重新评估护理/治疗二分法：护理领导中性别不平等的欧洲视角

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Gender equality in leadership is highly topical across a range of professions; however, in the nursing profession, this issue poses a particularly interesting case. As a long-feminized profession, one might assume that gender disparity in leadership would be a non-issue in nursing. However, the statistics paint a different picture. While the nursing workforce in Europe is 89% female, only 25% of health leadership positions are held by women (World Health Organization, 2019, 2020). How can this be? In a recent report (Balkin et al., 2022), from our perspective as three social scientists, we overviewed the interplay of gender dynamics within nursing, with a particular focus on leadership across a select set of European nations: Denmark, Germany, Greece, Norway, Poland, Spain, Sweden and the United Kingdom. In doing so, we shine a light on the gender paradox in nursing, while men are reluctant to enter the highly feminized nursing profession, those who do, rise more easily to the top. We consider the multifaceted factors at play in producing this inequality and keeping female nurses from advancing to the top of their profession.

While the structural factors impeding women's ability to advance to leadership positions, in general, are now well-known - such as the ‘sticky floor’ effect, which keeps women from advancing due to working a ‘double shift’ of professional and domestic labour–there are also other, more specific factors at play in the gender and power gap within the nursing profession. In our report, we provide an analysis of the gender norms that underpin these disparities in nursing. Though there are significant cultural variations between the countries included in this report, the gendering of the nursing profession persists across the board, as exhibited by the statistics in Table 1. Through a sociocultural lens, we unpick how these norms affect the career opportunities of women nurses, as well as how they deter men from entering the profession.

1 UNVEILING CULTURAL NORMS AND STEREOTYPES

Societies across Europe hold ingrained cultural values that assign caregiving and bodywork roles to women, while leadership and decision-making roles are typically considered more suitable for men. Although nursing encompasses various technical and clinical expertise, it is often associated with hands-on care rather than clinical aspects of healthcare. This perception reinforces a gendered division within the nursing field, limiting opportunities for women to assume leadership positions while men rise up the ‘glass escalator’ (Brandford & Brandford-Stevenson, 2021). Furthermore, gender biases discourage men from participating in caregiving or bodywork, further entrenching traditional gender roles. This bias is reinforced by the persistent gendering of healthcare professions, where nursing is predominantly viewed as ‘women's work’ and medicine as a primarily male domain. As such, we are not only dealing with the gender of individual members of the nursing profession but a gendering of the profession as a whole. Such distinction perpetuates inequality between professions and undermines the significance of care work within the healthcare sector, as the focus on cure overshadows the crucial role of care.

Care work has been closely linked to women's perceived ‘natural instincts’ as an extension of the stereotypical relation of women to motherhood. Nurses, who are often assumed to be female, have historically been viewed as assistants to doctors, typically assumed to be male, rather than recognized as professionals in their own right (Newman et al., 2019). Despite the increasing professionalization of nursing in recent decades, the perception of nursing as a predominantly female occupation continues to influence the field's identity. This image, rooted in broader gender norms that valorize masculinity over femininity, contributes to the devaluation of nursing, which directly impacts the persisting gender inequality in nurse leadership.

Due to its association with femininity, nursing is often considered a ‘soft science’, while biomedicine, traditionally seen as a male domain, is regarded as a ‘hard science’. These associations persist, even though women now outnumber men in medical schools in many places.

The association of care with femininity and softness dissuades men from pursuing careers as practitioners. Instead, it encourages them to seek promotions in ‘less soft’ managerial positions in the nursing field. As a result, there has been a suggestion that nursing should emphasize its technical and highly skilled aspects to counteract this association (World Health Organization, 2019). However, although nursing encompasses clinical and technical skills and expertise, often differing significantly from the stereotypical image of a woman providing maternal care to the bedridden, it raises the question of whether the solution lies in distancing nursing from its association with care work. By doing so, there is a risk of reinforcing cultural beliefs prioritizing ‘cure’ over ‘care’ and perpetuating the notion that care is inferior.

2 NAVIGATING STRUCTURAL CHALLENGES AND BARRIERS

Even in countries that are often considered to be gender egalitarian, such as the Scandinavian nations, gender disparities persist in the nursing field, also when it comes to equality in leadership positions. In Denmark, 96.5% of all nurses are female, and gendered stereotypes surrounding the profession continue to deter men from considering it as a viable career option. While at the same time, a closer look at the numbers of gender representation in nurse leadership reveals that men are 62% more likely to become leaders than their women counterparts (Balkin et al., 2022).

