RCN’s gender report highlights reasons for poor pay

An RCN report calls out historical misogyny and calls for fairer and more realistic job evaluation frameworks

An RCN report on why nurses have been historically underpaid calls for fairer and more realistic job evaluation frameworks

  • Gender and Nursing report says profession has lost influence, power and pay parity
  • Steps urged so nurses are on correct banding to match their responsibility and skills
  • Report wants support for career progression, calls on members to advocate for change
Picture shows perplexed young woman holding a credit card and tablet computer. An RCN report on why nurses have been historically underpaid calls for fairer and more realistic job evaluation frameworks.
Picture: iStock

Look around your workplace and the chances are that most of your nursing colleagues are women. On average, nine out of ten nurses are women, a proportion that has not changed significantly for years.

But the history of the profession being almost entirely female, from Florence Nightingale and Mary Seacole onwards, has a major impact on the working lives of nurses today, a report commissioned by the RCN has found.

Having a largely female workforce has led to nurses remaining underpaid and undervalued, despite an ongoing major workforce crisis that should push up the profession’s wages, the document argues.

The report, Gender and Nursing as a Profession: Valuing Nurses and Paying Them Their Worth, states that nursing has suffered by caring being seen historically as a naturally feminine skill, a view that sits in opposition to the high level of skills and professionalisation required in contemporary nursing.

Nursing therefore suffers in being seen as a vocation or a calling that usually attracts women.

Report ‘is trying to set a platform’ for people to start talking about issues

RCN senior research lead for employment relations Rachael McIlroy says nurses may feel angry when reading the report, which describes a profession that has lost, or never had, the ‘influence, power and pay parity it deserves’ due to the gender of the people who tend to enter it.


nursing vacancies in England

Source: RCN

These issues are likely to feed into the current workforce crisis, with many nurses leaving the profession.

Ms McIlroy, who is one of the report’s authors, hopes it will be a call to action to the profession. ‘It is trying to set a platform for people to start talking,’ she says.

‘A lot of nurses feel a lack of power and strength, and will recognise what it is saying, but it hasn’t been articulated in one place before. There is no single solution, but it seeks to provoke debate and conversation about what nurses intrinsically need.’

Among healthcare professionals, women receive 30% less pay than men

There is a substantial gender pay gap among all healthcare professionals, with women receiving on average 30% less than men. This is generally due to men working more hours and sex discrimination against women.

But, when it comes to nursing, the gender pay gap in which male nurses earn on average 17% more a week than women is almost entirely due to extra hours worked by males. In other words, the whole nursing profession is underpaid because it is seen as ‘women’s work’.

‘Not valuing nursing manifests itself through a devaluation of its status, pay and autonomy... associated with the construction of the nursing profession as work for women’

Gender and Nursing as a Profession report

Director of the Centre for Diversity Policy Research and Practice at Oxford Brookes University Anne Laure Humbert, also one of the report’s authors, says: ‘What is so interesting is that we talk so much in other professions about the gender pay gap; in nursing gender does matter but, because it is predominantly female, everyone is paid badly.’

Men in nursing benefit slightly from being promoted more rapidly, the report says. For example, while men make up 10% of band 5 registered nurse roles, they represent 15% of band 8 roles.

Nurses are among the lowest paid professionals in the health sector

Essentially, nurses remain substantially underpaid, and this leaves them stressed and struggling financially. According to an RCN employment survey in 2017, 21% have struggled to pay bills, 56% have cut back on food and travel costs, and 11% have been late with rent or mortgage payments.

‘Results from our analysis show that nurses are amongst the lowest paid professionals in the health sector,’ the report says.

‘Not valuing nursing, we contend, manifests itself through a devaluation of its status, pay and autonomy, which is associated with the construction of the nursing profession as work for women.’

The pay of registered nurses is 81% of the sector average, which includes healthcare professionals, allied health professionals, health managers and directors. Nursing pay also shows little variation despite the wide ranges of roles, responsibilities and levels of seniority. 

NHS wage levels act as a benchmark for all other healthcare sectors

Part of the problem is that, despite a major shortage of nurses, with the RCN stating there are 40,000 nursing vacancies in England alone, there is little competition when it comes to wages because they are set by the NHS.


of nurses are female

Source: RCN

As the NHS is the largest employer of healthcare workers in the UK, its wage levels act as a benchmark for all other healthcare sectors. When coupled with a gradual erosion of trade union powers by governments, and a relative lack of industrial unrest from nurses, wages across the healthcare sector appear resistant to orthodox markets forces, the report says.

It calls on the RCN to take action and strengthen the nursing voice, and says the college must help the profession articulate exactly what it can do and how skilled its members are.

