Who could resist being a “rape-kit nurse”?

The New York Times, and its headlines, on women and men in nursing

One Times opinion piece ably explains the need for more sexual assault forensic nurses. Another looks at barriers to men entering nursing. But both items have clickbait headlines that reinforce stereotypes and call into question why anyone would become a nurse.

July 2, 2017 – Two recent opinion pieces in the New York Times highlighted some of the nursing profession’s roles in current gender issues. Specifically, they discuss how more forensic nurses could help handle U.S. sexual assault cases, and how to address nursing’s own gender balance problem. Sadly, both items had distorted clickbait headlines that undermined the pieces themselves to some extent. In an op-ed on June 20, Times contributor Brittany Bronson argued that shortages of sexual assault forensic nurses were limiting efforts to provide competent health care and legal assistance to victims of sexual assault, including in clearing the backlog of rape kits. But the headline “Where Are the Rape-Kit Nurses?” suggested that the nurses are narrowly-focused technicians who just fill up rape kits, rather than comprehensive health professionals. On June 24, Times editor Susan Chira offered a generally fair “news analysis” about the reluctance of some men who have lost jobs in shrinking fields to pursue traditionally female work like nursing in which there are jobs, as well as the lack of adequate social support for them to do so. But the headline didn’t exactly convey a balanced view: “Men Don’t Want to Be Nurses. Their Wives Agree.” Nor did a less-than-nuanced quote from a UC Hastings law professor that “pink-collar jobs are crap jobs for anyone.” Fortunately, today the Times published two responding letters. The first was from Yale nursing research dean David Vlahov, who explained that nursing was a rewarding career in which he had been able to “ease suffering and make a true difference in people’s lives.” And Molly Spurlock of Illinois wrote to say that she was proud of her husband, a well-paid emergency nurse who “exudes masculinity,” who is a “a thinker, a leader and a doer,” and who “come[s] home every day knowing that he saved a life.”

Stalled

Dying hard

 

Stalled

Brittany Bronson’s June 20 op-ed highlights the national shortage of sexual assault forensic examiners. The University of Nevada English instructor notes that the problem exists throughout the United States, especially in rural areas. But even in Las Vegas, which has high rates of domestic violence, there are only two nurses at the only hospital with the specialized training to assemble a rape kit for adult victims. Bronson describes how the exams work, stressing the importance of preserving evidence, which is difficult when the nearest health facility does not have the needed staff or resources to do the “highly personal exam” or provide sensitive care. That may mean the assault is simply not reported. She refers to the recent national outcry about the backlog of rape kits, as seen in initiatives like End the Backlog, which has “revealed the staggering numbers of untested kits sitting in law enforcement storage rooms.” 

But before those rape kits can even accumulate in police departments, they have to be administered and sealed, typically by nurses. Certified nurses receive training on how to properly collect and preserve forensic evidence. They are prepared to testify in court. Research shows that sexual assault nurse examiners finish examinations in shorter time periods than untrained staff. They offer more emotionally sensitive care.

Bronson says there are not enough of these nurses. Some hospitals do not see enough patients who need the exams to make having the nurses “financially feasible.” But that is not the case for Las Vegas, where University Medical Center provides 50-80 sexual assault examinations each month. Low-income women are especially vulnerable to rape but also less likely to be able to travel to hospitals farther away. Bronson notes that very little of the federal funding states receive to address sexual assault goes to train sexual assault forensic examiners. She ends the piece with a short discussion of recent efforts to improve the situation. Nevada Gov. Brian Sandoval recently signed a bill requiring state law enforcement agencies to lower the time between exams and DNA analysis, allocating funds to help pay the costs, but not directly addressing what Bronson calls “our severe shortage of examiners.” At the federal level, Washington Senator Patty Murray’s proposed Survivor’s Access to Supportive Care Act would increase the training forensic nurses get, “but the legislation, like many bills that primarily benefit women, stalled.”

This piece conveys some very helpful information about forensic nurses. The passage quoted above briefly explains what they do for patients, although there could have been more detail on their training and skills. In addition, the piece’s underlying messages that the nurses are sorely needed but inadequate funding has been allocated for them are critical. Those themes reflect the profession’s larger problems—caused at least in part because nurses themselves remain overwhelmingly female—although the status of nursing is not Bronson’s focus here. Unfortunately, the headline “Where Are the Rape-Kit Nurses?” could appear in a dictionary entry for “reductive.” As the piece itself shows, these nurses do far more than fill up kits. The use of such a term is a grotesque distortion and reinforces the sense that nursing is low-skilled work. On a less obvious note, the piece’s term “sexual assault nurse examiner” (SANE) is not as strong as “sexual assault forensic examiner” (SAFE), which improves the acronym greatly. On balance, the piece is probably a net gain for nursing, but as published, it could have been better.

 

Dying hard

The problem Susan Chira’s June 24 news analysis confronts is that “notions of masculinity die hard, in women as well as men.” The headline: “Men Don’t Want to Be Nurses. Their Wives Agree.” In the piece, the New York Times “senior correspondent and editor on gender issues” asks why men who have lost jobs in traditionally male fields have been slow to embrace fields where there is job growth. The answer seems to be that those new jobs are in traditionally female fields.

It’s not just that men consider some of the jobs that will be most in demand — in health care, education and administration — to be unmanly or demeaning, or worry that they require emotional skills they don’t have. So do some of their wives, prospective employers and women in these same professions.

