Negotiating Masculinity in a Post-Socialist Society: The Case of Chinese Male Nurses

Introduction

Occupational gender segregation and discrimination are important sociological concerns. Men in female-dominated occupations receive attention, as there has not been any marked increase in their participation in ‘women’s jobs’ (Cross and Bagilhole, 2002; Torre, 2018; Williams, 2015). Nursing is an archetypal example; in the 2010s, there were severe shortages of male nurses worldwide (Cheng et al., 2018; Cottingham, 2019; O’Connor, 2015). Over the years, feminist researchers have developed new concepts and insights to identify barriers, address identity difficulties and strategies, and untangle complex power issues related to the topic. Nevertheless, current discussions mostly draw on the experiences of Western and/or capitalist societies. Analyses from countries with different socio-economic-political systems are currently lacking, and would help to reveal the complex interplay of gender dynamics at global, national, and local occupational levels, as well as the cultural specificity of masculinity (Connell and Messerschmidt, 2005). Utilizing in-depth interviews with 12 male registered nurses in post-socialist China – where the state-command economy has undergone substantial market reforms and been integrated into global capitalism in the past few decades – this article seeks to enrich the current discourse. First, we outline insights borrowed from existing critical studies on men and masculinities, and from Chinese masculinities studies.

Men and masculinities in nursing – a female-dominated occupation

Scholarship on male nurses or minority men in female-dominant occupations has the following three remarkable strands: the barriers and experiences of minority men, the negotiation of masculinities at work, and the reconstruction of masculinities. Many studies have identified the construction of nursing as ‘women’s work’ as a major barrier deterring men from entering the profession (Evans and Frank, 2003; Fisher, 2009; McDowell, 2015; Snyder and Green, 2008). This idea, first popularized by Florence Nightingale to legitimize women’s participation in hospital work, established nursing as an extension of women’s ‘natural’ feminine qualities, such as caring, nurturing, and altruism, from the domestic to the public sphere (Evans, 2004). This essentialized, gendered construction has developed into a global discourse (Harding, 2007) and has also inadvertently caused nursing to be regarded as unskilled and of lower status (Evans, 2004: 323). This cultural association-come-devaluation, alongside the lower wages typically paid to nurses, explains why men are not motivated to join this doubly devalued, female-dominated occupation (Torre, 2018; Williams, 2015). Male nurses are likely to suffer from a loss of money and status, experience cultural disapproval from peers and family, and be ridiculed as effeminate, deviant, or even gay (Evans and Frank, 2003; Harding, 2007; Lupton, 2000).

Empirical studies find that male nurses, as a numerical minority, encounter various challenges. They are perceived as less caring than female colleagues but are expected to help with tasks that require heavy lifting (Wingfield and Myles, 2014). Their touch is more easily sexualized and they therefore have restricted access to certain kinds of care training (Fisher, 2009). Nevertheless, gender stereotypes and their numerical inferiority can also work to men’s advantage. Because society values masculine traits more highly, men receive preferential treatment from female colleagues and are encouraged to aspire to higher status specialties and/or are channeled to administrative positions (Williams, 2015). The disproportionate number of men in the nursing hierarchy affirms the existence of the ‘glass escalator’ effect – the hidden advantages that men receive in women’s professions (Williams, 2013: 609).

Concerns about persistent gender inequalities in the nursing profession have caused some researchers to borrow insights from critical studies of men and masculinities, and to seriously appraise the social power of masculinity at work and in broader society (Evans and Frank, 2003: 278). Critical studies define masculinity as ‘the pattern of practices that allow men’s dominance over women to continue’ (Connell and Messerschmidt, 2005: 832), differentiate masculinities as multiple, address the importance of work or the workplace to men’s identity, and explore the active processes that masculinities are accomplished in daily conduct and organizational life (Collinson and Hearn, 1994). The concept of ‘hegemonic masculinity’ further underscores the social pressures faced by men and the hierarchical relations involved in men’s relationships with women, as well as with other men (Robinson, 2007). Hegemonic masculinity denotes the socially and culturally ideal masculine characteristics expected of a man, which wins ascendency through culture, institutions, and persuasion (Connell and Messerschmidt, 2005). Even though few men can fully embody this ideal, its normative power requires all men to position themselves in relation to it. As work and money are key components defining hegemonic masculinity, when a man crosses over into a gender-atypical domain, his gender identity is threatened and needs to be reestablished (Morgan, 1992).

