B ACKGROUND

Healthcare has traditionally been highly gendered. In the old days, doctors were male and nurses female. However today realty is not so clear-cut. In most developed countries, the medical

56 “Total NHS staff” refers to all figures with tenured employment status. This excludes “Direttori generali” (781 headcounts in 2001 and 813 in 2007) and “Personale contrattista” (684 headcounts in 2001 and 608 in 2007), reported in the Conto Annuale despite their non-tenured status.

57 For 2001, the structure of the database does not permit to extract from this group a small number of non-nurses counted among "Coll.re prof.le sanitario esperto Ds". However, this represents less than 0.5%

of the total category here referred as "Nurses" so it does not imply serious flaws in our analysis.

58 The database contains information about 335 institutions. In fact, in a broad and comprehensive view, the Italian NHS in 2007 encompassed 273 Local Health Authorities (LHAs) and Independent Hospital Trusts (IHTs), 6 Teaching hospitals directly owned and managed by the Ministry of Education, 10 Institutes for zoo-prophylaxis, 18 hospitals of healthcare and scientific research, 8 nursing home organisations, 17 regional agencies for the environment, and few other agencies or institutions.

profession is experiencing a long-range process of heavy feminisation⁵⁹. And nursing today is anymore the female profession established by Florence Nightingale⁶⁰, where the only relevant exception was in military services or in psychiatric care, requiring the strength and the determination of men to restrain violent patients (Evans, 2004; Girard, 2003). Neither male nurses are anymore closely associated to homosexuality as it was the case in several Anglo-Saxon countries (Harding, 2007).

While some legacies exists for linking the profession to the female world and this rises till today some concerns – for example, for male nurses providing intimate care to female patients (Inoue et al., 2006) – the trend is clearly leading to a more gender-balanced profession. This has several possible explanations:

- first, this is explained by more balanced roles in the society at large as well as in families or in the labour market;

- second, with the professionalization process of nurses, the vocational attitude argument⁶¹ has lost ground in favour of the development and appraisal of technical skills, that are much more neutral in terms of gender;

- third, this can also be explained by tighter labour market conditions in several countries, pushing males to enter into a profession characterised by a high employability.

Three organisational dimensions often present in literature with reference to males in nursing are:

- relations with patients, because of both cultural differences with female nurses, patients’

expectations when receiving nursing services (Chur-Hansen, 2002; Evans, 2002), and some special issues regarding services that involve sexuality, such as in obstetrics or gynaecology (Lofdge et al., 1997);

- different motivation and results in career development, showing that in most countries men, despite their low prevalence in total nursing workforce, are often successful in

59 In some countries this is been already the case for the last 50 years or so, as the Eastern European countries – characterised by a prevalence of females often above 50% of total doctors – demonstrates.

60 As Evans (2004: 322-323) points out, «To her, every woman was a nurse, and women who entered nurse training were doing only what came naturally to them as women […]. In the apprenticeship style of education championed by Nightingale, it was deemed that women as ‘natural’ nurses did not require

124 career development both in administrative and elite specialty positions (Evans, 1997;

Whittock et al., 2002⁶²; Tracey and Nicholl, 2007)⁶³;

- relations with other professional groups, first of all with physicians (for example, Floge and Merrill, 1986).

In Italy male nurses represent a percentage higher than the OECD average⁶⁴.

If we look closer to most recent years, in academic year 2006-2007 32.9% of the 12,000 students enrolled at the first year of the bachelor in nursing where male (IPASVI, no year: 10).

In the same years, males represented 31.7% of the 32,500 total enrolled in the first, second and third year of the bachelor programme (ibidem: 15). Finally, male represented 21.3% of the 7,000 nurses obtaining their bachelor degree and ready to enter the profession (ibidem: 17).

In general, the prevalence of men is higher for students from the South of Italy. This can be seen in two different dimensions:

- the first and most obvious is the prevalence of male students in Southern universities.

There, in academic year 2006-2007 males represented 40.3% of students enrolled at the first year of the bachelor, compared with 31.0% in the West, 27.7% in the North-East, and 32.3% in the Centre (ibidem: 10);

- the second dimension is mobility from the residence area to other Provinces or Regions for studying. In fact, 50.0% of male students enrolled at the first year of the bachelor were studying in universities outside their Province of residence, while females scored 41.3%⁶⁵.

62 Wittock et al. (2002: 305) highlight the role of working arrangements: «Working part-time and taking career breaks, usually because of caring commitments, results in female nurses falling behind male colleagues in terms of career development and promotion prospects, with managers selecting males over females (particularly those who work part-time)»

63 However, this is not always the case, as the Israeli example demonstrates (Romem and Alson, 2005:

178).

64 In France in 2002 men represented 13% of total nurses (Berland, 2002: 37). In UK they have rarely made up more than 10% (Whittock and Leonard, 2003: 243). In 2005 in Australia the male prevalence among employed registered and enrolled nurses was 7.9% (AIHW, 2008: 9). In 2003 men were around 8.5% of total registered nurses in the U.S. (Buerhaus et al., 2004: W4-530).

65 25.4% of males were enrolled outside their macro-region of residence, compared with 12.8% for females. Partially, this is explained by the higher prevalence of males among students coming from the South, coupled with their higher mobility. While only 10-12% of students residents in Centre-Northern Regions moved in other Regions to study, this percentage was 45.8% for students residents in Southern Regions (ibidem: 14).

Another point that is possible to get from IPASVI (no year) is about the relations between gender and entry age into the bachelor in nursing for academic year 2006-2007. «The gender analysis shows a significantly higher percentage of “young” enrolments (below 21 years of age) among women (49.1%) than among men (37.8%). This seems to confirm the fact that for women, more than for men, nursing represents a first choice in terms of education and professional projects» (translation of the author; ibidem: 11). This is confirmed also by the fact that 2.3% of total women enrolled were 40 years old or over, while men scored 4.5%.

However, Martellotti et al (2006) show how employability is only one of the several causes declared by young people when asked why they chose to enter into the nursing profession. A questionnaire answered by almost 50% of students enrolled at the third year of the bachelor in nursing in the academic year 2004-2005 says that the first reason for choosing the profession is the possibility to be useful for others, leaving the reason “to have a sure work” only second.

Table 2.1 also shows limited differences between males and females and between Italian macro-Regions.

Table 7.1. Reasons for choosing the nursing profession (answer frequency in percentage; more than one answers possible), students enrolled in the third year of the bachelor in nursing, academic year 2004-2005.

Be useful for

others Have a sure work

Work in multi-professional

teams

Career perspectives

No expectation

at the moment

Other

Males 52.2 35.2 19.7 2.7 2.0 1.2

Females 57.3 33.0 18.0 2.3 1.7 1.0

21-25 years 58.9 35.1 16.4 2.3 1.8 0.4 26-30 years 52.3 32.3 22.5 2.1 0.9 1.8 31+ years 51.0 30.9 21.5 3.0 1.9 2.3

North-West 55.4 33.0 18.8 2.4 2.1 0.8 North-East 57.6 33.0 17.9 2.5 1.5 0.6

Centre 54.3 34.0 18.9 2.3 1.7 1.8

South 56.8 36.4 18.3 2.5 1.4 0.2

Total 56.0 33.6 18.5 2.4 1.8 1.0

Source: Martellotti et al., (2006: 14).

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