The RCN should also lead a review of the Agenda for Change pay system and job evaluation processes, to ensure that they judge nursing work effectively.

Nurses can take inspiration from pharmacists

The report adds that there must be a review of whether nurses are employed on bands that match their levels of responsibility, skill and autonomy.

‘Nurses can take inspiration from pharmacists, who have been good at putting boundaries around their profession and generating better value,’ Dr Humbert says.

‘We have been our own worst enemy in that we have always coped, we have always gone over our working hours and so we are taken for granted as a profession’

Senior nurse quoted in Gender and Nursing

And they need to be prepared to speak out more clearly about what their jobs involve and what they want in return, and push more ardently for this to happen, the report says.

The report quotes one senior nurse as saying: ‘There’s unwillingness to stand up as a nurse in terms of working conditions, one of which is pay.

‘It’s always put against this argument of “but the patient comes first”, but I think in some instances we have been our own worst enemy in that we have always coped, we have always gone over our working hours and so we are taken for granted as a profession.’

Women often need more flexibility due to caring responsibilities

The RCN has been urged to call for the development of a career framework that enables, rewards and supports horizontal and vertical progression, and supports flexibility at all career stages.

Women often need more flexibility due to caring responsibilities, but Dr Humbert says this is often unavailable.

‘I was surprised by the lack of flexibility,’ she says. ‘I understand that there are operational reasons for that, but it seems that the needs of nurses at different stages of their lives are not taken care of.’

Pay is not the only way that nursing is valued

When it comes to tackling the problem on a more individual level, Ms McIlroy says good management and support of colleagues is essential. Pay is not the only way that a profession is valued; working conditions can also show how a role is perceived.

‘Good management is important and can help recruitment and retention by making people feel valued,’ she says.

‘What do people want from work and how do we persuade them to stay? Work flexibility, continuing professional development and pay are all key. Lack of flexibility at work can really be the straw that breaks the camel’s back and pushes people to leave.’

Managers talking to and listening properly to their staff is essential, Ms McIlroy says.

‘That individual conversation is a really important thing to help people feel valued and feel they have a voice and someone is working out what they need. It is not always about having an NHS or employer-wide policy; it is about individual relationships between colleagues and managers who listen to what people want, from career progression to working patterns,' she adds.

Nurses don’t always help in reform of their image

Outdated views of the profession among the public and nurses themselves are holding back the workforce, the report says.

Interviews with 15 senior nurses found concerns about an increasing number of new roles, such as the nursing associate, that are confusing the public and affecting nursing’s ability to develop a clear professional identity.

One nurse in a senior strategic role said that, when talking to the public, nurses need to speak about their skills.

‘We are specialists, we have expert knowledge, we’re researchers’ 

‘When you listen to nurses, you ask them “What do you do?”; they always default to “We care, we support and offer compassion, cradle to grave” – all these kinds of expressions.

‘I’m trying to get nurses to say “Actually, we are specialists. We have expert knowledge, we’re researchers, and we bring and deliver all that in a caring and compassionate way.” This is what is unique about our profession.’

‘When they talk about career women they never once mention a nurse’

A nursing academic said nursing needs to be promoted as the interesting career it really is: ‘When you pick up a glossy magazine and they talk about career women, they never once mention a nurse. People just see you as a nurse; there’s very little progression.’

But the RCN report’s authors say there is also a widely reported feeling that the profession is in a ‘strange place’ in trying to keep hold of ‘traditional’, hands-on and rewarding work. Although this work is often described as what attracted people to nursing in the first place, some acknowledge that it potentially curtails nursing advancement.

Gender and Nursing: report recommendations for the RCN

  • Engage with members to reseach and understand the meaning of work for nursing as a profession and how the profession responds to the changing world of work
  • Create a platform for the nursing profession to articulate the full scope of nursing as caring, compassionate, evidence based and safety critical
  • Conduct further research into the intersections of sex and gender with other variables such as ethnic background, disability, age and social class
  • Lead on the development of a clear and in-depth assessment of the mix of knowledge and skills in nursing in job descriptions and evaluation frameworks
  • Lead on the development of fairer and more realistic job evaluation frameworks for use in all settings, and for the benefit of all of its members. This will be followed by steps to ensure that nursing staff are employed on the correct banding to match their level of responsibility, skills and autonomy
  • Call for the development of a career framework that enables, rewards and supports horizontal and vertical progression
  • Promote the need for a change in how work is organised, and to call for the NHS and other employers to use their reputational power and resources to enable women and men to develop their careers at all life stages
  • Invite members and nursing leaders to debate and support the recommendations of the report and engage them in becoming advocates for change

Erin Dean is a health journalist

Find out more

RCN (2020) Gender and Nursing as a Profession: Valuing Nurses and Paying Them Their Worth

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