The shifting gender landscape in nursing: Trends, challenges, and implications for healthcare

From the time Florence Nightingale donned her first uniform to care for the soldiers of the Crimean War, nursing has been considered a female role.^[1] Though born in London, her impact on nursing in America is significant, and this influence has helped sustain the tradition of gendered expectations for nurses across the pond. Her Notes on Nursing has served as the foundation of nursing programs across the United States (U.S.).^[1] In spite of the stereotypes and emasculations, male nurses have made great strides within the nursing profession. James Derham, a former slave owned by several doctors, was the first African American (AA) to formally be recognized as a medical practitioner in the U.S.^[2] Derham would begin his own medical practice after gaining his freedom in 1783.

Historically, men played a significant role in the early development of nursing in the United States. During the 1700’s, as American hospitals began to emerge, nursing responsibilities were primarily carried out by men, commonly referred to as stewards.^[3] These individuals functioned largely as orderlies and were predominantly employed in military settings, providing care to soldiers wounded in combat.^[4] This pattern persisted until the onset of the Civil War in 1861. As increasing numbers of men were recruited for military service, a shortage of male caregivers created opportunities for women to assume nursing responsibilities. Women began volunteering to care for the sick and injured, marking a transformative moment in the history of nursing. This shift ultimately contributed to the establishment of women as the predominant workforce within the nursing profession.^[3]

By 1901, men were completely excluded from nursing due to the reorganization of the United States Army Corps, which officially banned men from the profession.^[4] This discriminatory policy continued until 1955 when Congress passed a law authorizing commissions for male nurses in the U.S. Army Reserve for assignment to the Army Nurse Corps Branch and extended this law, in 1966, to the regular army.^[4] On October 6, 1955, Lieutenant L. T. Lyons became the first male nurse to be commissioned as a second lieutenant in the Army Nurse Corps Reserve in the United States. One of his initial assignments was serving as a nurse anesthetist. This historic achievement marked the elimination of gender-based barriers that had long prevented men from serving as commissioned officers in the Army Nurse Corps. The policy change followed more than five decades of advocacy, legislative efforts, and numerous appeals to Congress aimed at securing equal opportunities for men in military nursing.^[5]

Today, globally, there are approximately 29 million nurses, and the World Health Organization predicts a shortage of 4.5 million nurses by 2030.^[6] Of these 29 million nurses, men account for nearly 12% of all licensed practical nurses (LPNs), registered nurses (RNs), and nurse practitioners (NPs) worldwide. While the number of male nurses has increased in the last decade by more than 59%, there continues to be stigma associated with what some think is “women’s work”. Male LPN increased by approximately 112%, NP increased by 108%, and RNs by 51%.^[7]

In the United States, nursing is the largest healthcare profession, boasting approximately 4.7 million RNs, and 89% of them are actively employed. However, within the next five years, over one-quarter of nurses intend to retire.^[8] The average age of nurses in the workforce is 46 years. In 2022, the racial composition of nurses was as follows: 80% Caucasian, 7.4% Asian, 6.9% Hispanic, 6.3% African American, 0.4% Native American or Alaska Native, and 0.4% Hawaiian or Pacific Islander. Additionally, men represented 11.2% of the nursing workforce in 2022, up from 9.4% in 2020.^[8] The American Association of Colleges of Nursing (AACN) states that it has been a high priority to increase the number of men in nursing to create more representation and inclusion in the nursing profession. The Bureau of Labor Statistics did report an increase in the percentage of male nurses from 2019-2021, with a decrease noted in 2022. By 2022, male nurses made up roughly 12% of the national nursing workforce. Although the percentage of males in nursing has risen consistently over the past 20 years, this growth has plateaued over the past three years^[9] (see Figure 1).

Figure 1.

Percentage of male nurses employed in the U.S.

Nationally, the number of male nurses varies widely by state. The U.S. Department of Health and Human Services published a report in December 2014 that examines the future of the nursing workforce from 2012 through 2025 by state and region. The South region also varies widely by state, but most of the southern states show a surplus of nurses by 2025, with only a few showing negative results,^[10] see Table 1. According to the Mississippi Board of Nursing (MBON) statistics for the state, there are currently 46,063 female and 5,614 male RNs. The number of male RNs in Mississippi (MS) mirrors the national average. The number of LPN nurses in MS varies widely from RNs. There are 13,475 female nurses and 773 male nurses in MS, with men only accounting for 6% of the total LPN workforce. Additionally, there are 6,694 female advanced practice registered nurses (APRNs) and 793 male APRNs. Again, males make up only 12% of the workforce. With the advanced degree of a certified registered nurse anesthetist (CRNA), females and males are evenly distributed between 513 and 515, respectively^[11] (see Figure 2). Data from AACN’s Annual Survey of baccalaureate and higher degree programs shows that the proportion of male nurses enrolled in nursing programs varies by degree level. Across different program levels, the number of male students has remained relatively steady over the past five years. Contrary to these student trends, there has been an increase in the percentage of male faculty, which rose from 6.5% in 2018 to 7.8% in 2022,^[8] (see Figure 3).

