Bridging the nursing gender pay gap

Experts say the NHS has to take action to correct the huge gender imbalance – and female nurses need to learn how to help themselves.
Pay gap

Nursing may be a largely female profession, but men are vastly over-represented in senior positions. Experts say the NHS has to take action to correct the huge gender imbalance and female nurses need to learn how to help themselves

While women make up almost 90% of the UKs nursing workforce, men occupy almost two thirds of the health sectors top jobs.

The huge gender imbalance is among the key facts in a report assessing the lack of senior opportunities for women in nursing published in June by international recruitment company Randstad. It highlights that women are paid on average about 14% less than their male colleagues, with 84% of female nurses saying that they had never asked for a pay rise.

Women just dont talk about money, says Randstad Care managing director Victoria Short. They never ask for a pay


Nursing may be a largely female profession, but men are vastly over-represented in senior positions. Experts say the NHS has to take action to correct the huge gender imbalance – and female nurses need to learn how to help themselves     

Pay gap
Picture: iStock

While women make up almost 90% of the UK’s nursing workforce, men occupy almost two thirds of the health sector’s top jobs.

The huge gender imbalance is among the key facts in a report assessing the lack of senior opportunities for women in nursing published in June by international recruitment company Randstad. It highlights that women are paid on average about 14% less than their male colleagues, with 84% of female nurses saying that they had never asked for a pay rise.

‘Women just don’t talk about money,’ says Randstad Care managing director Victoria Short. ‘They never ask for a pay rise, feeling embarrassed and fearing rejection. It doesn’t seem to bother men – they are not ashamed or afraid of it. It’s a stark contrast.’ 

The report combines research from organisations such as the RCN, NHS Employers and the King’s Fund, with Ranstad’s own studies, including a 2016 survey looking a women in work. Ms Short says the report ‘reinforces’ what the recruitment company is seeing on the ground. While there are differences between the private sector and the NHS – with women managing more nursing and care homes – these are less senior roles than those in the public sector, where the report describes the gender imbalance as ‘worrying’. 

Even when female nurses reach the peak of their profession, becoming directors of nursing, they are commonly paid the least on the board, says Ms Short. ‘I suspect men are more confident about asking to be appointed at the middle or the top of the pay band, while women don’t have that confidence,’ she adds.

Break the mould

Yet for many women, even aspiring to reach such senior positions feels daunting. According to the report, more than one third of care workers believe a glass ceiling exists for women, while 45% of healthcare professionals think that not enough is being done to get women into the top jobs. 

In health care more generally, women are similarly under-represented at senior leadership levels. More than three quarters of NHS staff are women, but they make up just over one third of chief executives and around one quarter of finance and medical directors, according to the Health and Social Care Information Centre. In primary care, while 70% of the workforce is female, just 37% of the governing bodies of clinical commissioning groups (CCGs) are women.

‘At procurement level particularly there are more men than women,’ says Ms Short. ‘We tend to see women at senior roles where there is a nursing and care element and they are managing nursing staff at lower bands, but not in other roles. In reality, these are often taken by doctors or men who come from outside the organisation. Nurses cannot follow in someone’s footsteps.’ 

To begin to break the mould, she would like to see more positive role modelling. ‘We need strong female leaders,’ argues Ms Short. ‘A lot of effort has been put into this in the private sector.’

She cites initiatives including the Institute of Directors’ annual Women as Leaders conference, now in its ninth year. She would also like to see NHS trusts creating a strategic objective to fill a certain number of posts with women from a nursing background. ‘You need to create a belief,’ she says.

Clearer career pathways are also vital, with training and development that looks at the range of extra skills nurses might need to acquire to be able to move upwards, including business, strategic and financial expertise. ‘These can feel far from the skills they’ve developed as nurses,’ says Ms Short.

Women should not have to experience career setbacks because of what Ms Short describes as ‘the motherhood penalty’. Often women won’t ask about flexible working because they fear it doesn't demonstrate good leadership, while employers don’t offer it, she says. ‘But they need to have an attitude of 'yes you can and we welcome it'.’

Take responsibility

So how can you take your career to the next level? Ms Short says it is a good idea to find someone who is in a job you would like to do and then ask the person how they got there.

‘What did they need to do to get that job? What training did they have? What mentoring or coaching? And will they consider supporting and mentoring you?’ suggests Ms Short. ‘You cannot control the machine, but you can take responsibility for what you need to get you where you want to be,’ she adds.

