Martínez-Morato et al. BMC Nursing (2021) 20:114 https://doi.org/10.1186/s12912-021-00641-z RESEARCH Open Access Emotion management and stereotypes about emotions among male nurses: a qualitative study Sergio Martínez-Morato1,2, Maria Feijoo-Cid2,3*, Paola Galbany-Estragués4,5, Maria Isabel Fernández-Cano2,3 and Antonia Arreciado Marañón2,5 Abstract Background: Nursing requires a high load of emotional labour. The link between nursing, emotional labour and the female sex, complicates the figure of the male nurse, because masculinity is associated with physical or technical (rather than emotional) and moreover is defined in contrast to femininity. Our objective was to understand how emotion management is described by male nurses who work in the paediatrics department of a Spanish tertiary hospital. Methods: Qualitative descriptive study. The participants were selected through intentional sampling in the paediatrics department of a Spanish tertiary hospital. We conducted semi-structured interviews until reaching data saturation. We carried out a content analysis, using Lincoln and Guba’s definition of scientific rigour. Results: We identified two key themes in the data: 1) Stereotypes related to the emotional aspects of care: Participants took for granted some gender stereotypes while questioning others and defended alternative ways of managing emotions related to care. 2) Emotion management strategies: Participants described keeping an emotional distance, setting boundaries, relativising problems and using distraction and humour. Discussion: Nursing care is conditioned by gender roles and stereotypes that present men as less capable than women of feeling and managing emotions. However, emotion management is necessary in nursing care— especially in paediatrics—and our participants reported using strategies for it. Although participants continued to interpret care in terms of traditional roles, they contradicted them in adapting to the emotional labour that their job requires. * Correspondence: maria.feijoo@uab.cat 2 Department of Nursing. Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain 3 Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 2 of 10 Conclusions: New behaviours are emerging among male nurses, in which care and emotion management are not exclusively the purview of women. Our participants reproduced some gender stereotypes while disrupting others, and they tended to cling to the stereotypes that were favourable to them as male nurses. As we work towards a gender-neutral profession, these results represent a first step: male participants reported that they provide care and manage their emotions as well as (or better than) women. However, because they substantiated their claims by drawing on negative stereotypes of women, further progress must be made. Keywords: Emotion management, Male nurses, Gender roles, Gender stereotypes Introduction children means having to handle the emotions of chil- The presence of men in nursing is significantly lower dren, their families and the professionals themselves. than that of women. According to the Spanish National These emotions are linked to sickness and death in Institute of Statistics [1], for the last 10 years, about 15% childhood and are subject to shared values and beliefs of Spain’s nurses have been men, and this proportion is and individual experiences [18]. It is precisely in emo- increasing. Internationally, the figures range from 2% in tion management where nurses have the most difficulty China (2017) [2] and 7% in Canada (2016) [3] to 9.6% in [19, 20].. A meta-analyisis shows that paediatric nursing the US (2018), 10.5% in Sweden (2016) [4], 11% in the is the area in which burnout is most prevalent [21].. Ac- United Kingdom (2017) [5], and 11.7% in Australia cording to other studies, burnout is more prevalent in (2018) [6]. According to the World Health Organisation, male nurses, both in paediatrics and other areas [18, 22]. in 2019 the proportion of male nurses was 14% in Eur- Nursing is marked by the norms of social interaction ope and the Americas, 19% in Oceania, 21% in Asia and that are linked to gender. As men, male nurses are often 35% in Africa [7]. typecast in conventional masculinity, setting aside their Nursing has traditionally been carried out by and asso- emotional side to present themselves as rational, autono- ciated with women; as a result, men who wish to be- mous and technically or physically competent [23]. Men, come nurses often find that their masculinity is regardless of their occupation, tend to use rational cop- questioned by others [8, 9]. Professions traditionally ing strategies—developing plans to manage problems, practiced by women are associated with a higher load of establishing realistic expectations—which is in turn emotional labour [10]. According to Hochschild [11], linked to less chronic stress [12]. However, in the con- norms surrounding the expression of emotions vary text of professional care, male nurses have to reformu- cross-culturally. Emotions form part of daily life and late their role as men to adapt to the emotional nature allow us to understand motives underlying our own and of their work. For example, they use empathy to improve others’ actions. Emotions reflect personal and collective their therapeutic relationships and provide better care affective states, and, because of their multi-faceted na- [24]. Some patients highlight experiences in which male ture (biological, psychosocial and cultural), they play a nurses were