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The Nordic angle

Nordic countries generally rank high with respect to women's access to work while a gender-segregated labour market persists. For instance, while Sweden leads the gender equality index in Europe, followed closely by Denmark, occupational gender segregation remains a substantial trend in the Nordic Region. Notably, significant disparities exist in the distribution of women and men working in the education, human health and social work sectors across all Nordic countries (European Institute for Gender Equality, 2023; Eurostat, 2024a; Statistisk sentralbyrå SSB, 2024; Þorsteinsdóttir & Heijstra, 2023).

Gender segregation in care occupations in the Nordic Region must be understood from both historical and structural perspectives. Historically, the Nordic welfare state model emerged within a context of relatively low female labour force participation and as a response to declining fertility rates. That model promoted care solutions for children and enabled women to balance family responsibilities with work. The rapid expansion of the Nordic welfare states after World War II led to the increased institutionalisation of traditional familial care functions, such as child-rearing, education and care for the elderly and sick. That transformation accelerated in the 1960s, with female employment in Denmark, for example, rising from under a quarter to three-quarters by the 1990s. Although the pace of change varied across the Nordic countries – women in Denmark and Sweden entered the workforce earlier than those in Norway – most employed women worked in care and education professions focused on nurturing and maintaining human relationships. As a result, middle-class women, in particular, assumed a dual role: serving as care workers in the public sector while also fulfilling responsibilities as working mothers within their families (Dahl & Eriksen, 2005). Therefore, when evaluating the high levels of occupational gender segregation in the Nordic Region, it is crucial to consider the structural aspect of significantly higher levels of labour force participation among women in this region compared to other parts of the world, alongside the historical aspect of recruitment of women to care occupations.

While there is evidence that occupational gender segregation has been declining in the Nordic Region in recent years (Ellingsæter, 2013; Gallen et al., 2019; Hustad et al., 2020; Madsen et al., 2023), gender segregation in health occupations remains marked (Eurostat, 2024a). It has been argued that, although more women are entering male-overrepresented occupations such as STEM, deeply entrenched societal stereotypes continue to persist in many Western countries (Block et al., 2019; Haines et al., 2016). Additionally, while the proportion of women working in traditionally male- overrepresented fields has increased considerably in many Western countries, the reverse trend of men entering traditionally female-overrepresented fields has been less prominent (Cohen, 2013; Froehlich et al., 2020), even in the Nordic countries with their egalitarian gender perspective (Nordfjell & Nielsen, 2019).

In recent research, the need for policies and strategies to attract men to nursing education has been highlighted (Nordfjell & Nielsen, 2019; Younas et al., 2019). Shortage of nurses is a recurrent challenge in Nordic countries. In part, and on a local level, the shortage has been temporarily alleviated by foreign workers (Þorsteinsdóttir & Heijstra, 2023, p. 67). Clearly, the challenges involved in continued functioning of a system faced with an ageing population and generally increased demand for quality nursing care would be eased by a larger workforce if men were more involved in care, as women currently are (Kronsberg et al., 2018, p. 46). In addition, higher numbers of male nurses can, in particular, help meet rising patient demand for male nurses (see also Nordfjell & Nielsen, 2019; Younas et al., 2019).

It is argued that the stereotypes associating caring with femininity and professionalism with masculinity have weakened the status of the nursing profession.

Core nursing values of helping and caring for others have long been associated with altruism (Carter, 2014, p. 702; Þorsteinsdóttir & Heijstra, 2023, p. 68). It is argued that the stereotypes associating caring with femininity and professionalism with masculinity have weakened the status of the nursing profession, creating a dilemma between traits of altruism and professionalism (Teresa-Morales et al., 2022; Þorsteinsdóttir & Heijstra, 2023, p. 68). In Sweden, it was suggested that the low wages that are typical within the nursing occupation might also hinder attracting more individuals, and in particular more men, into the profession (Glans, 2017, pp. 18–19).