Figure 2.

Mississippi female and male nursing by certification

Figure 3.

Percentage of male nurses enrolled in nursing programs

Male nurses encounter various challenges in the workplace.^{[12,13,14,15,16,17,18]} While several studies indicate that men are often overrepresented in senior positions and higher-paying specialties, they also face issues such as gender stereotyping, prejudice, and discrimination.^[16] For example, Smith et al. (2021) and Williams (1995) note that challenges to professional identity can mitigate the structural advantages men may have when it comes to promotions. Additionally, Zhang and Tu (2020) describe how improved promotion prospects in China coexist with a low professional status and public prejudice against male nurses. Cultural and organizational expectations often steer male nurses toward technical or managerial roles rather than clinical or caring functions.^[12,19] Male nurses also report significant experiences of gender stereotyping, resulting in feelings of exclusion and role strain.^[12] For instance, they are often assigned physically demanding tasks or viewed with suspicion in intimate patient care situations.^[13] Such dynamics create a persistent tension between personal identity and professional expectations, which may ultimately affect employee retention.^[18,20] Additionally, in certain cultural contexts, such as China, male nurses face public prejudice and low professional status, further complicating their career advancement.^[18]

Moreover, male nurses report difficulty providing patient care.^[13,14,17] Studies by Inoue et al. (2006) and Vatandost et al. (2020) indicate that delivering intimate care, particularly to female patients, can evoke discomfort and negative emotions. Evans (2002) and Vatandost et al. (2020) highlight that the sexualization of male touch leads to suspicion and an increased need for caution, a challenge that is further complicated by cultural, religious, and societal norms favoring same-gender care.

Workplace dynamics also complicate professional and social integration for male nurses.^[12,15,18] Numerous studies detail feelings of exclusion from social interactions and a lack of support tailored to their needs.^[12,15] Limited evidence regarding educational challenges suggests that inadequate preparation for the gendered aspects of care can undermine male nurses’ professional identities.^[14] The literature suggests that increasing the number of male nursing faculty is an important strategy for preparing and retaining male nurses within the profession. Male educators and mentors provide visible role models, help normalize men’s presence in nursing, and offer guidance in navigating the gendered challenges that can undermine professional identity formation.^[14,20] Greater representation of male faculty may also foster more inclusive learning environments and broaden teaching perspectives, contributing to improved recruitment, educational experiences, and retention of male nursing students.^[20,21] Many studies note high-impact challenges, yet explicit coping strategies are rarely discussed, apart from calls for systemic or organizational change.^{[12,13,15,16,17,18,19,20]}

Despite these challenges, some male nurses achieve professional success. However, this success is unevenly distributed and is often tied to the pressure to adhere to traditional masculine roles.^[15,16] Addressing these gender-based challenges is vital for creating a more inclusive and equitable nursing workforce. Even though the challenges faced by male nurses include professional discrimination, difficulties in providing intimate care, and social isolation in the workplace, there is a steady uptick in men entering the field. Men are increasingly entering nursing for various practical, social, and personal reasons. One major factor is job stability and salary. Nursing is among the most secure healthcare careers, with strong demand across all specialties and regions.^[22] For many men, the opportunity to earn a solid income while working in a respected, meaningful profession is a key motivator.^[23] The expanding scope of advanced practice roles, such as nurse anesthetists, NPs, and flight nurses, has attracted men interested in technical, autonomous, and high-acuity work environments.^[24] These roles often involve leadership, procedural skills, and rapid decision-making, aligning with the interests of many male nurses.^[25] Social perceptions of nursing are also evolving. Men increasingly view nursing as a career that allows them to make a difference, care for others, and participate in a team-oriented healthcare setting.^[26] Campaigns to increase gender diversity in nursing have helped reduce stigma and promote awareness of the profession’s value for both men and women. Furthermore, personal values and life experiences such as caring for a loved one or military medical service often influence men to pursue nursing, reinforcing the idea that nursing is a viable career and a vocation rooted in service and compassion.^[27]