respectful and considerate, used active lis- determining role in the construction, maintenance and tening and supported them. Importantly, these charac- transformation of the social order. Emotional labour terisations could result from a contrast between conducted in the workplace is often viewed as an inher- expectations and experiences of being cared for by a ent attribute of the profession in question. Professionals male nurse [25]. Male nurses alternately reject and re- must deal with their own emotions without forgetting produce hegemonic masculinity, which presents them as that their social context conditions how they manage less able than women to provide emotional support [26]. them. Traditionally men are assigned a role in which This double-bind might be a factor contributing to the emotion management is considered secondary, because fact that male nurses are more likely to experience stress it is associated primarily with women [12, 13]. than female nurses [18, 22]. Nurses are expected to show empathy, but, at the The traditional rigid definitions of masculinity—a re- same time, detachment is identified as a trait of profes- flection of patriarchal culture—compromise the mascu- sionalism [14]. Using emotion management strategies linity of men who choose a profession that is “naturally” makes it possible to satisfy one’s professional obligations associated with women [27]. At the same time, these [15, 16]. However, while having good emotion manage- definitions call into question the acceptability of men in ment strategies protects the individual [17], emotion the profession [28]. This points out the necessity of ana- management in itself involves stress, which appears to lysing how male nurses manage the emotions linked to justify detachment and emotional disengagement to care and explore new non-hegemonic constructions of overcome suffering in the workplace [10]. In paediatric masculinity. Several researchers have investigated the care, emotions are particularly important. Working with figure of the male nurse, highlighting stereotypes and Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 3 of 10 difficulties that male nurses find on the job [29, 30] but year of experience working in these areas of paediatric also the advantages of incorporating men into care work care. The exclusion criterion was working in out-patient [2, 31]. Others have focused on the importance of emo- care, because such nurses do not have hospitalised tion management in nursing in general [32, 33]. How- patients. ever, little attention has been paid to emotion Sampling was purposive [38] to ensure a both management among male nurses in particular, despite homogeneity-regularity and heterogeneity-diversity the fact that care environments foster emotional devel- across the participants. In choosing participants, we con- opment, and men are often associated with roles that sidered age, work areas, professional experience and ex- make them feel greater discomfort in the work environ- perience in paediatrics (Table 1). Consequently, we ment [25, 34, 35]. Exploring how men manage their chose participants who had significant experience inter- emotions in professions considered to be women’s pro- acting with patients and families and who were moti- fessions, such as nursing (a field that also carries a high vated to speak with us. Data collection took place emotional charge) will make it possible to advance September–December 2015. knowledge about men’s emotion management strategies Supervisors were recruited to describe the project to and the gender stereotypes that are manifested in the male nurses in their unit and invite them to participate. area of care. The nurses who agreed to participate were screened by This study is part of a multidisciplinary project about the principal investigator (PI) using the diversity criteria the participation of men in professional and non- that we had established. Each selected participant was professional care entitled “Men as caregivers: challenges then contacted by the PI, who explained the study de- and opportunities to reduce the gender gap and to face tails, secured his consent in writing and arranged a time new care need.” Under the auspices of this project, we and date for the interview. One participant withdrew at published an earlier qualitative article [36] about how this point. The researchers didn’t know the participants male nurses manage relationships with the families of hos- before the study began. Participants were not pitalised children and how these are influenced by gender compensated. roles and stereotypes. We showed that male nurses inter- preted the relationship with families in terms of traditional Data collection gender roles and stereotypes, despite rejecting the notion The PI conducted semi-structured interviews [38] with that nursing is a women’s profession. In the current art- the participants in Spanish, between September and De- icle, we focus on a different question: How do male nurses cember 2015. The vast majority of the interviews (11) describe emotion management on the job? were held at a university classroom before or after the nurse’s shift. One participant requested that the inter- Objective view be held at a hospital office. We developed a semi- Understand how emotion management is described by structured interview guide, making minor changes after male nurses who work in the paediatrics department of the first interview. We asked: How do you feel when you a Spanish tertiary hospital. work caring for hospitalised children and their families? Could you tell me about your emotions, in comparison Methods to those of your female nursing colleagues, when you Design care for these children? What do you do to manage Descriptive qualitative study. We chose this design be- cause it enabled us to collect information about how Table 1 Characteristics of the participants male nurses’ experienced emotions in paediatric care. It Age (years) 25–60 also provided rich descriptive content from the partici- Paediatric nursing experience pants’ perspective [37]. 