Features

A few good men: where are all the Male CPs?

In some areas of nursing, men are commonplace, but community roles seem to remain largely off-limits. Journalist Phil Harris investigates.

'When I first said I wanted to become a health visitor, my colleagues just laughed at me.’

Ross Mawhinny was working in intensive care nursing – a field that has traditionally appealed more to male nursing staff. 

‘I’d been like a lot of other men in nursing, and had been attracted into roles like A&E and ITU. They seemed technical, with a bit of drama, and meant a chance to affect people’s lives and give a sense of achievement. 

‘I hadn’t thought about health visiting or community roles. But when I did my placement I was really struck by what they did and how they had to cope with the social challenges and the nature of the interventions.’

Ross decided to make the switch to health visiting after feeling his ITU career was stagnating, and is now one of only two practising male HVs in the whole of Northern Ireland, he reveals.

This picture of rarity is repeated across the UK. NMC figures show that for nursing as a whole there were 654,521 nurses on the register in September 2017, of which 73,902 (11.29%) were men.

But the proportion of men on the specialist community public health nursing part of the register is much lower. There are just 653 men out of a total of 28,996 (2.25%), and the percentage has been declining slowly yet steadily over the past few years (NMC, 2017).

What’s clear is that for many years, men in nursing have disproportionately gone into areas such as A&E, intensive care and mental health, and it is uncommon to find men working in community roles (for instance, see ‘Male CPs in numbers’, opposite). 

The data on the future workforce shows the situation isn’t set to change dramatically. Figures from the Higher Education Statistics Agency (HESA) for 2015-16 show there are 153,795 people studying nursing across the UK, of which 17,820 were male (11.6%) (HESA, 2017). Overall the proportion of males studying nursing has been declining since 2011-12.

The HESA figures also show there were 2340 people specifically studying community nursing, of which just 130 (5.5%) across the entire UK were male. Again, this proportion has been declining
 – from a high of 10.4% in 2008-9.

 

Barrier grief

So what is stopping more men from taking on nursing roles generally, and community roles in particular?

Mark Lees, lecturer in nursing at Edinburgh Napier University and a former HV, thinks there are several reasons, with old-fashioned views of male and female roles still being very powerful and significant. 

‘There is certainly still stigma in society and there is an expectation that men and women should have certain types of jobs,’ he says. ‘This means men are less likely to go into nursing as a whole. And then people just don’t think of jobs like health visiting being male roles. This can be hard to overcome, as some healthcare staff have the same expectations and views as wider society.’

Media coverage of child abuse, and paranoia about being considered an abuser, is also likely to act as a deterrent to many men.

‘I think it’s hard enough for men to overcome stigma about going into nursing,’ Mark says, ‘but if they also say they want to work with children and vulnerable families, then people may wonder what their motives are, and maybe even think they could be some sort of sexual deviant. And men are obviously very concerned about this.’

Ross adds: ‘I am very cognisant about abuse and am very careful about how I go about my role. The safety of the child has to be paramount. There are safeguards in place, and these are for me as well as the children and families I work with. I think this could put some men off. It has never felt like a barrier to me but I am careful.’

Ross also says that men may also take the view that community jobs are less appealing because the skills involved are not as portable as they are in other roles. 

‘I think men are more likely to think strategically in terms of their careers, and to plan for the future. Men often go into areas such as intensive care because they consider them to be passports to anywhere, such as working on cruise ships, in prisons or on virtually any type of ward, and moving to these situations wouldn’t be a problem.

‘But there is a perception that health visiting is more specialised and not as useful if you want to be flexible and move around in your career.’

Pay may also be a factor: equal pay for men and women is an ongoing and topical issue. Office for National Statistics figures show the median earnings of full-time male employees in the UK across all industries is £592 per week compared with £494 for women (ONS, 2017). 

Mark adds: ‘With all this in mind it’s probably not surprising that the numbers of men in community roles have not improved.’

