A little after 8 pm on a Sunday in November, Samuel Sathe was ready by his patient’s bedside. He greeted the bedridden man with a smile and a bright “How are you, uncle?”, and went on to check his temperature, pulse rate, oxygen level and blood pressure.

The 65-year-old Parkinson’s disease patient was recovering from an unsuccessful brain surgery. If any of his vitals were out of range, Sathe would have to immediately give him the medicines that the doctor had prescribed. Sathe, himself, was the nurse.

That day all was well, and Sathe moved on to his next set of duties, propping the patient up into a chair and gently feeding him a broth of blended khichdi and soup, one small spoonful at a time. After the meal, Sathe wiped the patient’s mouth with a napkin, administered his night-time medicines, and helped him get comfortable in bed. This was just the beginning of his 12-hour shift at the patient’s home.

As a professional nurse, 28-year-old Sathe is aware that the care work he performs is widely perceived as “women’s work”. In the five years since he started out in the field, he has grown used to people reacting with confusion when he mentions that he is a nurse. “Do you mean ward boy?” they often ask. Sathe then slips into a calm explanation about how “men can be nurses too”.

“There is a stereotype that some kinds of work can only be done by women, like being gentle and caring for others,” said Sathe. “But that’s not true. Men have the same natural caring abilities as women. Almost all the brothers I know in the nursing profession are polite, soft and humble in nature.”

Sathe certainly embodies those qualities. He has kind, expressive eyes, speaks softly, almost shyly, and frequently breaks into warm smiles. His petite frame and stylish goatee make him look like a college student, which he technically still is.

Sathe is from Maharashtra’s Nashik city, where his Dalit grandparents had adopted Protestant Christianity decades ago. His father supported the family with a modest income as a priest at their church, and Sathe studied at the church’s convent school. After Class 12, he took up a variety of odd jobs to be able to enroll in a four-year BSc Nursing course at a private college.

“I chose nursing because I felt passionate about it. I wanted to be in a caring profession,” he said.

In 2016, however, in the middle of his second-year final exams, Sathe was forced to drop out. Despite his best efforts, he had not been able to pay his fees on time.

Unwilling to give up on his dream, Sathe began to look for nursing jobs on the basis of his unfinished degree. He did stints at non-profit organisations working in healthcare and even managed to bag a brief traineeship at a government hospital in Badlapur, a city adjacent to Mumbai.

In 2019, Sathe was able to put himself through a one-year diploma course in auxiliary nursing and midwifery. The job of an ANM is technically open only for women in India, but the men who take up the course can become “assistant nursing midwives”. It was a stop-gap degree for Sathe, who still hoped to complete his Bachelor’s degree in nursing.

But the Covid-19 pandemic hit the country soon after he finished his ANM course, and nurses were suddenly in high demand. For a year, he was on his toes, working on short-term contracts at two designated Covid hospitals in the Mumbai Metropolitan Region, learning rapidly on the job and performing the same tasks as senior, more qualified nurses.

“During that time, hospitals were hiring female and male nurses in equal numbers,” Sathe said. “And with all our PPE, it was hard to tell who was who,” he added, referring to the personal protective equipment worn by medical professionals on the frontlines.

Samuel Sathe, a nurse in Mumbai, believes that men "have the same natural caring abilities as women". Photo: Aarefa Johari

Outside of the Covid hospitals, however, Sathe’s gender has often become an obstacle in his career path.

In Mumbai, he is not eligible to study at any municipal nursing college. “I have applied, but they only accept female students,” he said. At job interviews, he has been rejected from several public and private hospitals in the past year. “Many of them have specifically told me that they don’t hire male nurses. Getting a job is never easy for us.”

The issue of job availability for men in nursing, historically considered a women’s profession, has blown up in India in the past two years.

In July 2019, the central administrative body of the All India Institute of Medical Sciences introduced a gender-based quota in all new nursing staff appointments in the 20 AIIMS hospitals across India. It reserved 80% of the positions for women and 20% for men, claiming that more female nurses were required for “patient comfort and care” in several specialised wards and departments.