1–10 years 7 11–30 years 5 Setting and participants Participants’ work area The study population belongs to a public tertiary hos- Paediatric Hospitalisation Unit 4 pital in Barcelona, Spain, which employs over 3000 nurses. The maternal and child department treats an Neonatal Intensive Care Unit 3 average of 300,000 patients per year and employs a total Paediatric Intensive Care Unit 4 of 624 nurses, of which 31 are male (study population). Paediatric Emergency Unit 1 To be included in the study, participants had to meet Is the participant a parent? the following inclusion criteria: to be eager to partici- Yes 5 pate; to be employed as a paediatric nurse in hospitalisa- No 7 tion, emergency, or intensive care; and to have at least 1 Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 4 of 10 these emotions and how would you compare it to what Results female nurses do? We asked follow-up questions de- We interviewed 12 male nurses working in paediatrics. pending on how participants answered. Interviews lasted They ranged in age from 25 to 60. Participants’ charac- 50 min on average. The interviewer took field notes. We teristics can be seen in Table 1. defined data saturation as the point at which inter- We identified two main themes in the interview data: viewees repeated responses provided by previous partici- stereotypes in the emotional aspects of care and emotion pants, without providing new information [39]. We management strategies (Table 2). Stereotypes in the reached data saturation in interview 11. However, to be emotional aspects of care. sure that saturation had been reached, we conducted a The participants reported that providing care led them twelfth interview (which also showed repetition and the to face emotional challenges on a daily basis. They re- lack of new themes). We then ceased data collection. ported butting up against societal norms according to We audio recorded the interviews and later transcribed which care falls under the purview of women. For some them. We did not return transcripts to participants. participants, being a man in a women’s profession wasn’t However, we provided them with a summary of their easy, because the patient or the family usually expected interview and allowed them to make changes, if neces- to be attended by a woman. These situations reinforced sary. All participants accepted their summary without the stereotype that nursing is a women’s profession and changes. caused the male nurse to feel he wasn’t meeting the ex- pectations of the patient and the family. Data analysis “You may find a little more misunderstanding We carried out a content analysis of the data in the fol- among people, (...) who don’t understand that a man lowing steps. All recordings were transcribed verbatim. might have to provide care for a woman.” (I1). The PI and another author read and reread the tran- scripts and notes. Next, the PI coded the first four tran- Following this argument, participants believed that in scripts, which she later discussed with the other author the collective imagination care is still associated with the until reaching consensus. From this point, these two au- female figure, especially in the case of children or in sit- thors divided the remaining transcripts between them, uations that involve providing emotional care through each coding some of them based on the shared criteria the use of touch. Still, some participants questioned this they had developed. They discussed any cases in which hegemony and aimed to undermine this prejudice. it was unclear how to apply the coding criteria. After the When talking about a female nurse he used to work 12 transcripts were coded, they were shared with the with, one participant reported: remaining authors and analysis proceeded jointly in the team. Finally, the data were refined and grouped hier- “‘A man can’t do this job well. A man can’t bathe a archically into themes, and these themes were named child, take care of a child, show affection toward a [40]. We used the Dedoose software package to codify child. A man can’t do it well.’ That was her argu- and organise the data. ment. But then I set myself a goal and it was to show her that we could do well” (I8). Rigour Participants also reported that they had developed We followed Lincoln and Guba in ensuring the credibil- their own ways of handling the emotional aspects of car- ity, transferability, dependability and confirmability of ing for children. According to them, emotional and the study [41]. Credibility: Each participant was offered physical comfort can be offered in different ways by the chance to correct the summary of his interview. As male nurses. mentioned, we conducted the initial data analysis and coding separately. Finally, we used the technique of con- “Well, you can comfort him [the child] in many stant review to compare our results with those reported other ways: you can use touch differently, you can in the scientific