The current study aimed to explore nurses’ perceptions about challenges that they might have faced during their clinical experience as they progress from being a student nurse to professional nurse. This has revealed very thought-provoking findings and points to the needs to discuss the situated identity of nursing . These experiences explain why increasing numbers of nurses still hold the intention to leave their jobs, which is causing severe skills shortages in Pakistan.
Socio-cultural norms have reinforced the concept of gender-based segregation on the basis of role assignment. This has caused less acceptance of male nurses, because society does not consider nursing a suitable profession for men. The inherent qualities, traditional household roles, and fundamental nature of work are preferable characteristics that adhere to female nurses only. The gendered context is the construction of an identity of a person which is highly relevant to the division of labour work on behalf of performativity. In patriarchal societies, the continuous observance of gender roles denies the entry of men into female-dominated professions, but when men do come to join the nursing profession, they cannot sustain their prevailing role of hegemonic masculinity .
The presence of male nurses in the healthcare system changed over time. On the one hand, male nursing is beneficial for sharing the burden of duties, workload and gender balance within the profession. But on the other hand, male nurses are seen as separate identities in this feminine domain, which results in feelings of isolation and affirms their sense of not belonging or being acknowledged as part of the profession . Gul  explained that the gender of nurses and the nature of nurses’ work both affect the image of the nursing profession and depict a scene of domestic doing that relates to femininity only. Professional identity may be highly relevant to female nurses and occupational career assessment may be highly relevant to male nurses . If a man chooses nursing as a profession, then his motive will be to earn money as the breadwinner of his family. Boughn  explained that male nurses tend to place more importance on salary.
Media portrayals are not accurate about physical appearance, dress codes or doctor–nurse relationships. This is shown in the very stereotypical media portrayal of low-profile professionals. The on-screen representations of female nurses are characterised by their overestimation of the profession’s foundations, whereas male nurses are presented very rarely in the nursing profession . An examination of 36,000 feature films highlighted that, in these films, nurses were depicted as self-sacrificing, strong and confident professionals in early times. The most popular medical dramas and television shows, like ER and Grey’s Anatomy , offered audiences the chance to learn very little about nurses, because physicians were portrayed as the dominant and appreciated health professionals in the medical field, whereas nurses were defined to play their subservient roles.
Studies explained that the nursing profession has partly influenced their invisibility in media by themselves for not raising their silent voices. The mass media image of nursing transformed its professional status from cliché to provocative vocation of female which is continuously damaging the public perceptions. For that reason, nursing professionals do not understand their position with respect to their profession and do not recommend others to join nursing as a career. Their reshaped conflicted identity receives less recognition of more powerful roles, because they have not been considered as autonomous healthcare providers or advocates of the clients. Rather, they are only seen as care workers within patriarchal organizational systems who are just working as competent machines of dominant physician [36, 37].
In this study, most of the nursing professionals shared stories about facing issues around marriage settlement, because of the nature of nurses’ work and working environment. Nurses usually are not preferable choices for men in terms of marriage and face difficulties in finding life partners. This is due to their night shifts in hospitals as well as negative perceptions about nurse-doctor interactions and gender mixing at the workplace. Nurses’ work has been described in negative terms such as hard, dirty, and with minimal chances of marriage and family, as well as low paid . Nurses who want to continue with their job after marriage are usually mounted by their husbands to discontinue their job. This results in less satisfaction of work performance in delivering healthcare.
Society does not give due regard to nurses and they have to face rejection in marriage proposals. Sometimes marriage settlement agreements include the conditions that they must either leave the nursing profession or not be accepted for marriage . Hiding their professional nursing identity is one of the cultural practices employed by nurses to save the honour of their family and to receive social support. Nurses do not often recommend others to join their profession, unless they do so for the salary and get remuneration for their work as economic support.
The current study also collected information about nurses’ perspectives on religious aspects which is a cornerstone of this profession and influences nurses’ attitudes during nurse-client human interaction. Religious considerations are important in terms of the process of caring for and touching male patients during clinical practice. In Western societies, religion does not always have much influence upon people’s attitudes as it does from an Islamic perspective. The learned touching behaviour is the foundation of nursing, but this can be significantly changed by the nurses’ socio-cultural background and practice in nursing school .
Physical touch in nursing brings humanity and compassion in work patterns of care-oriented tasks. It provides emotional containment and empowers clients’ wellness. Nurse’s try to reduce caring tasks on their male clients to reduce the time of physical touching, although handling patients’ bodies has been labelled as the essence of the nurses’ role , but in Pakistani culture many dilemmas exist in society because people consider nurses to be impure from a religious point of view as they have to touch male patients and perform night duties outside the home. This crosses cultural boundaries of mobility and modesty and becomes a confusing puzzle for social fabrication of society .
The overall limitations linked with qualitative research also apply to the interpretation of this study. One might expect that the study population is quite selective, as respondents have been recruited from large public and teaching hospitals. Furthermore, their willingness to participate in the study may lead to a selection bias. For that reason, it is not clear in how far the results are generalizable. A further limitation may occur in the form of data analysis. Although a thematic analysis is based on the articulated phrases, not expressed attitudes and non-verbal information has not been included. Religious practices and beliefs play a major role in perceptions and practices in the study region. Therefore, these aspects may have influenced the perceptions and reports of the study participants.