as part of the “Nurses Change Lives” campaign, the Virginia Partnership for Nursing (VPN) distributed posters “to elementary, middle school and high school students across the state to encourage interest in nursing as a career choice” while also informing the public through a press release (VPN 2002, para. 4).
In line with scholarly work (Allison, Beggan, and Clements 2004; Hesselbart 1977), nursing reports and newsletters note that men in nursing often face stereotyping concerning sexuality, gender expression, and competency, and are often assumed to be gay, effeminate, or lacking the intelligence and ambition for medical school. Previous campaigns tackled this directly with slogans like “Are You Man Enough to be a Nurse?” and “Real Men Choose Nursing.” The AAMN has tried to move away from this rhetoric, using the slogan “Choose Nursing” with the specific aim to “‘de-genderify’ nursing” (Anderson 2011, para. 6). However, as my analysis shows, this shift in rhetoric does not necessarily result in a corresponding change in the masculinities idealized in the recruitment material. Following theoretical critiques of the “androgynous” and “de-gendering strategies” of early second-wave feminism (Howson 2006, 6), efforts to de-gender nursing without detailed knowledge of hegemony’s specific characteristics in this sociocultural time and space fail to achieve professional transformation.
Mobilizing Hegemonic Masculinities
In the overall analysis, 14 hegemonic and nonhegemonic codes were applied 287 times to 248 excerpts. Hegemonic constructions of masculinity were used to define nursing and emphasize culturally ideal masculine qualities of male nurses. Table 1 displays the hegemonic themes that emerged from the analysis: rational/technical skills, autonomy/independence, breadwinner/provider role, athleticism/physicality, and risk-taking/adventure. I discuss these primary themes in greater detail, drawing on the data to illustrate their use.
Frequency of Hegemonic and Nonhegemonic Masculinity Codes
NOTE: Percentages in parentheses are for all code applications, n = 287.
The AAMN’s (2011) campaign poster “Adrenaline Rush” illustrates several hegemonic themes (see the online appendix at gas.sagepub.com/supplemental for links to all referenced content). The poster shows a white operating room (OR) nurse wearing a surgical mask next to an image of the same nurse wearing a mask for mountain climbing in extreme weather. Risk-taking/adventure, athleticism/physicality, and detachment from emotion are reflected in the image because of the emphasis on athletic and dangerous mountain climbing and masked facial or emotional expression. Similarly, the Oregon Center for Nursing (OCN) and Virginia Partnership for Nursing (VPN) developed posters in the early 2000s titled “Are You Man Enough?” that clearly emphasized hegemonic masculinities, including athleticism/physicality (evidenced by showing a snowboarder, marathon runner, rugby player, and basketball player), risk-taking/adventure (evidenced by an emphasis on military service), and emotional detachment (figures with unsmiling, expressionless faces, directly facing the camera, several with arms crossed and leaning back). The text of one poster references “intelligence,” “courage,” “skill,” and “unlimited opportunities,” embodying themes of rational/technical skill and autonomy.
Among videos used for recruiting men to nursing, 39 percent (seven of 18 videos) began with a “hegemonic opener”—images of men engaging in sports or using technical equipment, or images of ambulances/helicopters in transit emphasized in the first 10 seconds of the video. In one brochure, a nurse acknowledges the wide use of hegemonic openers: “Ads showing men jumping out of helicopters is exciting, but it only touches on the choices available to men in nursing. Nursing is a career that lets you chart your own course” (unidentified race, University of North Carolina brochure, 2007). The risk-taking/adventure aspect of the career is emphasized in hegemonic openers, while the brochure comment illustrates another element of hegemonic masculinity—autonomy and independence. Materials frequently cite unlimited opportunities and freedom to do whatever you want as a means of enticing men, catering to autonomy and independence as masculine ideals (or the “frontiersmanship” ideal [Trujillo 1991]). The autonomy/independence theme is also illustrated by Bill’s comment, “I can work anytime I want, anywhere I want” (white, California Institute for Nursing and Health Care [CINHC], 2009)
An emphasis on the technical and rational skills of the job was also common. Will, an emergency nurse classified as “racially other,” highlights this distinctly masculine feature of nursing: “If you love math, if you love sciences, I mean, this is a great career to get into” (other, ConnectEd, 2010). Science and math references allude to the rational and technical skills needed in nursing: “[Emory] gives me access to science so that I can do the best job that I can” (white, Emory, 2009).