These insights have been employed to illuminate male nurses’ active negotiation of masculinities in a feminized occupation and the range of strategies they use to bolster their masculine identity, defend heterosexuality, appropriate specialized units, and ascend the career ladder. For instance, when aspiring to hegemonic masculinity, male nurses affirm their sense of manliness and heterosexuality by demonstrating their superior strength when assisting female colleagues or subduing violent patients (Evans and Frank, 2003; Lupton, 2000). To resist stigmatization, they tend to differentiate themselves from female nurses (Evans and Frank, 2003; Lupton, 2000), harass less ‘masculine’ male colleagues (Cross and Bagilhole, 2002), and avoid contact with gay colleagues (Harding, 2007). To avoid feminization, they distance themselves from caring and nurturing narratives (O’Connor, 2015) and bedside care and general nursing (Simpson, 2004), and perform less emotional labor (Cottingham et al., 2015). To assert their skills and contributions as men, they retitle or redefine the job content as more ‘masculine’ (Cross and Bagilhole, 2002; Lupton, 2000) and gravitate toward specialties – such as the intensive care unit (ICU), the operation room, and the psychiatry department – by framing these units as requiring ‘masculine’ qualities, including high-intensity work, technological sophistication, and physical strength (Simpson, 2004; Snyder and Green, 2008). Moreover, they swiftly aspire to prestigious administrative positions (Evans and Frank, 2003; McDowell, 2015). These various strategies maintain male domination over women, reinforce horizontal and vertical segregation, and marginalize non-masculine or gay male nurses.

Nevertheless, researchers have also noticed changes, contradictions, and diversity among minority men in the female-dominated nursing professions. Some men have changed their perceptions of nursing, seeing it now as a professional, good salary job, and therefore, a viable career for men (O’Connor, 2015). There are also ‘settlers’ who were disillusioned with the ‘male’ careerist model in male-dominated occupations and moved into the profession (Simpson, 2004). In addition, men also report playing down overtly masculine behavior (Lupton, 2000), enjoying working with women (Simpson, 2004), feeling capable and satisfied managing emotional work (Cottingham et al., 2015), and identifying with the ‘caring’ job nature (Cross and Bagilhole, 2002). Yet, researchers also caution against these reconstructed masculinities, as they observe no substantial transfiguration of gender boundaries and dominance at work. Instead, they assert that men seem to refashion their masculine ideals and practices, such as selectively appropriating feminine skills and displaying emotional adeptness, to meet the changing demands of the new economy (Cross and Bagilhole, 2002; Huppatz and Goodwin, 2013; Simpson, 2004), particularly those from the health and service sectors (Cottingham, 2017, 2019). To address the new complexities of occupational gender inequalities, Huppatz and Goodwin’s (2013) concept of ‘gender capital’ (p. 203) is useful; it is conceptualized as a non-essential, fluid resource to be utilized by women and men in diverse ways. It effectively directs researchers to consider the ways that ‘femininity may be a necessary resource for men in femininized occupations’ and ‘both masculine and feminine capitals can be wielded by men operating in the new economy’ (Huppatz and Goodwin, 2013: 305).

The above studies have greatly advanced our understanding of gender dynamics in non-traditional occupations. However, their significance and validity are somewhat limited, as theoretical and empirical discussions mainly drawn on Western capitalist contexts, where hegemonic masculinity is now recognized as being mainly associated with White, middle class, heterosexual men (Cottingham, 2019; Wingfield and Myles, 2014), and where recent economic restructuring has struck and dislocated traditional masculinities, especially those of the working class (Walker and Roberts, 2017). It is unclear how and in what ways non-Western male nurses (specifically, Chinese men in this study) negotiate masculinities at work, where the forms and meanings of hegemonic masculinity can differ and change, and where authorities have been active in regulating nursing training and practices.

Nursing, male nurses, and hegemonic masculine ideals in China

In China, the health care system, including its hospitals and health care providers, was centrally managed and financed but has undergone significant changes after the launch of market reforms since the 1980s. An important development is the growth of private hospital, which had its numbers increased from 6240 in 2009 to 22,424 in 2019, and accounted for 65% of the total hospitals (National Health Commission of the People’s Republic of China, 2020). Meanwhile, while public hospitals receive less subsides from the central government, they now are allowed to generate revenues by charging patient-fees and higher markup on non-basic drugs, which can be used to compensate medical staff with bonus (Qian et al., 2019). Therefore, tertiary and secondary public hospitals – larger public hospitals located in key provinces or cities – remain to be the most attractive and stable career options for doctors and nurses (Meng et al., 2015).

Despite these deregulation initiatives, the central government retains control of the employment and training of medical professionals (Qian et al., 2019). Since 1998, to meet the rising demands of quality medical staff, China rapidly expanded its tertiary education system by integrating medical and nursing schools within comprehensive universities (Anand et al., 2008). This has successfully increased the number of medical doctors, but the number of registered nurses remains low. In 2019, only 23.6% of registered nurses had completed undergraduate training (National Health Commission of the People’s Republic of China, 2020). The main reason is because nursing is a low-status job in China, which is characterized by a heavy workload, low wages, and poor working conditions (Yang and Hao, 2018). It is also a common prejudice to regard nurses as less important than other health professionals, and to perceive the skills required from nurses as simple, superficial, and mundane (Wang et al., 2011). These factors explain why China has more doctors than nurses (Anand et al., 2008).