The above findings on persisting disparities in the nursing sector are further enhanced by a pay gap in favour of male employees that still exists despite the low numbers of male engagement in the profession. For example, in Sweden, which ranks 1st on the EU Gender Equality Index, women nurses earn less than their male co-workers. Efforts have been made in Norway to increase engagement in educational programs dominated by one gender, allocating ‘gender points’ to those who apply, for example, to attract more women to engineering and more men to nursing. But could such interventions have any impact on leadership opportunities? Healthcare departmental managerial positions are still under-represented by nurses, with physicians holding 67% of managerial positions. This low representation of nurses in leadership, which is evident across European contexts, augments the cultural perception of nursing as devalued within healthcare. Action is required to support the participation of women nurses in health care leadership.

3 PATHS TO TRANSFORMATION

To address the issue of gender inequality in nursing leadership, we must acknowledge its roots in deeply ingrained cultural values. Our assessment reveals how these implicit influences shape perceptions of the profession and the worth assigned to nursing, which has care at the heart of its identity. In our report, we present various cross-sector recommendations at the international, national and institutional levels to tackle the issue of gender disparity in nurse leadership. These suggestions include conducting comprehensive qualitative and quantitative research, enhancing vocational training and identifying potential policy foci. However, the challenge lies in addressing the disparities stemming from cultural norms extending far beyond nursing and nurse leadership. Furthermore, it is essential to note that in this piece, we have discussed gender as a binary. Currently, this is the faultline along which gender is demarcated in the statistics on gender equality. We recognize that this is a simplification and not representative of all the gender identities within the nursing workforce.

As social scientists and non-nurses, we offer a distinct outsider's perspective on gender disparities in nurse leadership. While it may surprise those less familiar with the profession, the fact that a feminized profession has a disproportionately low number of female leaders is not unfamiliar to those within the nursing community. Our research uncovered ongoing initiatives aimed at diversifying voices in nursing, developing a nursing pedagogy that supports horizontal leadership and fostering a deeper appreciation for the skills and values underpinning quality care work. Future reforms should prioritize engaging with nurses to cultivate a leadership approach that moves beyond the traditional management-oriented model and acknowledges the unique characteristics of the nursing profession. There is no singular solution to address the pervasive gender disparities in nurse leadership. In many ways, this parallels the ‘care vs cure’ dichotomy that undervalues nursing skills as ‘soft’ while viewing clinical, technical approaches to healthcare as more advanced, ‘harder’ and scientific. Perhaps here, too, we need more of an ongoing, encompassing ‘care’ approach to the issue of gender equality in nurse leadership than a focus on any one-off ‘cure’.

FUNDING INFORMATION

This project has received funding from the European Union's H2020 Research and Innovation Programme under the MSCA-ITN-2018 under grant agreement No 813928. The financial sponsor played no role in the design, execution or analysis of data nor in the writing of this article.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

全文翻译（仅供参考）

领导层中的性别平等是一系列职业的热门话题;然而，在护理专业中，这一问题构成了一个特别有趣的案例。作为一个长期女性化的职业，人们可能会认为，性别差异的领导将是一个非问题的护理。然而，统计数据描绘了一幅不同的画面。虽然欧洲的护理劳动力中89%是女性，但只有25%的卫生领导职位由女性担任（世界卫生组织，2019年，2020年）。怎么会这样？在最近的报告（Balkin等人，& nbsp; 2022），从我们作为三位社会科学家的角度来看，我们概述了护理中性别动态的相互作用，特别关注一组选定的欧洲国家的领导力：丹麦、德国、希腊、挪威、波兰、西班牙、瑞典和联合王国。通过这样做，我们揭示了护理中的性别悖论，而男性不愿意进入高度女性化的护理行业，那些这样做的人更容易上升到高层。我们认为，在产生这种不平等，并保持女护士从推进到他们的职业生涯的顶端在发挥多方面的因素。

虽然结构性因素阻碍妇女晋升领导职位的能力，一般来说，现在是众所周知的-如'粘地板'的效果，这使得妇女的进步，由于工作的专业和家庭劳动的'两班制'，也有其他的，更具体的因素在发挥作用的性别和权力差距的护理专业。在我们的报告中，我们提供了一个分析的性别规范，支持这些差距在护理。尽管本报告所包括的国家之间存在着重大的文化差异，但正如表1中的统计数据所显示的那样，护士职业的性别化仍然存在。通过社会文化的透镜，我们解开这些规范如何影响女护士的职业机会，以及他们如何阻止男性进入这个行业。

1.揭示文化规范和陈规定型观念

整个欧洲的社会都有根深蒂固的文化价值观，将照顾和身体的角色分配给女性，而领导和决策角色通常被认为更适合男性。虽然护理包括各种技术和临床专业知识，但它通常与实际护理有关，而不是医疗保健的临床方面。这种看法强化了护理领域内的性别分工，限制了女性担任领导职务的机会，而男性则上升到此外，性别偏见使男子不愿参与照料或车身工作，进一步巩固了传统的性别角色。这种偏见是由医疗保健行业，护理主要被视为“女性的工作”和医学作为一个主要的男性领域的持续性别化加强。因此，我们不仅要处理护理专业个别成员的性别，而且要处理整个专业的性别化。这种区别延续了职业之间的不平等，破坏了医疗保健部门内护理工作的重要性，因为对治愈的关注掩盖了护理的关键作用。