Also emphasized in the hegemonic openers, and a frequent theme throughout, are references to sports and athleticism. For example, a Johnson & Johnson video opens with Romel introducing himself: “I’m a full-time nurse and a part-time beach volleyball player” (Asian, 2010). Videos also included footage of cyclists, runners, four-wheelers, football, martial arts, surfing, and weightlifting. Athleticism occasionally co-occurred with risk-taking and adventure (eight instances of co-occurrence), as shown in the case of Ed, a white hospice nurse whose past career as a firefighter is highlighted in a Johnson & Johnson video (2010).
Autonomy/independence and risk-taking/adventure were also referenced by visuals of motorcycles and nurses as bikers. The “Men in Nursing” video highlights a white man who embodies the tough, risk-taking ideal: While interviewed, he leans against his motorcycle (away from the audience) while the camera pans across his neck and arms, focusing on his many tattoos. Before riding off, he tells the camera, “I’m a nurse. I’m doing it and I love it” (white, CINHC, 2009). A recruitment video about travel nursing also references the hegemonic notion of risk-taking/adventure multiple times: “The exciting thing about being a travel nurse is just the adventure that it takes you on” (white, American Mobile Healthcare, 2011).
Another frequently cited hegemonic ideal was the provider/breadwinner role. While good pay and benefits are necessary for attracting skilled workers to any profession, nursing has historically faced lower wages that may have turned men away from a nursing career (Evans 2004). In emphasizing high wages, good benefits, and job security, recruitment materials dispel the myth that nurses are poorly paid. In doing so, they allude to the traditional role that men have had in providing financially for a family:
You can make great money—great money. (Troy, white, Clover Park Technical College, 2005) You will always have a job. (white, CINHC, 2009) Benefits are great. (Doug, white, Whatcom Community College [WCC], 2011)
Tapping into the traditional provider role that men have historically fulfilled (Bernard 1981), these assertions signal to the audience that being a nurse does not require sacrificing a high-paying and dependable career.
Constructing Alternative/Nonhegemonic Masculinities
While less frequent overall, alternative masculinities were highlighted in the recruitment materials, with men in the videos citing caring for others and making a difference as significant reasons for choosing nursing as a career. Purposeful, meaningful work was categorized together with the theme of making a difference, as they often co-occurred. Twenty-four of the 248 excerpts reflected this theme. References to caring/helping others were common, as well as an emphasis on teamwork and coworker interdependence. Frequencies of nonhegemonic codes are also displayed in Table 1.
The most common of the nonhegemonic themes was caring for/helping others. Many men noted that being able to help others and provide care is what drew them to the profession. Doug articulates the unique element of carework: “The ability to be able to help others in a special way—it’s being allowed into the life of someone’s most intimate and maybe most difficult time of their life and maybe somehow having a part in improving their lives” (white, WCC, 2011). The human element of nursing is clearly valued by these nurses.
Helping and caring for others often dovetailed with the second most frequent nonhegemonic theme: making a difference/having purpose. The two co-occurred nine times. Hillcah illustrates the link between caring for others and feelings of purpose and making a difference: “Last week when I was taking care of a little premature infant that needed intensive care, and to watch that baby get better and it’s because of what you do to the point where that baby could go home with his mom made a huge difference” (black, CINHC, 2009). Thomas, a hospice nurse, also reiterates how helping others relates to feeling like he has made a difference: “If I can help my patients, their families, the community be more comfortable with this natural and inevitable experience [death], I’ve made a difference” (white, St. Francis Health, 2010).
Hegemonic codes rarely co-occurred with making a difference or having purpose. Technical competence or job security did not explain the feelings of meaning and purpose often elicited from caring for others. When financial reward co-occurred with helping others and making a difference the tension between the two was explicit: “You really do make a difference every day you work as a nurse helping people, but it’s also financially rewarding as well” (black, CINHC, 2009, italics added). While financial matters are referenced in the same sentence as feeling as though one has made a difference, the “but” makes this connection appear polarized, highlighting the distinction between hegemonic and nonhegemonic concerns rather than constructing alternative masculinities that transcend hegemony. This stands in contrast to feeling like one has made a difference because one has helped others, a sentiment captured in Thomas’s if–then statement in the previous quote.