China has also experienced a severe shortage of male nurses. Same as western countries which have used media campaigns to attract male recruits (see Clow et al., 2015), Chinese male nurses have been presented as ‘Xiang Bobo’ (scarce resources), who are highly sought after by hospitals even before their graduation (Wang et al., 2011). There is, however, a unique recruitment strategy in this post-socialist country, which is the assignation of male university applicants to nursing programs. In China, students have to file an application form indicating their preferred major after the results of the highly competitive Gaokao (the National College Entrance Examination) have been released. To enhance their chances of getting into their preferred university, students with marginal scores will often choose an option that allows the university to assign them a major. However, a great number of male nursing students were found to have taken their nursing major involuntarily (Fang and Jian, 2007; Wang et al., 2011), and most of these ‘reluctant students’ did not enter the nursing profession after graduation (Fang and Jian, 2007). Hence, despite the efforts, the number of male registered nurses remained low, which increased slightly from 1.7% in 2009 to 2.6% in 2019 (National Health Commission of the People’s Republic of China, 2020).

Chinese academics are equally concerned about the severe shortage of male nurses. To retain male recruits in the feminized profession of nursing, they have suggested channeling minority men into administrative positions and compensating them for undertaking an unconventional career choice (Fang and Jian, 2007; Wang et al., 2011). These suggestions warrant a closer examination of the challenges to masculinity experienced by male nurses at work and in wider society.

Normative masculine ideals in China have undergone significant changes since the late 1970s. In Mao’s era, the masculine ideal deemphasized masculinity by stressing a collectivist ethos (Cao and Lin, 2019). In post-Mao China, following successive market reforms and further integration into the global economy, China has experienced a dramatic growth in material wealth and consumerism, which has further accentuated the importance of formal education and personal accomplishment (Liu, 2019). These developments promote a new discourse of desirable masculinity, which places stronger emphasis on entrepreneurial spirit, competitiveness, achievement, wealth, consumer power, taste, and self-reliance (Hird, 2016; Song and Hird, 2014). This new discourse valorizes the importance of economic success and its attendant elements, including wealth, income, professional excellence, and social mobility, in defining ‘desirable’ manhood. Therefore, multiple masculinities exist in contemporary China, yet ‘entrepreneurial masculinity’ – attainable mainly by an elite group of highly educated, accomplished, white-collar professionals – is the most culturally prestigious, and thus hegemonic, form of masculinity that most men try to emulate but may not succeed at attaining (Chen, 2019a; Hird, 2016: 142; Liu, 2019: 299).

Nevertheless, economic success may make a man respectable, but a ‘chenggong nanren’ (successful man) needs to also perform his family responsibilities well to accomplish his masculinity (Liu, 2019). As in many other countries, the breadwinner role is important in defining a Chinese man’s identity (Chen, 2019b; Kong, 2019; Liu, 2019) and has two areas of cultural distinctiveness. First, the breadwinner’s masculinity, once alleviated by Mao’s planned economy (Cao and Lin, 2019), was revitalized by the state, which buttressed it with a discourse of ‘natural sex differences’ to strengthen the new masculine ideal in order to promote economic development and social stability (Hird, 2016; Liu, 2019). Therefore, under China’s new economy, as ‘the pillar of the family’, men have to provide not only the basics but also ‘a good life’ for their family, including material comfort, educational resources, and developmental opportunities for their offspring (Cao and Lin, 2019; Liu, 2019: 306).

Second, the cultural norm of filial piety persists in contemporary China, which makes inter-generational relationships, particularly the role of the ‘filial son’, a unique demand in Chinese masculinity, regardless of men’s social class, age, and migration status (Choi and Peng, 2016; Lin, 2013). In the past, a filial man was obliged to satisfy his parents’ needs, defer to their wishes, and elevate their status in the community. In post-socialist China, men born after the 1980s are likely the only child in their families and are expected to also win honor for their parents by aspiring to entrepreneurial masculinity and achieving educational and economic success (Liu, 2019).

In short, a ‘successful man’ in post-socialist China has to both aspire to the economic success emphasized in the idea of entrepreneurial masculinity and satisfy the continued and renewed demands made by filial and family responsibilities. It is against these new hegemonic masculine ideals that Chinese male nurses in our study negotiate their masculinities. How do they manage, negotiate, and reconstruct their masculinities in a feminized job while being pushed to become entrepreneurial, accomplished, and responsible men in an increasingly market-driven economy?