Occupational statistics

Finland has the highest density of nurses in Europe with 18.9 nurses per 1,000 inhabitants, which is well above the European average of 8.5 nurses per 1,000 inhabitants (OECD & European Observatory on Health Systems and Policies, 2023a). Nonetheless, the proportion of male nurses in Finland is relatively low; it increased from 6.4% in 2000 to over 10.1% in 2021 (Terveyden ja hyvinvoinnin laitos, 2024).

Excluding midwifes, which account for fewer than one percent of male nurses

Due to a structural shortage of medical doctors, nurses have come to assume more responsibilities in the healthcare system, including prescribing medication, fulfilling tasks in primary care and taking on advanced roles in hospitals (OECD & European Observatory on Health Systems and Policies, 2023a). While in Finland positive discrimination (also known as affirmative action) can be used to combat segregation in gendered fields, its constitutional status is vague and it is often perceived as unjust. It was argued that gender quotas in Finland have decreased the number of nurses in Finnish municipalities in horizontally segregated sectors, impacting the maintenance of welfare services. This snuggest that segregation requires a comprehensive range of measures related to working conditions, management, pay and training in the sector (Kurvinen et al., 2020).

As in Finland, Norway’s nursing workforce is overwhelmingly female, with only 11.8% of nurses being male in 2023 (Statistics Norway, 2024). Norway has the second highest density of nurses per capita in Europe (over 18 nurses per 1,000 inhabitants), but faces challenges in recruiting and retaining nurses.

Note that Norway also has the fourth highest proportion of practising doctors for its population in Europe (OECD & European Observatory on Health Systems and Policies, 2023c).

It has been suggested that Norwegian nurses are increasingly choosing to work as temporary hires. That offers them higher wages and flexibility, but can affect resilience of the health system and even distribution across the country, especially in rural areas (OECD & European Observatory on Health Systems and Policies, 2023c). Vertical segregation among nurses in Norway has been documented, with male nurses attaining leadership positions more rapidly and in higher proportions (Abrahamsen, 2004; Drange & Karlsen, 2016; Karlsen, 2012). More recently, it has been suggested that perceived gender discrimination is a contributing factor to women not applying for management positions (Abrahamsen & Storvik, 2019). Abrahamsen and Storvik (2019), urge healthcare organisations to adjust their recruitment and hiring processes by balancing structural advantages given to men.

Iceland has the third highest density of nurses in Europe with 15 nurses per 1,000 inhabitants, though that includes both nurses with high qualifications and licensed practical nurses with lower qualifications (OECD & European Observatory on Health Systems and Policies, 2023b). In Iceland the care sector is horizontally segregated, with fewer than 30% of men working in public administration, education and health or social activities (Statistics Iceland, 2024). In 2017, only 2% of nurses were men (The Icelandic Nurses’ Association, 2017).

Enrolment in nursing education

Figures 1-3 illustrate the proportion of men enrolled in programmes corresponding to nursing at three educational levels: upper secondary, bachelor's and master's. The upper secondary programmes align with Healthcare Worker / Licensed Practical Nurse (LPN) programmes, while the bachelor's level corresponds to Registered Nurse (RN) programmes.

Starting with upper secondary level (Figure 1), in all Nordic countries, men represent a small minority within health education programmes, but substantial differences also emerge across countries, as well as variations over time. Overall, the figure indicates that Sweden and Norway have higher enrolment of male pupils in vocational upper secondary health programmes compared to other Nordic countries and the European Union average. Sweden consistently shows the highest percentage of male pupils enrolled in such programmes, with a peak of above 25% around 2019-2020 and remaining relatively stable at around 22-25% throughout the end of the observed period. Norway also maintains a relatively high percentage, increasing from 14% in 2015 to 20% in 2021. Finland has a lower percentage than Sweden and Norway, maintaining the most stable range of between 15-16% from 2015 to 2022. Denmark and Iceland show the lowest percentages among the countries listed. In Denmark, the proportion of men declined throughout the period from 7.5% in 2017 to just 3% in 2021, while the equivalent figure in Iceland remains around 9.5-7.5%.