Feelings of making a difference often stood independently. For example, in a video a nurse states that “you can go home each day and look yourself in the mirror and say, ‘Hey, what I did today really, really makes a difference’” (black, CINHC, 2009). Thomas, the hospice nurse mentioned earlier, also reiterates the importance of feeling purpose in one’s work: “I love being a hospice nurse. It allows me to go home at the end of every day knowing that I have made a difference in the world” (white, St. Francis Health, 2010). Helping others and desiring emotionally and existentially satisfying work may appear at odds with hegemonic notions of independence and emotional detachment (Connell 2005; Lewis 2005; Lively 2000), yet these attributes of the profession and of the men themselves were openly acknowledged and highlighted in the material.
Mobilization Strategies
The frequency of hegemonic and nonhegemonic themes throughout the recruitment items provides a general impression of organizational efforts to recruit men. However, looking at the percentage of hegemonic and nonhegemonic codes per each individual recruitment item, we gain a better understanding of the type of mobilization strategy employed in the case of each particular poster, video, and brochure. Each recruitment item is a distinct unit, with a specific type of mobilization strategy. Calculating the percentage of hegemonic and nonhegemonic themes found in each item revealed three strategies of recruitment: full hegemonic co-option, partial hegemonic co-option, and alternative construction of masculinities.
Seven of the 32 recruitment items (22 percent) used hegemonic qualities of men in nursing, emphasizing hegemonic traits of rational/technical skills, physicality/athleticism, autonomy/independence, and the breadwinner/provider role. Five of the seven full co-option items were posters—suggesting that the poster’s format may be somewhat constrained compared to longer videos that can show a variety of men and masculinities. A video exemplifying this strategy is “Men in Travel Nursing.” Beginning with a hegemonic opener of rock climbing and surfing, men in this film reiterate adventure, opportunity, good pay, and excitement as the reasons they went into nursing. Helping patients or making a difference are not mentioned, nor do any of the visuals show a nurse interacting with a patient. Using only hegemonic themes, these materials illustrate a strategy of full hegemonic co-option.
Seventeen of the 32 items (53 percent) included a mix of hegemonic and nonhegemonic codes. This was the most common mobilization strategy, often illustrating continuing tensions within masculinity. Hegemonic and alternative codes co-occurred in only six excerpts from the materials. Hegemonic and nonhegemonic themes were often polarized, as in the case of the breadwinner/provider ideal contrasted against caring for others: “You really do make a difference every day you work as a nurse helping people, but it’s also financially rewarding as well” (black, CINHC, 2009, italics added). In a second example, a variety of men in a 40-second montage each mention perks of the job: “120,000 new nurses are needed every year,” “The opportunities are endless,” and “I’ve had steady income and pay increases all along the way.” Within this montage, a single man (Hillcah, black) emphasizes care in a distinct frame: “For me, I wanted to make a difference in someone’s life.” Rather than constructing transformed masculinities that simultaneously allow for motives of helping others and monetary compensation, income and benefits are polarized as ideals that contrast with making a difference. With hegemonic themes predominant, the coexistence of alternative and hegemonic themes appears conflicted rather than transformative of dichotomous views of ideal masculinity and caring for others.
Eight of the 32 items (25 percent) used a mobilization strategy that centered on the construction of alternative masculinities—conceptions of manhood that focused on caring for others, making a difference, or working with a team. These items did not reference any of the ideals of hegemonic masculinity. An example of this strategy is the short, 30-second commercial by Johnson & Johnson titled “Name Game.” In this commercial, a white pediatric nurse closely interacts with a young patient named Emma. Seated next to her, he says, “I know it’s not your favorite, but it’s time for your medicine.” Leaning in, he inserts the medicine into her IV and the two smile and sing in unison: “Emma, Emma, bo-bemma, banana-fanna-fo-femma, fee-fi-fo-femma, Emma.” No reference is made to pay, technical skills, or autonomy. Constructing a portrait of men in nursing without reference to hegemonic themes, the video’s mobilization strategy is one of alternative construction rather than full or partial hegemonic co-option.
Discussion
Results of the analysis of nursing recruitment materials aimed at men show how organizations mobilize hegemonic and nonhegemonic constructions of masculinity in order to diversify nursing and reduce the stigma of men in nursing. In doing so, they suggest a paradox: Some recruitment content appears to reproduce aspects of hegemonic ideals while other items exclusively emphasize caring, helping others, and making a difference. Materials varied in the extent to which they embraced hegemonic conceptions of masculinity, as well as which aspects of hegemonic masculinity were referenced. The data revealed three distinct mobilization strategies: full hegemonic co-option, partial co-option, and alternative constructions of masculinity.