The decision triggered vehement protests from the AIIMS Nurses Union and other nursing unions across the country, many of which are led by male nurses. The 80:20 quota, the unions said, was arbitrary, unconstitutional, discriminatory and an “assassination of merit”. They sent letters of protest to the union health ministry. In Bihar, a group of 158 male nursing job aspirants sued AIIMS for violating their constitutional right to equality. They lost their case in the Patna Central Administrative Tribunal and the High Court, but their petition is now pending before the Supreme Court.

It is not only AIIMS that has left male nurses in despair.

In February 2021, Maharashtra’s Directorate of Health Services introduced a 90:10 gender-based quota for nursing staff recruitment in district hospitals across the state, with the majority of posts reserved for women. The United Nurses Association, a national nurses union led entirely by men, challenged the quota in the state’s Administrative Tribunal in Nagpur in August, but the petition was dismissed.

Madhya Pradesh, too, has implemented a 90:10 ratio of female and male nurses in state-run hospitals since 2017. “But that was only because we protested,” said Gopal Parashar, a nursing professor from Jabalpur and the national president of the Nursing Students Organisation of India.

“From 2014 to 2017, the government had reserved 100% of nursing posts in state hospitals for women, even though the number of male nursing students had been increasing over the years.”

At several other public hospitals, like Chhattisgarh’s state-run hospitals, men are not hired as nurses even though there is no official rule against employing them. Everywhere, nurses, both men and several women, have responded by calling for gender equality in the field.

“In this profession, if nurses are qualified, there is no difference in the nature or quality of the work we handle,” said Jaseem Parol, a 28-year-old member of the AIIMS Nurses Union in Raipur, Chhattisgarh.

Parol and his wife, who is also a nurse, got jobs at AIIMS Raipur in 2018, a year before the 80:20 quota ratio was introduced. “I think there should be no reservations on the basis of gender, but if they have to have one, the ratio should be equal, 50:50,” Parol said.

These demands for equality coming from men may sound ironic in a world where women have always been and continue to be at the receiving end of discrimination in most professions. According to one index, women workers in India earn 19% less than male workers, and find it harder to get promotions. Between 2005 and 2019, the female labour force participation in India fell from 25% to an abysmal 21%. Nursing is one of the rare fields in which the gender dynamics appear to be completely flipped.

But though it appears to be simply a matter of equality, the issue is far more complex than it appears at first. Under the surface is a bewildering maze of arguments for and against equality in nursing, which range from the practical to the patriarchal to the feminist. The conversation is made even more fraught by the fact that though those who are at loggerheads with each other harbour a deep mistrust of the other.

This story is part of Common Ground, our in-depth and investigative reporting project. Sign up here to get a fresh story in your inbox every Wednesday.

Those who believe that nursing should be preserved as a woman’s profession argue that they are better at the job, and that India is not yet culturally ready to accept male nurses in large numbers.

“Women make better nurses. The way a lady can take care of others like a mother, no male can,” said a senior nurse from north India who wished to remain anonymous because she did not want to offend her male colleagues. “Women nurses are also housewives, so they make better managers. They care for their wards the way they care for their homes. They know where everything is in the hospital, right from medicines to brooms, and they are loyal and reliable during emergencies.”

Anita Panwar, a senior community health nurse in Delhi, also shares similar views. In a primary school, she asked, would children be more comfortable with female or male teachers? “Nurses, just like school teachers, need to be able to give warmth and care,” she said. “Who has these qualities more? This is not about gender discrimination – there are some qualities that god has only given women.”

For Panwar, the views of individual nurses or doctors are irrelevant when it comes to healthcare work.

“The only view that matters is that of patients who require treatment and care,” said Panwar, who currently works at a Covid-19 vaccination centre.

“Doctors don’t spend much time with patients, but nurses are with them all day,” she added. “So the only thing we need to ask is, who do patients feel more comfortable with? Most of them will say that they prefer female nurses, particularly in gynaecology, paediatric or women’s wards.”

The widespread preference for women nurses if commonly justified with the argument that patients are more comfortable with them. Photo: Francis Mascarenhas/Reuters

The question of patient preference and patient “comfort and care” is, in fact, the main reason cited by AIIMS and Maharashtra’s Directorate for Health Services for introducing gender-based quotas in their hospitals. (Officials at both AIIMS and DHS did not respond to phone calls or email queries from Scroll.in.)