Figure 1: Percent men pupils enrolled in vocational upper secondary health programs

Source: Own calculation based on Eurostat data. Students enrolled in tertiary education by education level, program orientation, sex and field of education [educ_uoe_enrt03] (Eurostat, 2024b)

Figure 2 shows the percentage of male students enrolled in nursing and midwifery at the bachelor's level or an equivalent level from 2015 to 2022 across the Nordic countries. Overall, the figure indicates that while there are variations among countries, with Denmark and Iceland deviating from the rest of the Nordic Region, the proportion of male students in nursing and midwifery at the bachelor's level has remained fairly stable over the observed period. In the European Union, on average the proportion of men in Registered Nurse programmes remains relatively stable, hovering at around 15%. In Iceland, the percentage of male students is the lowest among the Nordic countries shown; their proportion starts low at around 3% but shows a gradual increase over the years to about 5% in 2021.

Hakvåg et al. (2019) reported that fewer than 3% of students enrolled at the University of Akureyri and at the University of Iceland were men between 2014 and 2017.

The percentage of male students in Denmark is also low and very stable at around 5%. Interestingly the proportion of male students enrolling in nursing at the bachelor’s level is the highest in Finland at just above 15%, peaking in 2018-2019.

The same numbers are reported by Statistics Finland, comprising 15% of those enrolled in vocational and bachelor’s nursing programmes and 11% of those in master’s programmes in 2022. In addition, the proportion of male students has increased since 2004 at all educational levels (Statistics Finland, 2024).

In Norway, the data show a consistently upward trend, from 13% male enrolment to almost 16% in 2021. Sweden shows a slightly downward trend to about 13.5% male enrolment at the end of the period. In sum, the proportion of male students in nursing and midwifery programmes at the bachelor’s level has remained relatively stable in each country, with significant variations between the Nordic countries.

Figure 2: Percent men students enrolled in nursing and midwifery at a bachelor’s level

Source: Own calculation based on Eurostat data. Students enrolled in tertiary education by education level, program orientation, sex and field of education [educ_uoe_enrt03] (Eurostat, 2024b)

Figure 3 illustrates the proportion of men enrolled at the master's level. The rankings between countries remain relatively consistent compared to the bachelor's level. However, the overall percentage of men at the master's level is significantly lower, with less than 15% representation in all countries. Note that the larger fluctuations in Iceland are likely due to the smaller sample sizes inherent to the population.

Figure 3: Percent men students enrolled in nursing and midwifery at a master’s level

Source: Own calculation based on Eurostat data. Students enrolled in tertiary education by education level, programme orientation, sex and field of education [educ_uoe_enrt03] (Eurostat, 2024b)

Graduation and dropouts

Figures 4-6 illustrate the proportion of men graduating from programmes corresponding to nursing at the three educational levels, namely upper secondary, bachelor's and master’s. The picture largely reflects the situation in terms of enrolment, where the large majority of those graduating are women, with men representing fewer than 20% in most levels and countries. It should be noted that, due to differences in length of the programmes and a lack of longitudinal data, we cannot calculate the graduation rate, but must rather look at each date type separately (enrolment and graduation).

Figure 4 presents the percentage of male graduates from vocational upper secondary education programmes in nursing and midwifery across various countries from 2015 to 2022. Overall, Sweden and Norway show higher percentages of male graduates in such programmes compared to other countries, with Sweden experiencing the most significant peak in 2021. In Finland, the percentage of male graduates was consistently around 13% to 16%. By contrast, Iceland had significant variability and a lower proportion of male graduates among all nursing student graduates at the upper secondary level, compared to the rest of the Nordic Region.

Figure 4: Percent men students graduating in nursing and midwifery at a upper secondary level

Source: Own calculation based on Eurostat data. Graduates by education level, programme orientation, sex and field of education [educ_uoe_grad02] (Eurostat, 2024b)

Figure 5 shows the percentage of male graduates from nursing and midwifery programmes at the bachelor’s level. Again there is a notable division between Denmark and Iceland and the other Nordic countries. In the former group, fewer than 5% of graduates are men, while in the rest of the Nordic Region, men represent over 10% and in some cases even 15%. Although men are still a clear minority among nursing graduates, that highlights significant differences across countries. Interestingly, when examining graduation from master’s programmes (see Figure 6), the distribution is more varied, with less pronounced differences across countries.

