They call him the male Florence Nightingale, after the famed founder of modern nursing. Yet 50-year-old Xu Guobin is neither an inventor nor a pioneer in the medical field.

Rather, Xu has won fame in Chinese media as the first man to become a head nurse after earning a bachelor’s degree in nursing — a profession conventionally considered women’s work.

Nursing, teaching, and positions in other care and service industries are sometimes known as “pink collar” jobs, a term popularized in the 1970s by U.S. social critic Louise Kapp Howe, who found that such jobs typically offered low salaries and poor conditions compared with male-dominated professions that demanded equivalent levels of training.

Even today, nursing remains one of China’s most gender-skewed professions. According to Xu, while men make up 20 to 30 percent of nurses in the U.S. and Europe, in China the figure is as low as 1 percent.

Few men are drawn to the nursing profession, in part due to the low pay. “In China, men are the primary breadwinners in the family,” Xu tells Sixth Tone, adding that fresh nursing graduates don’t earn much, only around 5,000 or 6,000 yuan ($730 to $877). The average salary among urban residents in Nanjing — the city in eastern China’s Jiangsu province where Xu lives — was 6,578 yuan per month in 2015, according to government statistics.

Xu himself entered the profession by accident. When he finished high school, he enrolled in a five-year degree program in “advanced care” at Nanjing Medical University without realizing it was nursing.

Though China was one of the first few countries to offer bachelor’s degrees in nursing — beginning as early as 1920 — the major was suspended from 1952 to 1983, during which time nurses trained at vocational schools. The degree program was reintroduced in 1984 in a joint decision by the ministries of health and education at the time, in the hope that a university program would help develop the profession by attracting a high-quality cohort. Male nurses did exist before that time, Xu says, but primarily in the military.

When Xu began his degree in 1986, it was only the second year that Nanjing Medical University offered the course. After graduation, Xu says that only four out of 10 male students from his class worked as nurses, and after another four years, he was the only male nurse from his class who had stayed in the role.

Pink-collar professions are often plagued by low pay and a lack of respect from the wider society. In teaching, provincial governments have begun to implement affirmative action for men to redress the gender imbalance, but critics say that preferential policies are ineffective and unfair — especially since equivalent support is not offered in industries where women are under-represented.

Xu himself tried several times to escape nursing. He even took the bar exam, hoping to become a lawyer. But ultimately, he remained a nurse at Nanjing Brain Hospital from 1991 to 2016. After devoting himself to the profession for 25 years — during which time he rose through the ranks to become head nurse of the psychiatric ward in 1998 — Xu was appointed as the head of a new administrative unit at the hospital last year.

Xu spoke to Sixth Tone about his experiences as a male minority in a pink-collar profession and his views on gendered labor. The interview has been edited for brevity and clarity.

Sixth Tone: Why did you choose to major in nursing?

Xu Guobin: Back then, all we wanted from school was to move to the city and break away from our rural hukou [China’s system of household registration that determines access to health, education, and other rights]. I went to a high school where only three or four students would be admitted to college, so I never expected to make it because my rank in the class was usually around 10 to 15. So, when I filled out the application form for undergraduate studies, I did it randomly.

I had no idea what “advanced care” was. It was a new major in China. The high school principal even asked me, “What is this ‘advanced care’ program you’re applying for? Does it involve attending to senior officials in the central government?” I replied, “How would I know if you don’t?”

My family members from the countryside were illiterate. They didn’t even know what the word “major” meant. I was the most educated among them, so I made my own decisions.

Sixth Tone: What was your professional training in college like?

Xu Guobin: Even when we started college, our teachers were not sure what the major was either. I assumed that the state introduced the major to promote the development of the field.

We didn’t have specific textbooks for our major. We used the same textbooks as the department of medicine, plus “Elementary Nursing,” which was a textbook for vocational schools. For the first three years, we studied in the same classroom as all the medical majors. In the fourth year, our instructors were mostly doctors as well. They didn’t know what exactly to teach us, so we basically learned the same material as the medical department.

During our final-year internship, we felt disappointed that the work was so monotonous — distributing pills, giving injections — so we went back to complain to our teachers. We had been told that we were being “cultivated as senior talents,” but there was nothing senior about the work, so we felt cheated.

Sixth Tone: What are some of the challenges and prejudices male nurses face?

Xu Guobin: I remember that at the beginning, we would rotate through all the hospital departments, and each time it took around a month for the patients and their relatives to accept me. Later, it became a little easier and more relaxed once I won their trust based on my performance. Even then, female patients would be embarrassed if I had to take care of them when I was on duty alone.

The low level of public acceptance of male nurses impacted my personal relationships a bit. A few kind people helped me arrange blind dates, but they didn’t disclose my profession, so potential dates who had just been told of my workplace and graduate school took it for granted that I was a doctor. But I like to be frank about everything at the beginning. Some were shocked, and we had no further contact.

I got married at 29. I was waiting for the right person. My wife knew the industry pretty well and wasn’t against my career. In fact, my mother-in-law was a head nurse at the hospital where I did my final-year internship.

Sixth Tone: What impact has your gender had on your career?

Xu Guobin: I sometimes ask myself why I stayed in nursing for so long. For one thing, I’m easygoing — quite content in any situation rather than adventurous or ambitious. For another, my supervisor was a big name in nursing who cared about me and helped me with my professional development.

I always say that I have had two advantages compared to others: one is my bachelor’s degree, and the other is my gender. Because there is such a small number of male nurses, we attract more attention, so I have been featured many times in influential television programs and newspapers, and whenever the hospital received national recognition, I was often one of the employees featured in its publicity material.

Sixth Tone: Would nursing benefit from more men entering the field?

Xu Guobin: In my view, any industry that is dominated by a single gender will not develop fully. Men and women are different in their ways of thinking and behaving. Men have their delicate sides, too, and they are more daring, creative, and aggressive than women. I think an appropriate gender balance can promote the industry’s development.

In addition, when I was interviewed on a talk show in Shanghai, some male audience members mentioned that they feel it’s awkward to be cared for by female nurses, especially when it comes to their private parts. Therefore, I believe there is a need for more male nurses in front-line care.

Sixth Tone: You have been working in the health care system for more than 25 years. How has this system — and the role of nurses — changed in that time?

Xu Guobin: The state has a standard for the ratio of nurses to patients, but I’ve seen that many hospitals don’t reach that standard. During the reform and opening-up period [in the 1980s and 1990s], some even reduced the number of nurses for cost-effectiveness. That creates hidden dangers to patient care.

I figured that if I commented from the position of a nurse, it would not be effective. I was interested in becoming a lawyer because I thought if I filed lawsuits that made hospitals lose money, that would attract attention. But the situation is better now. Hospitals see the importance of nursing and are adding more staff and improving the quality of care.

The principle of the system has changed from “treating the diseases” to “treating the people.” Last year, China released the “Healthy China 2030” blueprint prioritizing disease prevention; it’s not only about diagnosis and treatment, but also how to improve people’s overall health. Thus, a nurse’s role has changed from the simple job of distributing pills and administering injections to providing comprehensive care. This is a significant change.

In terms of male nurses, I figure that it’s up to social development and market demand. When there is a brighter future for those joining the profession, the number of male nurses will increase naturally.

Editor: Qian Jinghua.

(Header image: A male nurse and his colleague care for a patient in the ICU at Xuchang People´s Hospital in Henan province, May 11, 2017. Niu Zhiyong/IC)