This idea was even echoed in Maharashtra’s Administrative Tribunal’s brief order dismissing the petition of the United Nurses Association. The order compared patient preference in hospitals to the comfort of sexual assault complainants, whose cases are heard through private, in-camera sessions rather than in public courtrooms. The law allows these private sessions because “what the victim woman thinks and her comfort zone matters more than the right of the public to come to court”, the tribunal said. Similarly, it held that a 90% reservation for female nurses would be justified for the sake of patients, even if male nurses are qualified and competent.

History offers some insight into why the idea that women are inherently better nurses is so prevalent. The answer lies with a name that is always uttered with reverence in the corridors of nursing colleges and hospitals around the world: Florence Nightingale, the Englishwoman who became the founder of modern nursing nearly 170 years ago.

Before Nightingale arrived on the scene, most nurses in the West were nuns and monks who served the sick as part of their religious work. But in the 1850s and 1860s, after Nightingale volunteered as a nurse for wounded British soldiers, she began transforming the act of service into a streamlined, skilled profession. She introduced an emphasis on sanitation and hygiene in hospitals, established the world’s first secular school of nursing to train professionals, and wrote books on nursing that were adopted as training curriculum.

For Nightingale, an affluent woman, nursing was a means to reject societal expectations of marriage and live as an independent woman. But as her fame grew, the image that became prevalent in society, according to one paper, was that “of the nurse as subordinate, nurturing, domestic, humble, and self-sacrificing”. Concurrently, men were largely seen as incapable of the empathy needed for patient care, and ostracised from the profession.

Indian nurses pay tribute to Florence Nightingale on the occasion of her 195th birthday in 2015. Nightingale established the profession of nursing, which was closed to men for decades. AFP PHOTO/ NARINDER NANU

With these gendered foundations, modern nursing remained exclusive to women for decades. In the United States, for instance, the American Nursing Association banned men from nursing right up till 1930. Ninety years later, even though there is a greater social acceptance of male nurses, they make up just 11.5% of all nurses in the United States. In the United Kingdom, too, men comprised just 11% of nursing staff in 2019.

In India, at least 16.6% of nurses in 2001 were male, according to a World Health Organisation report on the country’s health workforce in India. By 2018, this number had increased to 20.5%. The growth of men in the field has been gradual, but there are regional variations.

In Kerala, a state known for supplying large numbers of nurses to hospitals across the country, the proportion of male nurses increased from 11% in 2011 to 21% in 2016.

In Maharashtra, by contrast, just 3.6% of the 2 lakh nurses registered with the Maharashtra Nursing Council in 2015 were male. It is a small number, but the Council, which regulates all registered nurses in the state, claimed that the number of new men registering with them had doubled in just two years, from 587 in 2013 to 1,038 in 2015.

In Chhattisgarh, men are hired in small numbers in private hospitals, rural community and primary health centres and even in standalone public hospitals. “But in all of our government hospitals attached to medical colleges, no males are hired in nursing jobs,” said Debushree Saw, a senior nurse at the Chhattisgarh Institute of Medical Sciences in Bilaspur and the state president of the Chhattisgarh Paricharika Karmachari Kalyan Sangh, a women’s nursing union. “For the past five years, our union has been writing to the state government about the need to hire more brothers, but we have not received any response.”

Whenever they discuss the doubts that people hold about their professional abilities, male nurses typically begin with the question that baffles them the most: if there is no gender-based quota for hiring doctors or admitting patients, why is there one for nurses? After all, they say, nursing education is exactly the same for women and men.

“We are all taught the same syllabus, just like doctors of both genders have the same medical syllabus,” said 35-year-old Jibin TC, the president of the Maharashtra chapter of the United Nurses Association.

Both male and female nursing students, he said, are taught how to examine patients of both genders. They are trained to perform procedures like catheterisation – inserting tubes into the urinary tract – for both men and women. Male students are taught how to deliver babies and are not excluded from the labour room on account of their gender. “We may get embarrassed as young students, but our teachers train us to see the patient as just a patient,” Jibin said. “And both men and women are taught about maintaining a professional touch while dealing with patients.”

According to Jibin, there is no written rule mandating the presence of a female nurse, attendant or doctor while a male nurse is examining a woman. “But it is something that we always make sure to do, based on an understanding of our culture,” he said. “In fact, sometimes male patients are also uncomfortable with female nurses and prefer to be handled by a man.”