record. Dependability: We carried out hold them in your arms and calm them in your constant review and a detailed description of how we arms, there are many ways. Just like women don’t collected, analysed and interpreted the data. Transfer- all show affection in the same way, do they? That’s ability: We collected data exhaustively and provided a what I think.” (I8). close description of contextual factors and participants to allow comparison and potential extrapolatability to However, the participants attribute to women sup- other contexts. Confirmability: Constant reflection en- posedly innate characteristics such as sweetness and the couraged us to consider our own positionality. use of touch in care, as well as a naturally acquired Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 5 of 10 Table 2 Table of themes, categories and codes Theme Stereotypes in the emotional aspects of care Codes ▪ Nursing is a women’s profession ▪ Care is associated with females ▪ Comfort can be offered in different ways ▪ Innate characteristics of women: sweetness, the use of touch in care ▪ Naturally acquired maternal role ▪ More relaxed male nurses’ attitude in the therapeutic relationship ▪ Male nurses show their emotional needs less Theme Emotion management strategies Category Emotional distancing Setting boundaries Relativising problems Using distraction and humour Codes ▪ Not feeling part of the work ▪ Learning affective touch ▪ Minimising the importance of ▪ Humour facilitates therapeutic environment ▪ Not taking work home work problems relationship ▪ Getting involved is harmful ▪ Not creating personal ties with ▪ To relativise is to protect ▪ Play and distraction are useful in ▪ Getting involved is patients/family oneself emotionally caring for children unprofessional ▪ Men relativise better than ▪ Greater sense of humour women ▪ Greater use of play and distraction maternal role. Additionally, they described the character- According to the participants, male nurses show their istics that they considered to be feminine to facilitate the emotional needs less and, in fact, do not express them in therapeutic relationship. They described these attributes the workplace. Women, on the other hand, show more as complex, in contrast to the emotional simplicity with of their sensitivity, affecting, according to them, their which most of them identified. ability to perform their job. “Because women may be more tactful when it comes “In the general emergency room and in traumatology to... men are like simpler, I think.” (I12). a male co-worker has never told me, “Man, take over for me. I can’t do it because I feel like crying” or “be- “You have that component of sweetness and you can cause I can’t cope.” Because it’s never happened to reach [patients] more easily with that component of me with a male co-worker, but it has happened to sweetness, of a sweeter approach, closer to families me with a female co-worker.” (I5). in specific situations. And guys, well, we may keep a little more distance in that regard.” (I3). Emotion management strategies While participants highlighted these characteristics, When children are hospitalised, emotions run strong they also associated female nurses’ maternal behaviour and nurses are forced to respond. Although participants with authoritarianism. In contrast, according to them, described themselves as less emotional and more object- male nurses have a more relaxed attitude in the thera- ive because they were men, they also claimed that being peutic relationship. male did not prevent them from expressing and man- aging emotions. “Well, that facet, on the positive site, my previous [female] teammate was more like a mother: “You “The first death that I had in paediatrics, I wanted have to take it because of this and that (...)” But to keep working. ( … ) Then I left the room and I I, for example, break protocol a little bit. Maybe I started crying. I needed a quarter of an hour. And picked up the child, put on music for her, danced actually, now that I’m telling you about it, I’m get- with her... We stimulated her in another way.” ting emotion, you know (...) because we get more (I3). emotional with a child” (I5). One of the participants asserted that some men pos- In our analysis, we detected four strategies that the sess a more developed maternal feeling than others. This participants used to manage their emotions in the care trait would in turn lead them to want to devote them- environment: emotional distancing, setting boundaries, selves to professional care. relativising problems and using distraction and humour. “This depends on the person. You have to like it Emotional distancing [providing care]. (...). Maybe some of us men that According to participants, the cultural expectations that have more maternal feeling.” (I7). attribute to women the caring role leads many male Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 6 of 10 nurses to distance themselves emotionally when faced the effect on the nurse and also bring about a simple with questions about how the patient and families will resolution to problems. This supposedly different ap- react to a male nurse. proach that men and women use to handle their profes- sional lives is also reproduced in personal life. In the “At the beginning, I think there’s a difference in be- words of one participant, men and women have “differ- haviour for the good, because you don’t know how ent ways of taking things in life” (I8). they’re going to accept a male nurse.” (I2). “When we [men] have