In an effort to reconcile conventional qualities of masculinity with a caring profession, some recruitment videos and posters rely exclusively on the image of a tough, emotionally detached, and rational man. Where recruitment items employ a strategy of full hegemonic co-option, aspects of care are eclipsed by hegemonic themes in a manner similar to other historic campaigns (see Evans 2004, 325-26). Aspects of hegemonic masculinity could be constructed in a manner compatible with caring for others (O’Lynn 2007), but compatibility cannot be highlighted when references to care are omitted altogether. In order to meaningfully represent men as caring, the historic conflation of femininity with care must be confronted along with increased understanding of how men may care differently than women (O’Lynn 2007).
While the number of hegemonic codes outnumbered nonhegemonic codes, the majority of recruitment items include themes from both categories. Nursing scholars acknowledge the difficulties in reconciling conventional masculinity with care, arguing that hegemonic notions of masculinity must be transformed (Evans 1997; Meadus 2000). From the current analysis, we see that this transformation is still in process, as aspects of hegemonic masculinity rarely reinforce an ethic of care. One of the organizational leaders in recruiting and retaining men in the profession, the AAMN continues to mobilize aspects of hegemonic masculinity despite claims to move away from overtly gendered tactics. Empirically, there is continued need to assess how hegemonic and nonhegemonic themes in recruitment material influence viewers and potential recruits, because their success in recruiting men is likely to influence their use and reuse. Further work is needed on the role that nursing and other organizations may play in critiquing, co-opting, or reconstructing hegemony.
Nurturing and providing care are not exclusively female skills, despite dominant cultural beliefs (Meadus 2000; O’Lynn 2007). Some recruitment materials constructed alternative masculinities that emphasize caring for others and making a difference (e.g., Johnson & Johnson’s “Name Game” and St. Francis Health’s “Hospice” video). This shift in masculine representations and the value of work centered on care illustrates how alternative masculinities are constructed. While future research is needed to assess the effectiveness of each mobilization strategy, adding alternative masculinities to the discourse counterbalances the hegemonic ideals of autonomy, stoic manliness, and the devaluation of work traditionally done by women—a necessary step toward transformative masculine constructions that might disrupt the dichotomous view of hegemonic and alternative masculinities.
One implication of the current study for gender theorists concerns the role of organizations in perpetuating gendering practices (Martin 2003). Gendering practices operate within organizations as the set of gendered knowledge from which individuals draw in order to enact masculinity and femininity in workplace situations. The analysis reveals how gendering practices, specifically configurations of hegemonic and nonhegemonic masculinities, are mobilized by organizations. Although organizations are not people, the analysis further suggests that, like people, organizations “mobilize” particular aspects of culturally idealized and alternative masculinity in order to recruit men to nursing. Reflecting one further theoretical implication, the analysis shows how these gendering practices are enacted at the organizational level—that is, through the ideological mechanism of mediated representations of men. Suggesting continued tension between ideal and alternative masculinities, the analysis reveals a dialectic within, rather than a transformation of, hegemony.
Martin’s (2001, 2003) fieldwork on gendering practices showed that mobilizing masculinity is not without consequence, as men and women often suffer professionally if they fail to mobilize masculinity appropriately at work. While the implications are unknown, the use of gendered practices, such as mobilizing hegemonic masculinities at the organizational level, may also be harmful. Tough questions remain. Is the use of hegemonic masculinity—ideals that often constrict men and reproduce gender inequality—justified by the overall goal of desegregating a traditionally female profession? How might recruitment efforts that target men transform hegemonic ideals in such a way that makes them compatible with notions of helping others and making a difference?