Methodology

This article draws on in-depth interviews with 12 registered Chinese male nurses. In China, working conditions and pay for nurses vary widely, depending on location, qualifications, the size of the hospital, and the work unit. Being unable to consider many variations in an exploratory study, we decided to recruit our interviewees from a public hospital in Guangzhou for a closer examination. The case study method employed is an established approach for interrogating previously unexamined research questions (Yin, 2009: 5). Our choice of a big city’s public hospital was influenced by the general profile identified by a recent large-scale survey of registered male nurses (Chinese Nursing Association, 2017), in which the majority of respondents (n = 10,676) worked in public hospitals in the following three major cities: Beijing, Shanghai, and Guangzhou. The case hospital had about 1500 nurses, of whom fewer than 100 (5.5%) were male. In 2019, 5.5% out of all male nurses and 5.9% out of all female nurses were head nurses.

Interviewees were recruited through purposive and snowball sampling. Using her personal network, one of the authors was able to recruit several male nurses in this hospital, who later introduced her to their colleagues. As a small-scale exploratory study, we restricted male interviewees to registered nurses and degree holders who had at least 4 years of working experience, to ensure that they had been in the profession long enough to contemplate their future career development. Meanwhile, we were mindful of maximizing the diversity of male interviewees in terms of work units, positions, and years of work experience. We purposely looked for male nurses from ‘less masculine’ units such as midwifery or the General Ward but without success. This is because, as we shall discuss below, the hospital authorities did not allocate men to those units. We reached data saturation in relation to male nurses’ masculinities after 10 cases were interviewed and analyzed, so we conducted two more interviews to confirm that no new information or themes were observed.

In total, 12 male nurses were interviewed in 2019. They were aged between 27 and 35 years, born in the 1980s and early 1990s, and were mostly the only child in their families. While the majority were from urban middle-income families, two were from rural farming households. Our interviewees had been nurses in the case hospital for 4–12 years. Two were team leaders and two were head nurses, who were promoted 1 or 2 years ago. All except one were married, and all identified themselves as Han – the main ethnic group in China. At the time of interview, three worked in the Emergency Room (ER), three were in the Hemodialysis Department (HD), two were from the ICU, and the rest worked in the Cardiology Intensive Care, Cardiac Catheterization Lab, Operating Room, and Radiology. As our male interviewees were university graduates with substantial working experiences, who work in specialized work units in a city’s public hospital, so their average monthly income is considered high, ranging from 9000 to 12,000 yuan (US$1400–1868).

Interviews were semi-structured and covered themes including reasons for joining the profession, work experiences, difficulties, and privileges experienced at work because of their gender, relationships with colleagues, and career aspirations. All of the interviews were conducted in Putonghua and took place in cafés near the hospital or in offices provided by the interviewees. Each interview lasted between 40 minutes and 1 hour. Ethical approval was obtained from the university ethical review committee. All participants signed the consent forms and allowed us to audio-record the interviews, which were later transcribed verbatim, and translated into English.

The second author, a young female university student, conducted the interviews. We initially worried that male interviewees might be reluctant to express their views to a female interviewer, as building rapport in a cross-gender interview could be challenging (Simpson, 2004; Sallee and Harris, 2001). However, most interviewees were keen to share. Probably perceiving the interviewer as an inexperienced young woman with a non-nursing background, our interviewees behaved like knowledgeable elder brothers or uncles, who patiently explained their job duties and working relationships. It was equally possible that these male nurses tried to construct their masculine identity in front of a young female interviewer when they aired their grievances and recounted their aspirations. Incidentally, the interviewer’s subordinate role, whether it be her age, gender, or professional background, worked to her advantage in this cross-gender interview setting.

Based on Mason’s (2002) ‘literal and interpretative readings’ (p. 149), we first read the transcripts through several times, paying close attention to the words and language used, and the meanings behind the narratives. Then, guided by the principles of an abductive analytical approach (Timmermans and Tavory, 2012), we reviewed back-and-forth between studies on masculinities and the data to further develop our understanding of the ways Chinese male nurses negotiate masculinities. In the following discussions, we focus on the following three themes: nursing as a career choice, work experiences, and job aspiration. To protect anonymity, all names used in this article are pseudonyms.

Nursing as an involuntary choice and an embarrassment

As the Chinese authorities have improved the pay and job prospects of trained nurses, we thought more men might now regard nursing as a viable career option. Nevertheless, only Jianhui, who is one of the two rural interviewees in this study, expressed satisfaction:

My Gaokao scores were not good enough to get into professional programs, so my high school teacher recommended that I took up nursing, as it was easier for a man to get a job in this profession after graduation . . . My parents were from the village, so they just wanted me to get a job in the city. Furthermore, in the village, my salary is considered high and my job stable, so my parents were happy.