Chiro notes that recent labor reports have shown “continuing low labor-force participation, with many men still unemployed and many no longer looking for work. The “rage and despair” of some of them, she suggests, helped Donald Trump win the 2016 election, in part based on a promise to restore manufacturing jobs that economists doubt will return. Meanwhile, in-demand jobs like “nursing and nurse assistants, home health care aides, occupational therapists or physical therapists” continue to experience shortages. Chiro consults University of Massachusetts sociologist Ofer Sharone, who notes that (in Chiro’s words) even white-collar men who might have been “willing to consider lower-paid jobs in typically female fields encountered resistance from their wives, who urged them to keep looking.” Sharone says sociologists have found that work is “at the core” of male identity in a way that is not true of women. Broader social views are also a factor, Chiro says. She quotes the head of caregiver company CareLinx Sherwin Sheik as saying that many families (in Chiro’s words) “remain suspicious of male home health care aides, worried about abuse or sexual predation, and convinced that women will be more caring.” Timothy Dage, “who has worked for 25 years as a nurse and home health care aide with CareLinx,” said that once a patient is in his care, that kind of concern disappears and he has never had a patient want to return to a female after that point. The piece focuses on nursing:

Men can also face resistance from their female peers. Jason Mott, an assistant professor of nursing at the University of Wisconsin-Oshkosh, said some of his male students were teased by their female classmates. “They feel they need to really express their manhood, stressing the athletics they take part in,” he said. Nursing offers a perplexing case study. In theory, nursing should appeal to men because it pays fairly good wages and is seen as a profession with a defined skill set. Yet just 10 percent of nurses are men, despite “Are You Man Enough … to Be a Nurse?” posters and other efforts to enlist men. The hope is to focus on millennials who may be less bound by notions of traditional masculinity, said Brent MacWilliams, president of the American Assembly for Men in Nursing and a former commercial fisherman who is now an associate professor of nursing at Wisconsin-Oshkosh. He has seen more men apply to nursing schools, but he acknowledges his group will fall short of its goal of 20 percent male nurses by 2020.

The piece concludes by asking whether there is a problem with the jobs themselves. On the one hand, jobs like nursing and teaching require levels of education that may be daunting for some men with manufacturing backgrounds. On the other hand, jobs that require less training, like home health aide work, often feature low pay. Women and members of minority groups may still be more willing to do such work; University of Akron sociologist Janette S. Dill wonders if health organizations don’t really want men because they will demand more than $8-9 an hour.

Little will change unless the jobs do, too. “Pink-collar jobs are crap jobs for anyone,” said Joan C. Williams, professor at the University of California Hastings College of the Law. “We need to reinvent pink-collar jobs so men will take them and won’t be unhappy — or women, either.”

It’s not totally clear what those comments mean beyond raising pay rates of home health aides; are nursing and teaching also “crap jobs” that have to be “reinvented”? If the idea is that the reinvention will mean more respect and resources in a broader sense—i.e., more material and social support for nurses—then that makes sense. And at least Williams did not urge people to abandon the “pink-collar” jobs, as at least one employment consultant has.

It seems that the headline was too much for some readers. Today the Times published two letters pushing back, under the headline “Beyond the Stereotype: The Nurse Is a Man.” David Vlahov, associate dean for research at the Yale School of Nursing, wrote that “after 40 years nursing continues to be a fulfilling profession, and my wife agrees.” Vlahov argued that nursing “provides security while offering a continuously rewarding opportunity in specialties like palliative, primary, trauma and critical care, where nurses ease suffering and make a true difference in people’s lives.” And Molly C. Spurlock wrote that she was proud of “my husband, the nurse.”

My husband exudes masculinity when I watch him work in the emergency department. He is a thinker, a leader and a doer. … My husband left his job in corporate America to pursue a career in nursing. Not for the money, although he makes well over $100,000 a year, but to come home every day knowing that he saved a life. Nurses care for people in their most vulnerable states, while solving problems, acting quickly under extreme pressure and thinking outside the box.

This passage makes many of the points we would make as a corrective to the headline and some nursing elements in Chiro’s piece:  thinker, thinker out of the box, leader, doer, life-saver, problem-solver, actor under pressure. Maker of money? Well, that is a mark of some social respect, and Spurlock makes clear that her husband is not in nursing for the money. 

And exuder of masculinity? That does get at some of the core issues—should nursing need to assure men that they can still be “masculine”? Do these jobs have to change to accommodate men, or should men change to accommodate the jobs? Of course, to the extent men are deterred because a job really is underpaid or unfulfilling, or because some of its current practitioners are hostile to them, then those are problems with the job. Nursing should address poor working conditions and welcome men. But to the extent men are deterred from becoming nurses because the work requires advanced education or interpersonal skills, or because of gender insecurity, or because of sensationalist headlines that reinforce such insecurity, that is not the fault of nursing. The piece seems to be put more emphasis on how traditionally female fields should change than on how career seekers hampered by their own gender bias should change. The piece might have benefited from further discussion of how we might help men and their families adapt.

Nevertheless, overall Chiro’s piece does offer a helpful, if not terribly encouraging, look at nursing’s ongoing gender issues.

See the op-ed: “Where Are the Rape-Kit Nurses?” by Brittany Bronson, published in the New York Times on June 20, 2017.

See Susan Chira’s June 24, 2017 op-ed in the New York Times: “Men Don’t Want to Be Nurses. Their Wives Agree.”