Although the number of men entering nursing continues to increase, men remain underrepresented in the profession, accounting for approximately 11%-12% of the U.S. nursing workforce as of 2022-2023.^[22,27] Research suggests that male nurses are not evenly distributed across nursing specialties and instead are more likely to work in areas characterized by high acuity, technical complexity, autonomy, and rapid decision-making.^[23]

Specialties and practice settings with higher concentration of male nurses include:

1) Nurse Anesthetists (Anesthesiology)

2) Emergency Nursing (Emergency Department/Trauma)

3) Intensive Care Unit (ICU) and Critical Care Nursing

4) Psychiatric-Mental Health Nursing

5) Surgical and Perioperative Nursing

6) Flight and Transport Nursing

7) Military and Veterans Health Care Settings

8) Nephrology (Dialysis) Nursing

Several factors appear to contribute to men’s concentration in these areas. Many of these specialties emphasize advanced technical skills, independent clinical judgement, leadership opportunities, and interdisciplinary teamwork, characteristics that have been identified as attractive to male nurse.^{[23,24,25,28]} In addition, specialties such as nurse anesthesia, emergency nursing, critical care, flight nursing, and military health care often provide greater autonomy, high-intensity work environments, and opportunities for specialized practice, which may align with career motivations reported by male nurses. These patterns suggest that both organizational culture and perception of role fit continue to influence specialty selection among men in nursing.^[23,29]

Men in nursing contribute significantly to the profession through their roles in clinical practice, academia, and research, helping to create a more inclusive and effective healthcare environment. In clinical settings, male nurses offer a vital presence, especially in areas such as emergency care, mental health, and critical care, where physical strength and gender sensitivity can enhance patient outcomes. Their presence can challenge traditional gender roles, encouraging acceptance and breaking stigmas associated with nursing as a female-dominated profession.^[30] Male nurses often connect effectively with male patients who may feel more comfortable discussing sensitive issues with a caregiver of the same gender, ultimately improving communication and patient satisfaction.

In academic settings, the involvement of men as nursing educators and mentors helps diversify faculty representation and provides role models for male nursing students, which has been shown to positively influence recruitment and retention.^[20] Male educators also bring different teaching styles and perspectives, which can enrich the learning experience and foster more inclusive classroom environments.^[21]

In research, including male nurses is essential for expanding the scope of inquiry and incorporating diverse lived experiences into nursing science. Male nurse researchers help balance gender perspectives in study design, implementation, and interpretation, contributing to more comprehensive evidence-based practices. Their involvement in research addressing men’s health issues is particularly valuable, as they can offer culturally and gender-relevant insights that improve intervention strategies and policy development.^[31]

Overall, increasing male representation across all facets of nursing helps address workforce shortages and enhances the profession’s ability to meet the diverse needs of patients through improved communication, innovation, and collaboration.

The presence of men in nursing continues to grow steadily, yet male nurses remain a distinct minority in the profession. While they may benefit from structural advantages in certain areas, such as leadership roles and high-paying specialties, they also face significant workplace challenges, including gender stereotyping, professional identity strain, and barriers to providing intimate care. These challenges often lead to role strain, social isolation, and higher attrition rates among male nurses.^[15,16,20] Cultural and organizational expectations frequently direct male nurses into technical or managerial roles, sometimes at the expense of their clinical development and holistic care contributions.

Despite these barriers, men are increasingly drawn to nursing due to job stability, meaningful work, and evolving societal perceptions of the profession. High-acuity specialties such as emergency, critical care, and anesthesia tend to attract more male nurses, largely due to the autonomy, technical skill, and intensity required in these roles. Additionally, male nurses are making significant contributions to the profession through leadership, education, and research, helping diversify the workforce and enrich patient care experiences.

Addressing the unique challenges faced by male nurses is essential for fostering a more inclusive and balanced nursing workforce. Although they represent a minority, male nurses bring valuable perspectives and skills that enhance care delivery, particularly in the settings that require physical stamina, crisis management, or gender sensitive care. Promoting gender diversity in nursing not only combats stigma but also strengthens the profession’s ability to meet the evolving needs of a diverse patient population. By recognizing both the obstacles and opportunities for men in nursing, the profession can continue to grow in equity, effectiveness, and excellence.

Dr. Audwin Fletcher drafted a working outline for the article after the authors met for a concept meeting. All authors chose a responsible section. Dr. Audwin Fletcher pulled all of the completed sections together for a working draft. All authors read and approved the final manuscript for submission. Upon receipt of corrections, all authors worked on edits. The agreement was Dr Audwin would be corresponding (first) author and the other authors would be listed alphabetically.

Not applicable.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Obtained.

The Publication Ethics Committee of the Association for Health Sciences and Education. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

Not commissioned; externally double-blind peer reviewed.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

No additional data are available.