a problem that’s pretty serious The participants reported that they become less in- and can affect us even in our partner relationship, volved emotionally than their female co-workers. For we have a tendency to relativise it, to play it down. I some of them, as expressed by I1, getting too involved think women don’t relativise as much.” (I5). isn’t healthy and makes it hard to be professional. Participants reported that relativising problems that “You establish a professional relationship, polite. But emerge around care was healthier and led to a greater you don’t get to the point of getting involved emo- emotional protection. According to them, women don’t tionally (...). We don’t get involved at an emotional relativise as much as they do, and they experience these level the way a woman could.” (I12). problems more personally, which leads to greater worry and reduces their well-being. Sometimes you get really involved (...) and I think it’s not healthy (...). It’s very difficult sometimes to be “Women take everything more personally, you know? professional when you have very mixed feelings for a And they experience it more like a pressing problem, certain patient.” (I1). they find themselves more worried, more anxious.” (I8). Setting boundaries For these participants, certain activities, such as provid- Use of distraction and humour ing affectionate touch, are not part of the profession, but Distraction and humour helped participants manage sit- they were forced to learn them because this was ex- uations that were emotionally problematic. They de- pected of them in paediatrics. Emotions linked to affec- scribed this emotional strategy as being more typical of tionate touch don’t go beyond the professional context. men and said that it facilitated the therapeutic relation- This delimitation is identified as an attribute of profes- ship and helped them handle moments of tension sur- sionalism that supports the child’s health. rounding their patients’ health. According to the participants, women handled these situations more emo- Yes, we can provide emotional and physical connec- tionally, while they tended to use other strategies, such tion, but it’s not our role. We do it like someone who’s as joking around. learned to play a game and practices it (...). You can get into it, like you’re acting, but then you don’t take “I try to make jokes to release some of the tension that problem home. We’re here to provide the most that the problem has caused (...). I do this more with professional care possible, and definitely the most hu- the parents (...) I mean, you use what could be a mane possible. But also professional. And when we problem as something positive, to downplay it and to mix feelings, we stop being professionals.” (I1). get them to calm down. (...) What my female co- workers achieve with emotion, I achieve with jokes.” Participants reported that, on occasion, their female (I5). co-workers crossed the lined in the therapeutic relation- ship, creating attachments outside of work with the The use of games was also identified by participants as people they cared for. According to participants, this necessary when they treated paediatric patients. They re- doesn’t occur with male nurses. ported that playing games helped them get closer to the child in the care environment and helped avoid compli- “Maybe being friends or palling around can take cations in carrying out their work. place sometimes. This, in the case of my male co- workers and me, doesn’t happen.” (I12). “With a glove, I blow it up and I make a drawing or a face. Through games I get quite close to the child. Relativising problems Then I see that I can get closer to him (...) If you Relativising means downplaying the importance of prob- move in with a serious face, we’re on the wrong track lems that emerge on the job. This strategy can minimise (...). The child is going to start crying and everything Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 7 of 10 is going to be more complicated (...). You always Despite the fact that our participants claimed that have to try to have a smile on your face” (I7). their desire to provide care was a key factor in deciding to become nurses and despite the fact that they devel- As we can see, when participants talked about what oped emotion management strategies, our participants supposedly distinguished them from female nurses, they interpreted care in terms of traditional gender roles relied on positive stereotypes attributed to the male sex, when they said, for example, that they become less emo- such as knowing how to keep emotional distance and set tionally involved than their female co-workers. This dis- boundaries, relativising problems and having a better cursive move highlights a simultaneous reproduction sense of humour. and disruption of the traditional, binary gender system, as seen in a previous article [36]. The study participants not only felt able to provide care, but also reported being Discussion able to develop emotional care strategies associated with The participants identified themselves as less emotional femininity, when the situation required it. Notably, they in care environments than female nurses and reported defined themselves as “good care providers”, highlighting expressing their emotions differently than their female technical aspects about controlling situations or using counterparts, although they also argued that male nurses physical force, to the detriment of emotional aspects of express emotions. Previous