Jibin TC, president of the Maharashtra chapter of the United Nurses Association, argued that the bias against male nurses was unfounded, since they underwent the same training as women. Photo courtesy: Jibin TC

Most arguments made in favour of male nurses centre on these questions of their capacity for as much gentleness and sensitivity as women. But there are also many who believe that men make valuable nurses in some situations because of their supposedly masculine attributes: physical strength and endurance.

“Men are able to do some duties better, like transferring a patient from wheelchair to bed, or dealing with any violence by relatives of patients,” said Dr Ajay Midde, a neuro-rehabilitation specialist at a large private hospital in Hyderabad.

Even some women nurses hold this view. “We need them to do work that requires heavy-lifting or standing for long hours,” said Debushree Saw. Saw believes – like many other nurses and doctors – that male nurses are particularly useful in the orthopaedic and psychiatric wards, or assisting in the operation theatre. “We female nurses also do all of this work, but it would be nicer to have men take it up.”

But those who are in favour of male nurses also cite other arguments, which have little to do with men’s abilities as nurses. “Male nurses are also more willing to take up double-shifts at the last minute, probably because women have responsibilities at home,” Midde said. Because of these reasons, said Midde, many corporate hospitals are now hiring more male nurses than before.

For Khushi Ram Meena, a nurse at the state-run Sawai Mansingh Hospital in Jaipur, and also a union leader, there is another reason why male nurses are useful: classic chivalry.

“Traditionally, our women nurses have been exploited a lot by the hospital managers. They are given extra work and face a lot of harassment,” Meena said. “If there are equal numbers of brothers around, they will speak up and not allow this to happen to the women.”

Indeed, compared to other states, male nurses are relatively prominent in Rajasthan. Although there is no recent data available, a 2009 National Rural Health Mission study of hospitals and health centres in five districts of the state found that half the staff nurses and one in five nursing superintendents were men.

But according to several Rajasthani nurses I spoke to, the reasons why male nurses were common was far from reassuring: low female literacy and strict cultural norms prevented local women from taking up nursing. Most of the female nurses in the state were, therefore, migrant workers from Kerala and elsewhere. In fact, in 2007, the Government College of Nursing in Jaipur launched its postgraduate course with a 25% reservation for female nurses, in order to encourage more women in the field.

When it came to jobs, Meena said that so far Rajasthan has not had any gender-based quotas in nursing recruitment. But he fears that AIIMS has set a bad precedent with its 80:20 rule. He pointed out that there was “already a lot of unemployment in the sector,” and added, “If hospitals in Rajasthan start introducing 80% reservations for female nurses, then it will lead to even more unemployment among us men.”

This fear is intensifying among male nurses across the country. In interviews with Scroll.in, several nurses claimed that limited job prospects would have a discouraging effect on young men planning a career in nursing.

“I have already started observing a change,” said Gopal Parashar, the nursing professor from Jabalpur. When he enrolled in a private nursing college as a student in the late 2000s, Parashar claims there were 51 male students in his class of 60. “In those days the number of men studying nursing was increasing every year, until the MP government decided to hire only female nurses in 2014,” he said. “After that the enrolments started falling, and today most nursing colleges have just 5% to 30% male students.”

Khushi Ram Meena, who works as a nurse in Jaipur, argued that male nurses are useful because they can protect female nurses from harassment they might face. Photo courtesy: Khushi Ram Meena

Many male nurses maintain that the idea of “patient comfort” is merely an excuse to keep men out of nursing. The real reason behind the quotas and unofficial female-only hiring policies in hospitals, they say, is that male nurses have been branded as trouble makers in a profession known for poor wages and exploitative working conditions.

“The truth is that women nurses follow orders and quietly do whatever is told to them. And men usually argue back if they are given extra duties beyond their role,” said Gopal Parashar. “Bechari female toh objection kam leti hai” – women, poor things, raise fewer objections – “and they are also not able to unionise as much as men, because of their family responsibilities. Nahi ho paata unse,” they can’t do it.