 

Society reflection

Of course, community nursing is not alone in showing a dramatic gender imbalance. Teaching is also overwhelmingly a female profession – just 15% of primary school teachers are male, while the figure rises to 38% for secondary school teachers (Department for Education, 2016). 

There are even fewer men in roles such as teaching assistants (8% male) and support staff (18% male). Overall, just 20% of all school staff are male, and the proportion of male teachers and staff has been falling steadily over recent years.

Yet men make up 51.2% of the British population (World Bank, 2013) so is it right that some professions do not reflect wider society in terms of gender balance?

Dave Munday, a Unite in Health lead professional officer and health visitor says: ‘Clearly there should be more male staff in health visiting and school nursing, and perhaps there is a vicious circle whereby having hardly any men means there are few role models and then this means men are put off because they can’t see themselves doing the work.

‘But if we had some more positive male role models, this would help to blow away some of the stereotypes and show what a great career it can be for both men and women. I’m sure this applies to other female-dominated professions too. 

‘And it wasn’t too long ago that people thought of medicine as a career for men only, and that has completely changed.

So society can change the way it views these things.’

 

Boys bring benefits

Dave says it is a pity there are not more men in community roles as they can bring a different mindset and approach, and help families in slightly different ways.

For instance, Mark says that he worked with many deprived families in Glasgow, many of whom had a man as the primary caregiver because they were unemployed or unable to work, while their wives or girlfriends had full-time jobs. He revealed it was important for them to be able to ask practical questions in a matter-of-fact way without the embarrassment they may have felt with female staff. 

He also said that mothers often complimented him on his matter-of-fact and practical approach. ‘I had to have a different perspective,’ he says. 

‘I had no experience of giving birth so I would focus more on the immediate problems and the future – asking the women where do we go from here and how we can we realistically make things better now. I would set targets and encourage the mothers to look forward.’

Ross says that being a man has always felt beneficial in his role. ‘Dads have always responded well to me. They don’t leave the room and they feel able to talk to me about practical things like paternity allowances, and their fears and concerns.’

Ross says that the mothers on his caseload never have a problem with his gender, and once they get beyond their initial curiosity, they always welcome his help and perspective. 

‘They often ask early on if I have children myself, and at first I joke that I have hundreds in my caseload. But I then add that my partner and I have been trying but so far haven’t been able to
have children. 

‘This establishes that although I am a man doing an unusual role, I am just a normal person with feelings and issues like anyone else, and it also means that they are likely to be equally honest with me about their situation.’

Dave warns though against treating all male health visitors as ‘a homogenous blob’. He says: ‘We are all different, just as all female health visitors are different, and we all have our own personal circumstances and motivations. 

‘Personally I never had any doubt that I would end up working as a health visitor. When working as a nurse on a ward I always thought it would be much better to keep people well for as long as possible so they didn’t need to be in hospital. Health visiting was a route to do this with its focus on prevention and helping people to be healthy and well right from the start.’

 

Changing times

Mark is confident that the future will bring a better mix of male and female staff in community roles. 

‘I definitely think times are changing. In the past, men were expected to be standoffish about children and not be involved in childcare. Now they are able to show emotions and affection more in society now than they ever could before. 

‘There is an expectation that men are more involved in childcare now, and many are becoming stay-at-home dads. This means we could be raising a generation of male children who have good role models and who are happy and comfortable being affectionate and caring. This might in turn lead to society being more accepting of men in caring roles.’

While Ross thinks that if men can get beyond the barriers they would find the health visiting role very rewarding. ‘Roles like intensive care are technical and involve a full system approach and action, and many find that appealing,’ he says. 

‘But health visiting is more like detective work. You’re independent, and out there on your own. You’ve got to think on your feet, move quickly and solve problems. 

‘It should be a lot more appealing to men than many people think.’

Ross also highlights that it’s a specialty that is about long-term relationships, communication and the ability to build rapport, something that many men, like many women, are good at. 