Figure 5: Percent men students graduating in nursing and midwifery at a upper secondary level

Source: Own calculation based on Eurostat data. Graduates by education level, programme orientation, sex and field of education [educ_uoe_grad02] (Eurostat, 2024b)

Figure 6: Percent men students graduating in nursing and midwifery at a upper secondary level

Source: Own calculation based on Eurostat data. Graduates by education level, programme orientation, sex and field of education [educ_uoe_grad02] (Eurostat, 2024b)

Several different programmes intended to increase the proportion of men in nursing have been implemented in the three countries involved in the project. For example, in Finland in 2006, the SoteMies project was launched to counteract gender segregation in healthcare by encouraging men to pursue practical nursing education. The project aimed to provide a male-only practical nursing programme, anticipating that the threshold for men to apply to a female-overrepresented field was high. When the programme was implemented, it saw unprecedented interest in nursing among men. In 2006, 21 men enrolled in the male-only practical nursing education and by 2008, ten of them had graduated (Ruokonen, 2008).

A study conducted in Norway, which followed 2,200 students who began studying on a female-overrepresented programme in 2012, found that male students are less likely to complete their studies (Abrahamsen, 2020). In the cohort studied, 29% of men pursuing nursing did not complete their programme, compared to 13% of women. Although men generally had a weaker academic background, including less academic interest and lower secondary school grades, those factors did not significantly impact their completion of the programme. By contrast, older male students were found to be more likely to complete their programme. That finding appears to contradict the current student admissions system, which considers secondary school grades, previous study experience and age up to 24 years as important criteria.

From 2018 to 2019, seven study programmes in Norway implemented gender points to favour male applicants in nursing and other welfare education (Nordfjell & Nielsen, 2019). That system was already in use for programmes in which women are underrepresented, such as Computer Science. The goal is to achieve a more balanced distribution of women and men in such occupations. Nonetheless, the findings of Abrahamsen (2020) suggest that providing extra points for academic interest and for applicants over the age of 24 might be more effective in increasing the number of men who complete their studies than gender points alone. That effect is particularly pronounced when the emphasis is on improving completion rates rather than merely increasing recruitment numbers (Abrahamsen, 2020). In the context of a comprehensive review of the admissions system for higher education, an independent Norwegian committee evaluated the use of gender points (NOU 2022). The committee concluded that the effect is limited and unpredictable. Based on the committee's recommendations, the Norwegian government (Ministry of Education and Research, 2024) (Ministry of Education and Research, 2024) has decided that, starting in 2027, extra points will be replaced by a 20-percent quota for the underrepresented genders.

In Iceland, despite financial incentives deployed by the Icelandic Ministry of Health since 2018, including paying school fees for male students, the number of men studying on nursing programmes has not increased significantly (Þorsteinsdóttir & Heijstra, 2023). Nonetheless, male students do not appear to have a higher dropout rate in Iceland (Nordfjell & Nielsen, 2019).

Practices for increasing the proportion of men in nursing education

The policies presented here focus on gender inclusivity in nursing but many of them are also relevant to other types of inclusivity and diversity. It has been argued that faculty for nursing programmes recognise the significance of fostering an inclusive learning environment but often find it challenging to translate that intention into practice (Beard, 2013, 2014). Implementation of effective, evidence-based strategies requires thorough understanding of the current research on inclusivity in nursing education.

Faculty support

In their literature review, Metzger et al. (2020) suggest that faculty support that emphasises diversity can enhance a sense of belonging for students from diverse backgrounds. They recommend supportive behaviours such as respecting, accepting and encouraging students; acting as role models and mentors; learning students' names; showing interest in other cultures; fostering student participation; and organising study groups. Additionally, faculty should recognise differences without problematising them and intervene against discrimination. It was also argued that, conversely, if faculty engage in or fail to address discriminatory behaviour, students’ feelings of isolation and exclusion may worsen. While such practices were highlighted as important to ensure a sense of belonging for students from diverse backgrounds, they are probably also relevant to the specific case of men in nursing.

