Share the care

The gender disparity in the Nordic healthcare sector has significant social, cultural and economic implications in societies that prioritise equality. Despite their progressive stance, Nordic countries continue to grapple with the persistent underrepresentation of menin healthcare, reflecting a broader gender division (Eurostat, 2024). Transformations in men's roles are critical drivers of broader social progress. Although men's participation in caregiving may initially seem secondary, it plays a strategic role in advancing gender equality and addressing major social challenges (Scambor et al., 2023).

Various factors contribute to men's reluctance to pursue careers in healthcare. For instance, men often face role conflicts when entering female-overrepresented fields like nursing, as they may feel they are transgressing traditional masculine norms while embracing their professional identity as nurse (Blackley et al., 2019). In addition, structural factors and historical context such as the expansion of the welfare sector and the role of gender in  caregiving in the Nordic Region further reinforce this gender imbalance (Dahl & Eriksen, 2005). Over the past two decades, research has consistently shown that gender equality and shared caregiving responsibilities lead to improved quality of life and better health outcomes for individuals of all genders (Scambor et al., 2023).

Women are largely overrepresented in nursing, like in many caregiving professions. Men in nursing face unique challenges, including stereotypes that question their masculinity or sexual orientation (Kronsberg et al., 2018). Such biases contribute to gender imbalances in nursing and deter men from pursuing or remaining in the field (Younas et al., 2019). Male nurses also experience gender discrimination, particularly in areas like high-touch care. This often leads them to pursue roles in management or technical specialities such as surgery or critical care, perpetuating segregation (O’Lynn et al., 2020).

Recruiting men into nursing education remains a challenge, with many male nursing students dropping out before completing their programmes (Nesje, 2023; Nordfjell & Nielsen, 2019). Male nursing students report encountering biases when declaring their study plans and within educational settings. They often receive less psychological support and are excluded from opportunities to perform essential caregiving tasks, particularly those involving female patients in private situations (Nordfjell & Nielsen, 2019). These experiences contribute to lower confidence levels among male students, making it more challenging for them to succeed in nursing programmes (Twidwell et al., 2022).

Male students also express the need for more male peers, mentors and instructors in their education. They prefer being called "nurses" rather than "male nurses," highlighting their desire for inclusivity within the profession (Nordfjell & Nielsen, 2019; Petges & Sabio, 2020). The persistence of gender bias in nursing education contributes to higher attrition rates among male students in some countries, (Feng et al., 2019).

The Nordic countries, despite their reputation for gender equality, exhibit significant occupational gender segregation in fields like health and education (European Institute for Gender Equality, 2023). The roots of this segregation can be traced back to the post-World War II expansion of the Nordic welfare state, which incorporated more women into the labour force, particularly in caregiving roles (Dahl & Eriksen, 2005). Today, women are overrepresented in care professions such as healthcare and education, contributing to the region's high levels of horizontal segregation.

Efforts to reduce gender segregation in Nordic countries have yielded mixed results. While progress has been made in encouraging women to enter traditionally male-overrepresented fields like STEM, men’s participation in nursing and other caregiving roles remains low (Cohen, 2013; Froehlich et al., 2020). Despite recurring nursing shortages, particularly in rural areas in the Nordics, few policies specifically target increasing male participation in the field (Nordfjell & Nielsen, 2019).

Finland, Norway and Iceland all face challenges related to gender segregation in nursing, despite having some of the highest nurse densities in Europe. In Finland, where there are 18.9 nurses per 1,000 inhabitants, the proportion of male nurses remains low, increasing from only 6.4% in 2000 to 10.1% in 2021 (OECD & European Observatory on Health Systems and Policies, 2023a).. Similarly, Norway has a high nurse density of over 18 per 1,000 inhabitants, yet only 11.8% of its nursing workforce are men and the country struggles with recruitment and retention, particularly in rural areas (OECD & European Observatory on Health Systems and Policies, 2023c). Within the nursing occupation, men in Norway are also overrepresented in leadership roles, perpetuating vertical segregation (Abrahamsen & Storvik, 2019). Iceland, with the third-highest nurse density in Europe, has an even lower representation of male nurses, with fewer than 2% of the workforce being men (OECD & European Observatory on Health Systems and Policies, 2023b). Across all three countries, the underrepresentation of men in nursing persists, alongside common issues of recruitment, retention and vertical segregation in leadership positions.

Enrolment patterns in nursing education across Nordic countries consistently show that men remain a small minority, with less than 25% participation at all educational levels. Significant variations exist between countries, with Sweden (22%) and Norway (19%) having higher male enrolment in Licensed Practical Nurse (LPN) programmes in 2022 compared to Denmark and Iceland with much lower rates (4-7%). At the bachelor’s level for Registered Nurse (RN) programmes, the gender gap persists, though Finland and Norway have around 15% male enrolment, compared to Denmark and Iceland at 5%. Graduation rates mirror these trends, with men representing fewer than 20% of nursing graduates across all levels, with Denmark and Iceland having even lower shares of men graduating. Despite some country-specific differences, the overall pattern reveals a persistent gender imbalance in Nordic nursing education: Share the Care: Strategies to Increase Diversity in Nursing Education

Based on the literature review presented above, it is clear that promoting gender equality in nursing is critical for improving health outcomes and quality of life for all genders (Scambor et al., 2023). Increasing male participation in nursing education is an important part of achieving gender balance in the Nordic Region, in line with broader goals of equality. This focus was also highlighted by the Men in Nursing Education project (Nordfjell & Nielsen, 2019), which serves as a key reference for this initiative. The Share the Care project, funded by the Nordic Gender Equality Fund (NIKK), aims to address these imbalances by gathering and applying best practices to support men in nursing education. The project was implemented in Iceland and at selected nursing programs in Finland and Norway. It introduces six targeted interventions at both individual and organisational levels to address the challenges that men face in nursing education, thereby contributing to a more inclusive and balanced health sector.