Tackling the larger problem of diversity needs, organizations are likely to turn to commonly held, culturally valued characteristics that define ideal masculinity in hegemonic ways. This is well-intentioned and pragmatic. Organizations utilize hegemonic and nonhegemonic masculine themes simultaneously. Like individuals facing constrained choice within systems of oppression, the mobilization of masculinities in recruitment materials involves both complicity and resistance (Pyke 2010). In her analysis of women’s inclusion in the Israeli army, Sasson-Levy (2007, 502) finds that the state’s “double-edged strategies” include women while simultaneously marginalizing them. The recruitment strategies of health care organizations can be seen as similarly double-edged, suggesting a simultaneous dialectic of hegemonic and alternative masculinities. While including alternative masculinities, recruitment materials often framed these in dialectic tension with hegemonic ideals, failing to fully transform hegemony. Echoing previous work on the inclusion of subordinated masculinities in television shows, “inclusion” of alternative masculinities may provide a false sense of balance that masks the “lead role” that hegemonic masculinity holds in relation to the subordinate roles of alternative masculinities (Hanke 1992, 194-95). Hence, ideological “inclusion” may serve to reinforce the “norm” of hegemony. Efforts to construct alternative forms of masculinity appear to subvert and resist strictly hegemonic ideals, while at the same time strategies of hegemonic co-option rely on entrenched ideals about what it means to be a man, often privileging these ideals over and above the value of helping others. A strategy of hegemonic transformation—one in which manliness and care are not constructed as antithetical categories—has yet to be realized (O’Lynn 2007).
Critiques of a gendering practices approach note the need to specify the role of power and inequality in such practices (Ferree 2003) and theorize beyond the level of the individual (Connell 2003). By positing organizations within the health care industry as agents in the construction and reproduction of masculinities, the current study extends Martin’s (2001) original conception of “mobilizing masculinity” from a primarily one-dimensional, individual act to a multidimensional organizational and ideological practice. In using hegemonic and alternative masculinities, organizational gendering practices are linked to the vast literature on gendered power (Connell 1987, 2005). Furthermore, concepts of full and partial co-option, as well as alternative constructions, provide useful language for discussing how organizations and groups use masculinities at the ideological level. For example, advertisers’ efforts to capture the male demographic through “manvertising” may also utilize mobilization strategies that transform or co-opt hegemony.
One limitation of the current study is the limited number of men of color represented in the materials. While the sample was predominantly white (69 percent), the representations of racial minorities, particularly black men, suggest ways in which race may shape masculinities. Hillcah is an illustrative case. One of two black nurses in a 10-minute promotional video, Hillcah provides a singular emphasis on helping others in contrast to the hegemonic themes of autonomy, provider/breadwinner, and risk-taking ideals promoted by white and Hispanic/Latino men in the same video. Hillcah’s presentation suggests that as black men negotiate hegemonic masculinity in a context framed by gendered racism, they may rely more heavily on alternative, care based constructions of masculinity. This echoes prior work on African American men in nursing (Harvey Wingfield 2010) and highlights the need for more research on the representations and experiences of men of color in caring professions.
The recruitment of men to a traditionally female profession such as nursing merits continuing scholarly concern. Results of the analysis highlight a tension between hegemonic masculinities and the caring demands of the profession, with nursing-related organizations using three strategies that mobilize masculinities in an effort to recruit men. Recruiting men to nursing as a goal cannot stand apart from the goal of recruiting highly qualified and compassionate workers, hence the need to transform, rather than co-opt, hegemony. Believing that hegemonic constructions of masculinity often hurt individual men and society, Kimmel calls for a new masculinity in the United States “that is more about the character of men’s hearts and souls than about the size of their biceps or their wallets” (Kimmel 1997, 333). Through a confluence of economic necessity and organizational practice, the alternative constructions of the contradictory male nurse may hold particular promise for a redefinition of masculinity based on heart and soul rather than biceps and wallets.
Footnotes
Acknowledgements
I would like to thank Becky Erickson for her guidance and feedback on numerous drafts. I would also like to thank Pat Martin, Kathy Feltey, Dani Jauk, Austin Haney Johnson, and Kelsey Risman for their valuable feedback. Finally, I thank the anonymous reviewers and Adia Harvey Wingfield for their suggestions.
This paper was awarded the 2012 Graduate Student Paper Award, Society for the Study of Social Problems, Health, Health Policy, and Health Services Division, and was presented at the Society for the Study of Social Problems 2012 Annual Meeting in Denver, Colorado.
Marci D. Cottingham is a postdoctoral research fellow in the Department of Social Medicine and Center for Bioethics at the University of North Carolina, Chapel Hill. Her research focuses on gender, social psychology, emotion, and health. She is currently involved in projects examining gender and emotion among nurses and the experiences of participants in pharmaceutical research.
References
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