Ultimately though, Ross believes that the gender of staff is not important: ‘The situation is challenging in terms of numbers of staff generally, and resources are few. So we need the best, whoever they are. Whether it’s men or women doesn’t matter. Ultimately people don’t care who’s looking after them, as long as they do their job well.’


What colleagues think...

The number of male CPs may reflect society views at large, for now, but what of fellow colleagues? And do their views have an impact?

The vast majority of female colleagues were highly supportive of nursing lecturer and former HV Mark Lees, treating him equally. But some were more suspicious:

‘I’ve had situations being the only man in the room on training courses with other health visitors, when no one would sit next to me,’ he says. ‘But I think it’s probably just a natural suspicion of something different. I’d have to start a conversation but then everything was fine.’

It tended to be older female staff, perhaps with more traditional views, who were more likely to keep their distance. 

‘I often got the feeling they felt health visiting wasn’t a suitable role for a man and they didn’t approve. But it’s maybe not that surprising, given the strong society conventions about gender roles. 

‘Lots of male and female staff don’t think community roles are for men. It was up to me to show them I could be as skilled and professional as any woman.’

Men tend to be encouraged to move away from frontline care into management or academic roles, found HV in Northern Ireland Ross Mawhinny:

‘People have often said to me: “You’re a man so you’ll go far,” and there has always been a perception I will end up in a management job,’ he says. ‘I just want to be on the shop floor, although I am also attracted to the idea of helping to teach, develop and inspire others. 

‘I’ve always thought promotions should be on merit, and that gender shouldn’t matter. But yes, I’m very motivated.’


Putting the word out

While views of gender roles may not change overnight, more can certainly be done to attract men to the profession.

For example, the government could promote it to men. Mark Lees says: ‘There’s not a lot of activity going on to change things. Certainly health visiting is not promoted that way. You don’t see men in any advertising or promotion about health visiting – it’s always young, white women.’

Ross Mawhinny believes the profession could learn from the police and their efforts to drive up recruitment from all parts of society – black, white, old, young, male, female. 

Educational establishments can also make a difference, and some are stepping up their efforts. Edinburgh Napier University is actively promoting nursing to men at its recruitment events, and working with student and qualified male nurses to research how to make the profession more attractive to men, and how barriers can be overcome. Findings so far on what appeals to men about a nursing career include that it’s seen as rewarding (Pollock, 2017).

Suggestions to get the right message out there also include hosting school pupil visits, and speaking to advisers who influence their career choices.


Have your say

Why do you think there aren’t more men working in CP professions? What value do
you think men could add? What can be done to attract more of the male workforce
to community health? Whatever your view on the topic, let us know. Tweet us on
@CommPrac and use #menCP to read other member’s views.


References

Department for Education. (2016). School Workforce in England: November 2015. See: www.gov.uk/government/uploads/system/uploads/attachment_data/file/533618/SFR21_2016_MainText.pdf (accessed 17 January 2018).

HESA. (2017) HESA student record. HESA: Cheltenham.

NHS Digital. (2017) NHS Hospital and Community Health Services (HCHS): Qualified nurses and health visitors by Area and Gender in NHS Trusts and CCGs in England as at 30 September 2014 – 2016 and 31 August 2017. NHS Health and Social Care Information Centre: London.

NMC. (2017) Register information (September 2013 to September 2017). NMC: London. Provided by Press office, Ben Jackson.

Office for National Statistics. (2017) Annual Survey of Hours and Earnings: 2017 provisional and 2016 revised results. See: www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/bulletins/annualsurveyofhoursandearnings/2017provisionaland2016revisedresults#average-earnings (accessed 17 January 2018).

Pollock, C.(2017) Why more men should consider nursing.
See scotsman.com/news/christine-pollock-why-more-men-should-consider-nursing-1-4539908 (accessed 26 January 2018).

World Bank. (2013) Gender statistics: highlights from 2012 world development report. See: databank.worldbank.org/data/reports.aspx?source=gender-statistics-:-highlights-from-2012-world-development-report (accessed 17 January 2018).

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