照料工作与妇女的“自然本能”密切相关，是妇女与母性的陈规定型关系的延伸。护士，通常被认为是女性，在历史上被视为医生的助手，通常被认为是男性，而不是被认为是专业人士（纽曼等人，& nbsp;2019年）。尽管近几十年来护理的专业化程度不断提高，但护理作为一种以女性为主的职业的观念继续影响着该领域的身份。这种形象，植根于更广泛的性别规范，重视男性对女性的影响，有助于护理贬值，这直接影响到护士领导中持续存在的性别不平等。

由于其与女性气质的联系，护理通常被认为是一个“软科学”，而生物医学，传统上被视为男性领域，被认为是一个“硬科学”。尽管在许多地方，医学院的女生人数超过了男生，但这些联系依然存在。

照顾与女性气质和柔软的协会劝阻男子追求职业生涯的从业者。相反，它鼓励他们在护理领域的“不那么软”的管理职位上寻求晋升。因此，有人建议护理应强调其技术和高技能方面，以抵消这种关联（世界卫生组织，2019）。然而，虽然护理包括临床和技术技能和专业知识，往往显着不同的陈规定型形象的妇女提供产妇护理卧床不起，它提出了一个问题，是否解决方案在于远离护理与护理工作。这样做有可能强化“治疗”优先于“护理”的文化信念，并使护理低人一等的观念永久化。

第2章导航结构挑战和障碍

即使在通常被认为是性别平等的国家，如斯堪的纳维亚国家，性别差距在护理领域也持续存在，在领导职位平等方面也是如此。在丹麦，96.5%的护士是女性，围绕这一职业的性别陈规定型观念继续阻止男性将其视为可行的职业选择。而在同一时间，仔细看看护士领导中的性别代表人数，发现男性成为领导者的可能性比女性高62%（Balkin等人，& nbsp;2022年）。

上述关于护理部门持续存在差距的调查结果进一步得到证实，尽管从事这一职业的男性人数很少，但仍然存在有利于男性雇员的薪酬差距。例如，在欧盟性别平等指数排名第一的瑞典，女护士的收入低于男同事。挪威已作出努力，增加对以一种性别为主的教育方案的参与，向申请者分配“性别分”，例如，吸引更多的妇女从事工程，更多的男子从事护理。但这种干预会对领导机会产生影响吗？医疗保健部门的管理职位仍然由护士代表不足，医生持有67%的管理职位。这种低代表性的护士在领导，这是显而易见的整个欧洲的背景下，增强了护理的文化观念，在医疗保健贬值。需要采取行动支持女护士参与保健领导工作。

3转型之路

为了解决护理领导中的性别不平等问题，我们必须承认其根源在于根深蒂固的文化价值观。我们的评估揭示了这些隐性影响如何塑造对护理专业的看法和赋予护理的价值，护理是其身份的核心。在我们的报告中，我们在国际，国家和机构层面提出了各种跨部门的建议，以解决护士领导中的性别差异问题。这些建议包括进行全面的定性和定量研究、加强职业培训和确定潜在的政策重点。然而，挑战在于解决的差异，从文化规范远远超出护理和护士领导。此外，必须注意的是，在这篇文章中，我们已经讨论了性别作为一个二元。目前，这是在性别平等统计数据中划分性别的断层线。我们认识到，这是一个简化，并不代表所有的性别身份在护理劳动力。

作为社会科学家和非护士，我们提供了一个独特的局外人的角度来看，护士领导的性别差异。虽然这可能会让那些不太熟悉这一行业的人感到惊讶，但女性化的职业中女性领导者人数不成比例地少，这一事实对护理界的人来说并不陌生。我们的研究发现了正在进行的旨在使护理声音多样化的举措，开发了一种支持横向领导的护理教学法，并培养了对支撑优质护理工作的技能和价值观的更深层次的理解。未来的改革应优先考虑与护士接触，培养一种超越传统管理导向模式的领导方法，并承认护理专业的独特性。没有单一的解决方案，以解决护士领导中普遍存在的性别差异。在许多方面，这类似于“护理与治疗”的二分法，即低估护理技能为“软”，而将医疗保健的临床，技术方法视为更先进，“更难”和科学。也许在这里，我们也需要更多的是一个持续的，包括“护理”的方法来解决护士领导中的性别平等问题，而不是专注于任何一次性的“治愈”。

资金信息

该项目已获得欧盟H2020研究和创新计划的资助，该计划根据MSCA-ITN-2018获得资助协议编号813928。财务赞助商在数据的设计、执行或分析以及本文的写作中没有发挥任何作用。

利益冲突声明

作者声明不存在利益冲突。

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