studies suggest that similar care. We observed that the participants clung to or findings are the result of social expectations [25] and rejected gender stereotypes depending on whether the that male nurses masculinise care to protect themselves stereotype was favourable to them in their profession. from exhaustion and emotional overload [42]. The social Other researchers show that continually having to decide perception that emotional expression is necessary for whether to act according to or against normative mascu- nurses and that it comes naturally to women is at the linity causes psychological stress, meaning that gendered core of the idea that nursing is a women’s profession expectations condition men’s well-being [48]. [43]. These cultural associations/social perceptions mean Integrating a focus on gender into the study of men that men engaged in professional care face a series of ex- who do “women’s work” highlights the need for research pectations and prejudices. to be oriented toward multiple masculinities instead of a Popular representations of Florence Nightingale led to single mode [27, 49]. For the men in our study, emotions the recognition of women in professional care, the exalt- linked to care are something to be learned and they de- ation of women as ideal carers and the idea that nursing pend on the care context. Paediatric care often requires is a women’s profession [8].. Social expectations often the management of difficult emotions that emerge from condition the preferences of patients—leading them to stressful situations related to communication, suffering prefer being cared for by a woman. This means that and taboos in care for children [18, 50]. The literature men must adapt their behaviour for a more effective highlights that male nurses in paediatric care are more therapeutic relationship [24, 44]. Other researchers have likely to suffer from stress and burnout [21, 22, 50]. The shown that men often face situations in which they feel data show that participants developed emotional prac- excluded in care situations [35, 45], although slowly the tices when necessary, depending on the context, as also figure of the male nurse is becoming consolidated and described in an earlier study [49]. When male nurses ex- accepted in professional care [30]. Our participants also press a preference for more technical areas, this prefer- felt excluded because they were men. Men and women ence can in itself represent a strategy of emotion share the same motive for becoming nurses: being able management, since it makes it possible to feel a sense of to care for other people [46]. Further, the main reasons accomplishment in a scenario in which the probability that some men choose not to become nurses or leave of success (such as the survival of the person being cared nursing are related to stereotypes surrounding the pro- for) can be low [24]. Notably, overall distress is more fession [9]. In fact, some participants also explained that prevalent in women regardless of occupation, and some men develop a “maternal feeling” that leads them women are more likely to use emotional coping strat- to devote themselves to professional care. Using the de- egies [12]. However, in the case of nursing, distress is scriptor “maternal feeling” links nursing implicitly to a more prevalent in men and men use rational coping supposed feminine instinct. In terms of patients’ per- strategies [18, 22]. spectives, some researchers show that patients highlight The first strategy we detected was emotional distan- traits of male nurses that make them apt for providing cing. This strategy involves staying emotionally separate care. However, these patients in fact identify the same from patients to maintain neutrality, an approach that is traits in female nurses [25]. This set of findings rein- also described as feeling separate from events and the forces the need to normalise nursing as a gender-neutral emotions that they generate [12], which is identified with profession [26, 47]. greater protection of the nurse’s mental health and a Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 8 of 10 more professional treatment of the patient [51]. Emo- participants to interpret care in terms of traditional gen- tional distancing, in the more physical sense of the term, der roles. is associated with males [10]. Physical contact is condi- Participants talked about using distraction and tioned by gender in the daily life of the male nurse, as a humour as a tool to reassure and comfort the people kind of taboo [31]. In fact, this taboo leads some male they cared for and their families. Strategies designed to nurses to choose to work in areas of care in which phys- provide comfort themselves act as a protective factor for ical contact is less necessary [34], highlighting how ste- nurses who use them, and these strategies are associated reotypes affect emotion management strategies and the with better psychological well-being, happiness and sat- choice of care area. isfaction [24, 54]. Humour additionally serves to human- Harris argues that inflexible distancing establishes ise health care and therapeutic communication, which hierarchies of power among professionals and the people requires practice [55]. Other studies do not make they care for, generating asymmetrical therapeutic rela- gender-based distinctions in this area, while our partici- tionships [52]. Although emotional distancing is recog- pants again understood this strategy to be the purview nised in