Staff-student mentorship model

Developing a mentorship model that pairs male staff with male students could be beneficial (Metzger et al., 2020). Male staff who have experienced being in the minority can provide empathetic support and share effective strategies for dealing with issues unique to men in nursing, such as practicing safely with certain patient groups and navigating a female-overrepresented curriculum. Such relationships can also offer general guidance for students new to the study programme, both in practical and academic respects. However, mentoring should not give male students an academic advantage over female peers and should focus on mutual respect. Mentorship can also help students align their learning objectives with their broader nursing aspirations (Guy & van der Krogt, 2021).

Since 2018, the nursing programme at NTNU in Ålesund in Norway has run the Ole project. In the scope of the initiative, two to three gatherings per semester are organised for male students. While the students themselves are involved in planning and selecting the topics and speakers for those events, the responsibility for coordination lies with the nursing programme staff. Through such gatherings, students are introduced to male nurses working in various healthcare sectors. The primary aim of the initiative is to enhance students' confidence in the nursing profession and reduce dropout rates. The gatherings provide an opportunity for students to discuss issues related to being a male nursing student and to connect with peers across different cohorts. Similar gatherings have been initiated by other nursing programmes in Norway and the feedback from students has been unanimously positive. On that basis, a report (Det helsevitenskapelige fakultet UiT, 2024) recommends that the government provide funding for such gatherings for all nursing programmes in Norway.

Mentorship in clinical practice

In general, it was argued that the clinical learning experiences of students from underrepresented minority groups were heavily impacted by the attitudes of nurses in the clinical setting. Nurses who were welcoming, respectful and supportive helped foster a sense of belonging (Metzger et al., 2020). When looking specifically at men, working with male role models was highlighted as beneficial for success (Powers et al., 2018). A challenge in establishing a mentorship programme is the scarcity of male staff in education. Expanding mentorship roles into clinical practice could help. Pairing male RN mentors with male students for long-term assignments can reduce isolation, especially at an early stage of the studies, where placements often lack male role models, such as in elderly care. Later, placements in areas with more male nurses can provide additional support. Mentors could periodically check in during studies and into the mentees' study development. Virtual interactions via chat or Zoom can facilitate such mentorships regardless of location (Guy & van der Krogt, 2021).

Grouping students together

Evidence suggests that facilitating more gender-balanced groups might effectively reduce dropout rates in non-gender-balanced fields of studies (Foss & Sataøen, 2022). In Norway, grouping men together rather than distributing them evenly across the individual programmes in teacher education and kindergartens has been used in efforts to recruit and retain men to the sector since the 2000s (Norway Ministry of Education and Research, 2006, 2008) and is still a measure promoted by several actors in the sector. Research indicates that the majority of male students in care, health and education programmes prefer and seek interaction with peers of the same gender (Nordfjell & Nielsen, 2019; Petges & Sabio, 2020; Powers et al., 2018; Svare, 2009). However, the extent to which grouping men together in nursing programmes is implemented in Nordic countries remains unclear. The issue of whether to group male students together in these fields is a topic of discussion within several programmes, with varying opinions on its effectiveness (Nordfjell & Nielsen, 2019). Notably, male students generally prefer not to have their gender highlighted (Nordfjell & Nielsen, 2019), suggesting that any implementation of this measure should be part of a predetermined and sensitive structure. However, experience has shown that forming all-male groups can lead to gender polarisation and a narrowing of the concept of masculinity within education. Therefore, careful monitoring of this measure is necessary to prevent such outcomes.

Aside from grouping students in the same course, other grouping policies were suggested. Implementing a peer-mentorship programme, either standalone or with clinician mentorship, can be valuable. Pairing or grouping second-year and third-year students with students new to the programme can build resilience and community, reducing isolation by showing new students their journey is not unique. Such connections should be established before the first clinical placement to ease anxiety. Staff must provide all mentors, whether RN clinicians or student peers, with training, support and supervision. Mentorship benefits both mentors and mentees through enhanced teaching and leadership skills and mentors should receive professional recognition, such as professional development hours (Guy & van der Krogt, 2021).