The challenges of recruiting and retaining public healthcare workers in NSW public health services have never seemed so insurmountable. Staff exodus in the wake of COVID-19, increasing demand for services, changing demographics and industrial relations pay disputes only highlight the complexities in attracting and maintaining a large, highly qualified workforce.

In this context, nursing faces persistent workforce shortages, posing an ongoing threat to the timely delivery of quality care. A shortage of over 70,000 nurses by 2035 is predicted across Australia, especially in acute care. The recently released Special Commission of Inquiry into Healthcare Funding in NSW reinforced this point, finding “significant shortages of midwives and enrolled nurses across the State” – one symptom of the absence of a “system wide approach to workforce planning”.

Strategies such as international recruitment and increasing university places have been the classic policy levers of the past to boost the nursing workforce. However, these approaches alone are no longer adequate solutions to address an increasingly difficult problem.

Though the healthcare industry has made significant strides in addressing gender inequality in areas of medicine and management, the same cannot be said of nursing. We continue to see men significantly underrepresented in nursing, with very little change in recent years. In 2016, just 10.8 per cent of Australian nurses were male. By 2021, this had grown by less than one percentage point to 11.60.

While some piecemeal efforts have been made in the past to highlight and address this problem, the profession overwhelmingly speaks to only half the population, making recruitment exceedingly difficult.

Australia is not unique in the demographic profile of our nursing profession. So, in a policy fellowship with the Australian Public Policy Institute, I sought to understand what strategies exist internationally to address this challenge.

Through an extensive literature review and with input from international experts, I identified a series of barriers and potential strategies to address them. These insights were then presented to a panel of stakeholders from NSW representing the university sector, the professional nursing association and the NSW Ministry of Health. Through this workshop, we tested and verified international strategies and prioritised what would work within an NSW context.

Barriers across the nursing workforce pipeline

I found that men in nursing face both personal and societal barriers throughout their careers, from initial recruitment to professional advancement.

Personal barriers include a lack of support from family and friends, experiences of role conflict (arising from the tension between societal gender norms and the expectations of the nursing profession) and the visibility of male role models.

Societal barriers involve stereotypes, media representation and gender norms, all of which hinder equal participation in the nursing workforce. While some barriers exist across the workforce pipeline, others are unique to different stages, whether commencing with recruitment or through to entering the profession.

Increasing the recruitment of men into nursing programs is crucial, with a focus on engaging high school boys. Early exposure to nursing and health professions is a consistent motivator for men. However, men continue to be prevented from entering the profession by a lack of promotion of the profession to male students, the reinforcement of stereotypes by career counsellors and the relative invisibility of men in nursing.

Once students have entered a nursing program, retention becomes a challenge. University programs are microcosms of the profession, meaning the experience of students will shape their perceptions of (and commitment to) a career in nursing. Men’s experiences through university are different from that of their female peers. Bias in assessment grading, gendered content delivery, differing treatment by teaching staff and a lack of visible male role models all contribute to higher attrition rates before male students even enter the profession.

Research on transitioning into the nursing profession is limited, with most studies focusing on clinical placements rather than the entry process or the first year of work. A 2019 South Korean study found a 25 per cent turnover rate among first-year nurses, with men in nursing experiencing higher turnover than their female counterparts. This transition period is a vulnerable moment for early-career nurses and requires cooperative support from universities and health services. Barriers reported by men include exclusion during clinical placements, particularly from specific clinical experiences, and professional isolation due to a lack of male colleagues.

Retention of nurses is also critical given the high organisational costs of turnover. In NSW, such costs are significant, with a 12.6 per cent turnover rate before COVID-19. Men experience higher attrition rates, particularly in their first year and in regional areas, impacting both financial sustainability and patient safety. Team cohesion and individuals’ job satisfaction are affected by the differential experiences of male nurses. This includes bullying and exclusion from social activities, a lack of role models and male professional mentors and gendered task allocation which sees men more often assigned physically demanding tasks.

Strategies to address workforce shortages

From the workshop with stakeholders, some key opportunities emerged that could meaningfully improve the recruitment and retention of men in nursing.

There is scope to boost recruitment into nursing programs by implementing education campaigns, enhancing career counsellor education and ensuring strong male nursing representation at school visits and career fairs. The allocation of resources and staff – including engaging men currently in nursing positions – could support such efforts.

Promising ways to improve the retention of men in nursing programs include reviewing teaching materials for gender diversity, implementing gender-neutral teaching practices and providing unconscious bias training for staff. Developing new peer support and mentoring programs which pair first-year and final-year students could also be implemented.

Action is needed to aid the transition of men into the nursing profession. Piloting mentorship programs for men in nursing is one strategy. Another could be to offer more long-term support for students on placement that carries through to their transition into the profession, working in partnership with healthcare services.

Retention could be improved by piloting mentoring and peer support programs for men in nursing across local health districts or healthcare services. Other options include providing unconscious bias training for nurse managers and investigating “train and retain” initiatives to transition existing healthcare staff into nursing, with a focus on rural and regional health districts.

Strategies directed towards attracting and retaining male nurses could form a key component of a multipronged approach to address NSW’s nursing workforce challenges that builds on the momentum of the Special Commission. More male nurses with long and successful careers in the profession will be critical to the ongoing provision of high-quality and timely care to the people of NSW.

Jodie Brabin is an academic in health management and leadership at Charles Sturt University. Her research spans the Australian and Pacific region, focusing on issues of workforce, governance and service evaluation. She recently completed a Policy Fellowship at the Australian Public Policy Institute.

This article draws upon Jodie’s APPI  Policy Insights Paper: From classroom to clinic: strategies for recruiting and retaining men in nursing in NSW.

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