In contrast, the rest of the interviewees were frustrated or uneasy when discussing nursing as their university major and career ‘choice’ (see also Fang and Jian, 2007; Wang et al., 2011). Our interviewees told us that they were assigned to nursing programs by their universities or strategically chose a nursing major to get into their preferred universities. They explained that they would have studied clinical medicine, pharmacy, engineering, or finance – more prestigious university majors – if their Gaokao scores had been higher. Zifeng, a head nurse at the time of interview, still recalled his nursing major experiences with bitterness:

I was assigned to study nursing. I did not have good enough Gaokao scores to get into my first choice (clinical medicine). In those four years of study, I kept thinking of changing to another major, but the university did not allow me to do so . . . I remember having internships with medical students in hospitals. The professors allowed those medical students to take part in operations and offer opinions but we nursing trainees just stood there as if we were their followers. We underwent similar years of training but were treated very differently.

While Zifeng complained about the lower status accorded to the nursing profession among medical staff, Yiming and Kaijun revealed other sources of frustration:

My family asked me if I had to clean patients’ urine and stool. I felt that they had negative perceptions about my job. (Yiming, 27 years, became a nurse in 2015)

My brother thought nurses did not have much to do except give injections and distribute medicine. He also felt that tasks such as giving injections, distributing medicine, looking after patients, and cleaning their stool and urine should be women’s business. Rather than taking us as technicians, he thought nursing was like a nanny’s job. (Kaijun, 30 years, became a nurse in 2012)

These male nurses are clearly dismayed because members of the public, including family members, have misperceptions about their nursing work; they culturally devalue it and regard it as a demeaning low-skilled job. The remarks of Kaijun’s brother also underscore a further devaluation; he dismissed nursing skills and relegated bedside care, especially those regarding bodily fluids and waste, to women’s work and, at worst, a nanny’s responsibilities (see also Fisher, 2009). These devaluation and stigmatization explain why our male interviewees preferred telling others that ‘I work in a hospital’, rather than ‘I am a nurse’.

However, the male nurses felt stigmatized not simply because the nursing profession threatened their manliness. Their narratives also reveal a culturally specific stigma: Nursing as a university major or a job fails to help these filial sons to win face – honor and status – in the eyes of their families, and hence, undermines their competence as Chinese men (Lin, 2013, 2019). Xuan, another rural participant in our study, stated frankly that he cared less about how others saw him than about his mum, who, sadly, ‘couldn’t accept the fact that I am a nurse. She wished I could be a doctor and have a higher status’. Pressure felt by male interviewees from urban families seemed to be equally, if not more, intense. Lei, the only son from an urban family in northern China, could not conceal his shame. He had aspired to be an engineer and mentioned ‘embarrassment’ twice when talking about his career ‘choice’:

In the beginning, my family felt too embarrassed to tell others that I was a nurse. They felt that they had lost face because their son ended up as a nurse. I am a northerner . . . I did not know how to tell others either at first, as I felt so embarrassed.

Masculinities at work

Once they have entered a female-dominated job, men tend to defend their masculinities by gravitating toward occupational spaces or specialties (see Lupton, 2000; Snyder and Green, 2008). Nevertheless, nurses in China do not choose their work units, but accept the hospital’s assignment. Jun, who has worked in HD since he joined the hospital 10 years ago, explained to us the arrangement:

We got no choice. The hospital assigns male and female nurses to a department. Usually, males are allocated to the ER, the ICU, the HD, and the Cardiovascular Department. You will not find a male nurse in the General Ward. We usually work in those more specialized departments.

Other interviewees concurred with his view; they were allocated to different specialized units and seldom to the General Ward. Nonetheless, all male interviewees seemed to be satisfied with this arrangement:

The ICU is more suitable for men. Its job nature is of high intensity. We need to use CPR (cardiopulmonary resuscitation) to rescue patients, which is much harder for women to operate. The ICU has many other machines, and men are more familiar with the technical equipment. (Yiming, worked in the ICU for 4 years)

The ICU is good as we do not need to handle patients’ family members. We don’t have too much contact with patients either, as most of them are intubated . . . I have a greater sense of success after moving to the Cardiac Catheterization Lab (CCL). Before that, I was just a nurse. I now tell people that I am doing interventional surgery or I am a technician. (Kaijun, worked in a Cardiology ICU for 5 years, then moved to the CCL 2 years ago)

I think the specialized departments are far more appropriate for men. Working in the Operation Room (OR) is relatively simple. I only have to get along with patients, doctors, and other nurses. However, in the General Ward, things are much more complicated. Perhaps men are naturally bad at handling complex relationships . . . I think male nurses in the OR also adapt much faster than women, especially when operating technical devices and installing complex medical equipment. Women find these technical tasks complicated, but we experience great satisfaction operating them . . . They help demonstrate our role – the role of being a man. (Guowei, worked in the OR for 9 years, team leader)