The objectives included creating sustainable data collection methods and conducting routine interviews with students that had dropped out. The project encountered challenges in harmonising data collection across countries and ensuring consistency. Norway made significant progress by identifying best practices from a university with effective student support, including reallocation of resources to retain male students and implementation of early interventions. Finland introduced a follow-up system to identify at-risk students, revised its curriculum for improved flexibility and addressed issues such as internships, loneliness and web-based studies that contributed to male student dropout rates. In Iceland, the lack of formal systems and administrative leadership for male nursing students led to informal efforts by faculty to reduce dropout rates. Across all countries, the project underscored the fact that institutional change begins with leadership recognition of gender imbalances and that staff require time, resources and inspiration to implement new structures. Interviews with male students and faculty members were recommended to address specific challenges and encourage retention.

In Norway, discussions focused on the gendered representation of nurses in textbooks like "Basic Nursing" (2016), which predominantly featured female nurses, often Caucasian and middle-aged. These discussions led to reflections on gender dynamics in the classroom and prompted a dialog with the textbook publishers about a more diverse representation of nurses in future editions. In Finland, existing structures facilitated conversations about gender bias in teaching materials, although male students expressed the wish not to be singled out in class rather than the materials themselves. The emphasis remained on the diversity and meaningfulness of nursing as a profession. In Iceland, nursing programmes frequently used educational materials from the United States or the UK, with such materials tending to be less gender-balanced. Nonetheless, a new course was developed to address gender imbalances, featuring expert talks and encouraging open dialogue. Overall, these activities enhanced teacher awareness of the need for male role models and addressed cultural biases in educational materials and the educational environment, resulting in updates and the development of new, more gender-aware courses.

In Norway, the initial analysis revealed that websites and social media platforms reflected the existing gender imbalance in nursing. Following feedback, colleges made significant improvements by adding male student profiles and showcasing best practices for more balanced gender representation. In Finland, health education marketing evolved to emphasise professional skills and international opportunities, although age and ethnic diversity remained underrepresented. Iceland also identified gender bias, particularly the underrepresentation of male faculty on nursing programme web pages. After formal reminders to update content, universities improved the gender balance, featuring stories of male students and professors. Across all countries, initial recruitment materials exhibited a strong gender bias, but improvements were made once the issue was recognised. While gender and ethnic diversity increased, age diversity remained lacking. The project highlighted the fact that addressing this issue is a low-cost, awareness-based solution that could further enhance diversity in how nursing is portrayed.

In Norway, male students were grouped together to promote regular peer interaction. In addition, workshops on gender dynamics and minority experiences were introduced, although participation was low. A peer mentoring programme was also established, with plans for expansion. In Finland, the focus was on providing gender-neutral study materials, increasing male role models and fostering social support. An online platform, which was initially unsuccessful due to complexity, was revamped using Discord to better engage students, with plans for expert talks on relevant topics like salaries and working conditions. In Iceland, a Male Nursing Committee was formed to promote inclusivity and a grant was secured to introduce nursing to younger boys, although the pandemic limited its reach. Across all countries, the project emphasised creating an inclusive culture for male nursing students by challenging stereotypes and fostering opportunities for dialogue, mentorship and networking.

In Norway, counsellors felt their role was to support student choices rather than guide them towards nursing. Counsellors appreciated the opportunity to reflect on gender norms in their work and highlighted the value of hands-on experiences like working in day care centres to challenge stereotypes. Finland implemented outreach activities, including sessions at lifelong learning centres and public events, but emphasised the need for better collaboration between teachers and students. Iceland faced funding challenges, particularly with respect to organising career events. Discussions with career guidance counsellors focused on gender balance in advice to students. Overall, early interventions are crucial in addressing gender stereotypes. Providing hands-on experiences from an early age can foster interest in nursing.

The goal was to assemble a reference group of researchers and practitioners to share strategies for addressing gender imbalances in the health sector. Discussions revealed several key findings: the importance of using male role models to attract men to nursing education, the impact of unemployment on men's access to health careers and the need to adapt curricula and job roles to make them more attractive to men. Participants highlighted the challenges of recruiting men into a predominantly female field and the necessity of creating a supportive environment that builds pride among male healthcare workers. Effective strategies discussed included tailoring educational content to men's interests, leveraging their caregiving experiences and improving marketing efforts. Addressing societal and structural factors such as stereotypes and unemployment was deemed essential. The group concluded that a comprehensive approach, including curriculum changes, a supportive environment and targeted recruitment efforts, is critical to addressing the gender imbalance in the health sector.