the literature as typical of men, it is a strategy of men. Here, too, they espoused a gender stereotype that is employed by nurses of both sexes [15]. In that benefited them. addition, as described by some study participants, this This study has several limitations. First, data collection emotional distancing emerges from feeling insecure took place at a single centre. However, the centre had a about how they will be received as men in a feminised large number of both male and female nurses, a plurality profession. However, emotional distance is described as of care department and high complexity of care. A sec- a mental health strategy, in that it prevents the patients’ ond limitation is that we didn’t interview female nurses, pain and negative feelings from contaminating the emo- meaning that we couldn’t compare perceptions of male tional labour of the nurse, thus helping to maintain pro- nurses with those of female nurses. Third, the interviews fessionalism [51].. Our participants described this were conducted by a woman, and the responses of par- strategy as one used by men and linked it to greater pro- ticipants could have been conditioned by the gender dif- fessionalism. Notably, prior research points to the im- ference between them. In any case, the interviewer’s sex portance of finding a balance between involvement and did not prevent participants from reproducing negative distance, to avoid being negligent in the provision of stereotypes about women, leading us to think that any care [53]. effect of the interviewer’s sex was small. Additionally, The participants defined setting limits as being able our team includes a male paediatric nurse, who was able to feel and to carry out the emotional labour required of to contribute his point of view to the analysis. Finally, the profession without taking these emotions beyond the we did not complement our interviews with direct ob- work environment. The participants described establish- servation in the hospital, which would have allowed us ing limits as a strategy that helped them strike a balance to collect empirical data about male and female nurses’ between respecting the patient’s privacy and understand- emotional behaviour for comparison with the interview ing his or her emotional world through the therapeutic data. Nonetheless, the study gives voice to male nurses, relationship, which improves the satisfaction of both the allowing us to understand how they view emotion man- patient and the nurse [15]. A therapeutic relationship in agement strategies and how they grapple with gender which emotional limits are balanced increases satisfac- stereotypes as they forge a new masculinity. tion and reduces stress in palliative care for paediatric patients [53]. Hammonds et al. [14] show that nurses Conclusions (without reference to sex) typically set boundaries out- Emotion management is necessary for professional side of work but also report that these limits are not carers, especially those in paediatrics, and male nurses uncrossable. learn strategies for it. Professional care is conditioned by Our participants talked about facing day-to-day prob- traditional gender roles, in which men are understood as lems in their jobs by relativising them. Similarly, Lartey less capable of feeling and managing emotions. However, et al. [32] show that nurses use strategies to minimise as human beings, both male and female nurses manage the importance of things that happen on the job, nor- their emotions; in no sense is emotion management the malising their emotional experiences to cushion the im- exclusive terrain of women. Nonetheless, our partici- pact of the emotional demands of professional pants tended to cling to gender stereotypes that favoured caregiving. In our study, participants took this minimisa- them in their professional role, including negative ste- tion beyond the professional environment, identifying it reotypes of female nurses as over-emotional on the one as a natural attribute of men. Other studies, in contrast, hand and humourless on the other. Future research describe this strategy as intrinsic to nursing [33]. This should explore other factors that influence the gender contrast again points out the tendency of our stereotypes linked to care, as well as the link between Martínez-Morato et al. BMC Nursing (2021) 20:114 Page 9 of 10 gender stereotypes and stress on the job. It is also im- Competing interests portant to explore how female nurses and the general The authors have no conflict of interest. population perceive male nurses, especially in relation to Author details the emotional aspects of care. Finally, it is important to 1 CAP Vila Olímpica, Parc Sanitari Pere Virgili, Barcelona, Spain. 2Department of learn whether female nurses use emotion management Nursing. Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain. 3Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 strategies linked to masculinity, both in paediatric nurs- SGR 917), Barcelona, Spain. 4Research Group on Methodology, Methods, ing and other areas. Models and Outcomes of Health and Social Sciences (M3O), Faculty of Further work needs to be done to develop nursing as a Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic‐Central University of Catalonia (UVIC‐UCC), 08500 Vic, gender-neutral profession, based on a definition of care Spain. 5AFIN Research Group and Outreach Centre, Autonomous University as a task of all humans rather than only of women. 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