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Let’s have an honest conversation about the way gender suppresses wages

Chronic workforce shortages should push wages up, so why has this not happened for nurses? 
Gender and pay

Chronic workforce shortages should push wages up, so why has this not happened for nurses?

Ensuring appropriate levels of nurse staffing is crucial to providing high-quality patient care, which is why the Royal College of Nursing (RCN) is running its campaign on staffing for safe and effective care.

Nursing shortages have been caused by too few people training as nurses, nurses leaving the UK in the aftermath of the vote to leave the European Union, and low job satisfaction driven by poor staffing levels, heavy workloads, work pressures and inadequate wages ( Health and Social Care Committee 2018 ).

The question is, in the face of crippling staffing shortages: why have wages not improved? The RCN has

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Chronic workforce shortages should push wages up, so why has this not happened for nurses?

Picture shows nurse in uniform with empty pockets pulled out. This article asks why nursing wages have not improved
Picture: Alamy

Ensuring appropriate levels of nurse staffing is crucial to providing high-quality patient care, which is why the Royal College of Nursing (RCN) is running its campaign on staffing for safe and effective care. 

Nursing shortages have been caused by too few people training as nurses, nurses leaving the UK in the aftermath of the vote to leave the European Union, and low job satisfaction driven by poor staffing levels, heavy workloads, work pressures and inadequate wages (Health and Social Care Committee 2018).

The question is, in the face of crippling staffing shortages: why have wages not improved? The RCN has been trying to answer this question with a research project in partnership with the Centre for Diversity Policy Research and Practice at Oxford Brookes University. 

To explain this paradox, the RCN set out how gender shapes and affects the status, value and authority ascribed to the nursing profession.

Average earnings lower for nurses than other professions

The RCN's analysis of earnings data from 2018 show that the average gross weekly earnings for nurses were £526.88 with a standard deviation of £182.24. Looking at all healthcare professionals, including doctors, dentists, healthcare managers, allied health professionals and scientific, therapeutic and technical professionals, the average gross weekly earnings were £650.67 with a standard deviation of £384.52.  

It is puzzling that, despite the increased professionalisation of nursing, along with chronic staff shortages and poor working conditions, market forces have not resulted in higher wages. But the clues lie in several areas – in the profession itself and in the wider labour market and its institutions. 

Huge efforts have been made to establish nursing as a career on a par with other professions, yet it can struggle to shake off its legacy of being a virtuous vocation for women and assert the reality of it being a highly skilled and demanding job. This often results in a lack of appreciation for, or understanding of, nursing as valued and productive work, despite its status as a graduate profession. 

When nurses talk about the rewards of nursing, they often emphasise the non-monetary over the monetary, pointing to their wish to care for others and valuing relationships with colleagues and patients, the praise and recognition they receive, their personal growth and achievement. Added to a British reluctance to talk about money and wages, the propensity for caring and nurturing often takes precedence over higher pay. 

Pay discrepancies within the nursing workforce align to gender and ethnicity

It is well known that men in nursing benefit from the so-called glass elevator, having a disproportionate access to high-level positions and higher pay (Busch 2018, Punshon et al 2019). It is also accepted that nurses from ethnic minority backgrounds are under-represented at senior levels, experience higher levels of physical and verbal abuse and bullying (RCN 2018) and are more likely than white nursing staff to be referred to the Nursing and Midwifery Council (NMC) for fitness to practise cases (NMC 2017).

There are ongoing conversations and plans focused on how to improve recruitment and retention in the nursing workforce, addressing important issues such as legislation on staffing levels, workplace flexibility, training and development opportunities and the whole student experience. These conversations need to build in two important, and irrevocably linked factors highlighted in the RCN's research: the role of higher wages in addressing staff shortages and the role that gender plays in suppressing wages.

Reframing nursing: what the profession's leaders can do

The RCN invites leaders across the nursing profession and across health and social care to use this research to debate the findings, conclusions and recommendations and to consider these two factors in their own decision-making processes, their institutions’ planning and policy development, and how they talk about or portray nursing.  

Considerations of gender and diversity are important when talking about the future of nursing, and there is a need to: 

  • Include a positive evaluation of nursing knowledge and skills, and its value and impact on society.
  • Be explicit about how the whole of the nursing role, its technical, emotional and cognitive skills, can be better measured and valued through job descriptions and evaluation frameworks.
  • Recognise that nursing is a female-dominated workforce and as such nurses should be supported at all stages of their career through flexible working, career progression and positive workplace cultures.
  • Demand that wages in nursing match its standing as a graduate profession.

Rachael McIlroyRachael McIlroy, @rachmac18is senior research lead for employment relations at the Royal College of Nursing

 


Find out more

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


References

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