In Mumbai, Jibin TC offered a less patronising assessment of female nurses and their social constraints. Most nurses come from lower socio-economic backgrounds. Once they get jobs, he said, their focus is earning money for their families, and not getting into trouble at work.

“This is worse for female nurses, because in a patriarchal society, they often don’t have control over their own earnings,” Jibin said. “If they don’t have financial freedom, how will they raise their voice?”

It wasn’t as if all or even many male nurses raised their voice against issues of low wages or labour rights violations, he said. “But because of the few who do, there is a general perception that we are problem creators.”

Jibin, who grew up and trained in Kerala, spent 14 years working as a nurse in Mumbai. “But after I joined the union in 2017, and started speaking out openly, I began to lose jobs,” he said. “It is true that most nursing unions are led by men, so by hiring a majority of women, hospital administrations get to exploit them more.”

Public health expert Dr Vandana Prasad acknowledges that hospitals may prefer to hire female nurses because they are perceived to be more deferential and obedient, but added that this was an acceptable skew given the prejudices women face elsewhere. “Nursing is a big source of livelihood for women, and is one of the few areas where care work done by women is actually remunerated,” she said. “Women’s opportunities for remunerative work do need some protection, but women also need to speak up for their rights a lot more.”

Prasad believes the key problems are broader. She argued that hospital administrations need to focus less on gender-based reservations and more on improving working conditions and wages for all nurses. “The main point is that all nurses get a raw deal in this field, men and women,” she said.

Male nurses and nursing students, however, do not readily agree with such a catholic description of the problem. In a field with seemingly reversed gender power structures, these men are in the rare position of experiencing many of the injustices that women have always faced in everyday life: being marginalised and underrepresented, being stigmatised for their choices, and having to limit themselves because of their gender.

Shoeb Khan, for instance, struggles with enduring social disapproval of his allegedly effeminate career choice. The 21-year-old, who grew up in Mumbai’s Mankhurd slums, chose nursing to pull his family out of poverty. In 2019, he completed a six-month course in basic nursing from a private college, and is now enrolled in a three-year general nursing course.

“But my family has been completely against my choice. They ask me, kya ladkiyon ka kaam karna hai? Do you want to do girls’ work?” said Khan. His family has stopped the jibes in recent months, after Khan began earning Rs 36,000 per month as a private nurse for a male patient. “But my cousin who works in a pharmacy has asked me to join his field, because he thinks it is at least a man’s line of work.”

Shoeb Khan's family stopped mocking him for his supposedly effeminate career choice once he began earning a substantial salary from it. Photo courtesy: Shoeb Khan

After over a decade in the nursing field, Jibin’s bigger grouse is the way in which the identities of male nurses are erased within the field.

“In college classrooms, conferences and every other platform, nurses are always referred to with the ‘she’ pronoun. Of course this will bother male students and nurses,” he said.

“Even the designations used in nursing are feminine, like ‘matron’ and ‘sister tutor’,” he added. “Male tutors get called ‘sister tutor’ on their offer letters even today.”

Samuel Sathe, meanwhile, has had to trim his ambitions and reshape his entire career plan because of his gender.

After being rejected from hospitals that only hire women, Sathe has decided to do what many male nurses do – work in private, home-based nursing, where men and women are required in equal numbers. To complete his unfinished degree, Sathe has also enrolled himself in a distance learning BSc in nursing from Karnatak University. His plan, initially, was to follow this up with a Master’s in gynaecological nursing.

“I love that field, and I don’t know of any men studying gynaecology at that level. I am always interested in breaking barriers,” said Sathe, who soon realised that as a man, getting a job in a gynaecological ward would be impossible for him. “So now I’ve decided to specialise either as an operation theatre nurse or in dialysis, with gynaecology as my third option.”

After a few years of experience, he aims to apply for a secure government job as a community health officer, at one of the many new community health and wellness centres being established across rural India under the central government’s Ayushman Bharat scheme. “Men are getting jobs as CHOs – I’ve seen many of my male batchmates get them,” Sathe said.

How keenly is Sathe aware that the hindrances he faces as a man in nursing are exactly what women face in every other profession?

“I suppose women do go through the same thing in other fields,” he said with a smile. “But I hadn’t thought about it until you mentioned it.”

This reporting is made possible with support from Report for the World, an initiative of The GroundTruth Project.