The male interviewees were excited at defending not only their assignments in those specialized departments but their masculine skills and contributions in a female-dominated job. Like their Western counterparts (e.g. Cross and Bagilhole, 2002; Snyder and Green, 2008), they accomplished a sense of identity and importance – their role as a man – by framing those units as requiring ‘masculine’ qualities, such as high-intensity work, focus, and technical competence. For instance, Kaijun, who was once mocked for doing what was perceived as a nanny’s job, now found himself transformed into a technician after moving to a more specialized unit. Their framing, as a strategy of differentiation, clearly reinforces gender differences as essential and binary (Lupton, 2000; Snyder and Green, 2008) – men are naturally bad at handling complex relationships and women are naturally poor with technology – and help establish ‘men’s jobs’ and ‘women’s jobs’ within the nursing profession. Differentiation aside, this strategy also shields men from emotional labor in an emotionally demanding profession (Cottingham et al., 2015). By clustering in specialized departments and interacting mainly with doctors, nurses, and machines, male nurses reportedly minimized their contact with patients and hence experienced fewer negative emotional expressions and demands from patients and their relatives.

Male nurses’ attempts to distance themselves from the General Ward deserve a closer examination:

When I had an internship in a general ward, I felt I was unable to properly display my power and abilities. The HD is different. It’s very professional . . . Probably, I am not a fussy enough person and so I would not have been able to adapt to the job duties required of those working in the General Ward. (Ming, worked in the HD for 7 years, head nurse)

If a man were to work in the General Ward, holding a plate of needles and medicines, he would be just like a woman. Then, how can he have any sense of self-achievement? It would be very depressing for him. He may leave . . . Things are very different in the ER. Male nurses here specialize in rescue operation and our rescue skills are very professional. (Zifeng, worked in the ER for 12 years, head nurse)

Ming and Zifeng, the two head nurses, clearly asserted that men should avoid the General Ward, as they saw it as a place of emasculation, where men’s power, ability, or self-achievement would be stifled. In resisting feminization and justifying men’s presence in the HR and ER, they asserted men’s readiness to offer professionalism and specialized skills. Moreover, they reconstituted the job nature of the General Ward by devaluing it as a low-skilled job and degrading nurses there as fussy women who cared less about self-improvement. Consequently, a gendered hierarchy of nursing work is established, in which (male) nurses with technical skills and technological competence, associated with specialized units, are deemed superior to (female) workers who do emotional labor and care work, associated with the General Ward. The male nurses disliked the public and their family members for misunderstanding their profession as a low-skilled women’s job. Nevertheless, the masculinity strategies at work – differentiation from female colleagues, distancing from emotional labor, and reconstituting and depreciating the General Ward – perpetuate the cultural devaluation of nursing and reinforce occupational gender inequalities.

Yiming, the youngest male interviewee, also distanced himself from female colleagues. He found female nurses gossipy, and thought they talked about him behind his back if he did something wrong. He lamented that, even though he thought male nurses are more capable than female nurses, ‘I don’t think I have the ability to manage a group of women’.

Nevertheless, other interviewees claimed to get along well with female colleagues:

Male nurses are like a strong ‘lubricant’, as we help ease the tense relationships between female nurses. I still remember how, when I first started working at the HD, its atmosphere was gloomy and stressful. When male nurses are present, we make jokes, provide mediation, and the atmosphere is improved. (Ming, head nurse)

When I am on duty, female colleagues are more willing to cooperate and follow my lead. I think they find me more careful and professional than some women . . . They always say that it is good to be on shift with me. (Guowei, team leader)

Ming was proud of his emotional skills, as he has accomplished the role of mediator in a female-dominated workplace (see Cottingham et al., 2015). Similarly, Guowei sees himself as more careful and professional than women, and as successfully winning female colleagues’ cooperation and followership. These positive self-appraisals contradict some of the gender differences that male nurses constructed earlier, such as the belief that women are naturally better at handling complex relationships. While male nurses may present themselves as equally, if not more, caring than women, their emotional adeptness and emphatic approach seem to illuminate the possibility that men might reconfigure their masculine practices to meet situational demands (Cottingham, 2017: 274) and perform gender differently by wielding both masculine and feminine capital (Huppatz and Goodwin, 2013: 305). The fact that these men are seniors – team leaders and head nurses – also underscores femininity as a valuable resource in a female-dominated occupation, which men cannot avoid, but do selectively appropriate if they want to attain job advancement (Huppatz and Goodwin, 2013).

Negotiating entrepreneurial and breadwinner masculinities

Chinese academics (e.g. Wang et al., 2011) have suggested retaining male nurses by channeling them to administrative positions, but the career narratives of male interviewees complicate this recommendation. Ming and Zifeng affirmed their preparedness to exit the field completely, even though they were head nurses:

I am the manager of this department, but my aspiration is to spread my expertise to the whole city and even to the whole Guangdong province . . . I face the enormous pressure of being a breadwinner . . . People make different choices at different stages. I may leave for another hospital if it gives me a better offer, or if friends of mine invite me to participate in a business venture. In the absence of a better offer, I will stay in this position and continue to do my best. (Ming, head nurse)

I don’t have any ambition to aspire to senior positions . . . However, if better job offers do present themselves, I will consider them. ‘A man should dream big and aim high’. If possible, I want to branch out and have adventures. In the past 10 years, I have taken the civil service examination on several occasions and applied for various other jobs. (Zifeng, head nurse)

Ming took pride in his knowledge and leadership but felt that his current position and salary could not sustain his ambition or help him perform his breadwinner’s role well. Zifeng’s ambivalent view on promotion is intriguing. He told us that he applied for a senior position, following the advice of his supervisors, to prove his ambition. However, the cost of assuming this new role outweighed its rewards, as he now had less time to perfect his clinical skills and ‘attend my kids’ school meetings or travel with them. I feel really bad’. More importantly, Zifeng admitted that, after all these years, he still did not see nursing as an ideal job for real men, who should aim to achieve positions within more challenging, prestigious, and promising fields, such as business or civil service. The reservation and ambivalence in these men’s aspirations are revealing. Chinese men not only have to negotiate their manliness as male nurses at work; they also have to measure up to the hegemonic ideal of entrepreneurial masculinity that is attainable by an elite group of white-collar professionals (Cao and Lin, 2019; Liu, 2019). Ostensibly, the prospect of a managerial position in nursing – a semi-profession with stable income – is insufficient in itself to retain ambitious men.

The pressures of living up to the ideal of a good breadwinner are also evident in the testimonies of other male nurses. Lei, the northerner who was once embarrassed by his nursing job, admitted that he was more ambitious when he first started working, but soon realized that promotion was not so easy. On the day of the interview, he had received a complaint from a patient and sounded particularly frustrated:

I think about switching jobs every day. I believe every man here has similar thoughts. Our work is full of difficulties: We meet angry, unreasonable patients and their family members; we receive criticisms from superiors for wrongdoing; and we have to accept OT and night shifts. Every day I ask myself, ‘what the heck am I doing here?’ However, I could not bear the loss of income if I were to switch jobs. I have to support my parents and kids. (Lei, 29 years, married)

Yiming, the young man who found female colleagues were not easy to get along with, felt promotion was equally challenging. At the time of interview, his greatest struggle was proving himself as a capable breadwinner who could provide ‘a good life’ for his future family.

We male nurses face great economic pressures. We have a stable income, but the cost of housing has risen rapidly in recent years. This puts a lot of pressure on me . . . My girlfriend’s parents are very concerned about whether or not I could financially provide for their daughter after we are married. I have not considered switching jobs, but I do have another income from my sideline. Honestly, quite a number of male nurses have sidelines because of the great financial pressures of purchasing a flat in the current housing market. (Yiming, 27 years, in a relationship)

It seems common for frustrated men in western developed economies to leave ‘women’s jobs’ for more ‘masculine’ professions (Torre, 2018). Paradoxically, the stable income of nursing in China holds depressed male nurses back from switching jobs, and allows less ‘ambitious’ men to take up a sideline – bringing in an extra income – to accomplish and protect their masculinity (see also Chen, 2019b). Jun and Kaijun are further illustrations of this issue. Jun worked as a nurse for almost 10 years, but told us that nursing could not bring him any sense of success. He stayed on and found satisfaction elsewhere, as he preferred ‘to live a simple life’. Kaijun’s experience was slightly different. He was content working as a ‘technician’ in the Cardia Catheterization Lab but was pushed by his wife to go further, and he turned to investment:

I only take this as a job to make a living. I never think about promotion; it is not my target. I prefer to live a simple life . . . I think that, no matter what job you are doing, you should always look out for new possibilities if you have time. You should not focus on nursing alone. I plan to make some investments soon. (Jun, 34 years, married)

I only treat it as a job and do not devote much time to it. Yes, my achievement could be greater if I worked harder. I don’t have any interest in or enough energy to start over and develop another career. I am the kind of person who enjoys stability. My wife said I was a coward . . . I have interests in finance, stocks, and funds. Honestly, I spend a lot more time and energy on investment than on nursing. (Kaijun, 30 years, married)

These candid confessions – desire (or pressure) to strive for personal success, self-actualization, wealth accumulation, and family recognition – reveal the normative power of entrepreneurial and breadwinner masculinities prevalent in contemporary China and the difficulties that middle-income male nurses have to grapple. The pursuit of financial investment as a sideline seems to help these men to stay on as a nurse and ‘halt loss’ (see Huppatz and Goodwin, 2013), but the viability of this strategy and its potential costs – their lessened commitment – to the caring profession remain to be seen.

Discussion and conclusion

This article argues that more empirical studies from non-Western contexts are needed to illuminate the complex interplay of gender dynamics in different socio-economic contexts and the cultural specificity of (hegemonic) masculinity, and hence, enrich the Westernized discourse on occupational gender inequalities. In our analysis of Chinese male nurses’ narratives, the double devaluation of ‘women’s work’ clearly acts as a strong deterrent to men who cross over to female-dominated occupations in China (see also Williams, 2015). Despite the Chinese state’s efforts to improve job prospects, nursing remains denigrated as dirty work and as comprising trivial duties and irksome demands. It is deemed a low-skilled, low-status job that is best performed by nannies. Yet, Chinese men do not simply find their masculinity threatened when they have crossed over into a gender-atypical profession; they also encounter a culturally specific stigma. They feel embarrassed about being nurses, because nursing as a job fails to help them perform their filial responsibility (Lin, 2013), winning honor and status for their families, and hence, undermines their competence as ‘successful men’.

The pressures on Chinese men to accomplish masculine ideals are intense in post-socialist China. We are wary of the normative power of entrepreneurial masculinity, which places heavy emphasis on achievement, self-actualization, and wealth accumulation (Hird, 2016; Song and Hird, 2014), and the revitalized breadwinner masculinity, which stresses men as ‘the pillar of the family’, who have to provide a ‘good life’ for and gain status for their family members (Cao and Lin, 2019; Liu, 2019). In narrating their ambition and job aspiration, we find male nurses’ active engagement with and struggle to measure up against the hegemonic masculine ideals, who apparently are constrained by the middle-income and low social status of their semi-professional job. Yet, their narratives also reveal some interesting paradoxes. Recent studies in western contexts suggest that frustrated male workers in female-dominated occupations augment their masculinity by leaving for male-dominated jobs (Torre, 2018), whereas some men abandon traditional masculinity by settling in ‘women’s occupations’ (Simpson, 2004). Contrary to these observations, Chinese male nurses who have accomplished professional masculinity and are ascending the career ladder actively seek more prestigious and lucrative positions in the fields of business or the civil service. In contrast, those who are hard pressed to perform the role of a good provider and demonstrate manly ambition resolve their struggles and desires by pursuing sidelines along with their nursing job.

Although Chinese men are allocated to nursing specialties by the hospital, they actively defend their ability and contributions in a female-dominated job as their Western counterparts do (Cross and Bagilhole, 2002; Evans and Frank, 2003). Working in specialized departments, they frame these units as requiring ‘masculine’ qualities, such as high-intensity work and technical competence, that men naturally excel at, and view women as being naturally better at handling complex relationships (Lupton, 2000; Snyder and Green, 2008). This strategy not only reinforces gender differences as essential binaries, but also shields men from performing emotional labor to patients (Cottingham et al., 2015). We also find a less discussed strategy in the current literature; in their attempt to distance themselves from bedside caring, ‘body- and dirty-work’ (c.f. Fisher, 2009; Simpson, 2004), Chinese male nurses construct general wards as places of emasculation and reconstitute the nature of the job as mundane and trivial, hence denigrating the duties and skills of those working there. These masculine strategies have important implications; they are likely to further reinforce the cultural devaluation of nursing among members of the public, create a gendered hierarchy of nursing work, strengthen gender segregation within nursing, shield men from emotional labor, and disparage those working in general wards and doing emotional labor and bedside care work – where women are the majority. In short, they perpetuate male dominance in a female-dominated and emotionally demanding job.

Finally, there has been a revisit of the concept of the glass escalator in recent feminist scholarship (see Harvey Williams, 2013; Wingfield and Myles, 2014), suggesting the usefulness of intersectional framework and highlighting how White men may be the main beneficiaries. Our small-size exploratory study cannot address these concerns, as it has not fully addressed issues of age, class, ethnicity, and the rural-urban divide; however, the self-appraisals of the senior male nurses in this study seem to support Huppatz and Goodwin’s (2013) observation that men who successfully wield both masculine and feminine capital are likely to advance in female-dominated occupations. More intersectional, culturally diverse, and larger scale research will be needed to further develop these insights. Meanwhile, studies exploring the interactions between male nurses and physicians and hospital managers, male and female, will be equally desirable to unfold the complex gender dynamics in this female-dominated job.