For black and minority ethnic (BME) female nurses, the struggle to attain senior positions can be even harder.

‘From conversations I’ve had with some BME nurses, there’s a perception that those who make it are special, different and get there because they know people,’ says chief nurse Heather Caudle. ‘Senior positions are not something they feel they can aspire towards. It’s sad – but we have to acknowledge there is this negative thinking.’

Of her own career, she says: ‘I bucked the trend and never felt held back.’ She joined Ashford & St Peter's Hospitals NHS Foundation Trust in Surrey in 2011 as an associate director of quality, was promoted to deputy chief nurse in 2013, and took up her current role a year later.

But being a female leader from a BME background is not without its challenges. ‘Sometimes I have to be authoritative and directive, rather than using a coaching style and being supportive. Some don’t like it,’ says Ms Caudle.

‘It’s perceived negatively for many women and compounded by being BME. There’s a stereotyped image of us and this doesn't fit, so it puzzles people.’

Development and mentoring

She believes that the ‘old boys’ network’ extends into nursing. ‘In nursing, men stand out because there are far fewer,’ says Ms Caudle. ‘By appointing white middle class men to senior positions, we’re replicating the dominant part of society. They are the ones picked out by leaders.’

Targeted development and mentoring could help to break the glass ceiling, she believes. ‘I’d like to see women in very senior positions paired with those at lower bands, so they can share their wealth of knowledge.’

Women also need to be less ambivalent about what they want. ‘Women don’t like thinking about having more money, status and what they need to do to get on the next rung of the ladder. But ambition isn’t bad – it’s good,’ she says.

For those struggling to make headway, she offers some specific advice. ‘Continue to be good at what you do. I can’t stress this enough,’ says Ms Caudle.

‘I’ve mentored people who have come to me in tears, saying 'why am I not getting ahead?' The first thing I always ask is: do you like what you do now? If they say, 'no, I’m unhappy', I will tell them that’s their answer. If you’re not enjoying what you’re doing, people see it straightaway. The love – or frustration – you feel for your job leaks through.

‘Employers don’t want to feel pushed to give you a job – they want to feel they’ve attracted you.’


The RCN’s head of employment relations, Josie Irwin, says the lack of fair pay runs throughout nursing. ‘The median salary for a registered nurse is around £31,500. This lags around £7,000 behind other graduate professions, whether in the public or private sectors. So already there’s an issue.'

Societal values are part of the problem, with nursing still often viewed as vocational rather than a job. ‘If you look beneath the surface, there’s a huge issue in the way that nursing jobs are perceived,’ she says.

When it comes to interviews, nursing skills and qualities may not be as highly prized as other attributes by those already in leadership roles, she argues. 

Women may also need more encouragement to apply for senior posts in the first place. Leadership and management training programmes help, although they may need to be targeted at a different audience. ‘They are often pitched at band 7 nurses, but they’ve already worked hard to get to that level,’ says Ms Irwin. ‘We should be looking at those in lower bands too.’  

The RCN continues to campaign for nursing to be valued, pushing the case for pay to compare more favourably with other professions. It also encourages nursing staff to realise their own potential, relaunching new clinical and political leadership programmes in the past 12 months.

Volunteering to become more active in the RCN may also boost your skill set, says Ms Irwin. ‘It can help your self-discovery, particularly when you see that you can make a difference, even in a small way.’   

How to get ahead

• Be clear about what you want. ‘Remove the ambivalence and you’ll be more successful,’ says chief nurse Heather Caudle.

• Take advantage of whatever training and development opportunities come your way.

• Seek free advice from the RCN Careers Service. ‘They may be able to point you towards opportunities you may never have thought about before,’ says RCN head of employment relations Josie Irwin.

• Lose your reticence to talk about money. ‘Don’t be ashamed that pay is a driver for your career, because it’s a reality,’ says Ms Caudle.

• Keep your eyes open and don’t take no for an answer. ‘Keep plugging away and try not to feel downhearted when there are setbacks,’ says Ms Irwin. ‘If you’re not succeeding, you’re not on your own – it’s part of a much bigger issue than just you.’

• Cultivate resilience. ‘It might be a buzz word at the moment, but it’s also a truth,’ says Ms Caudle. ‘Whether you enjoy running, singing in a choir or walking in the Pennines, factor it in. That’s your recharge – and it’s even more important for nurses and women.’

• ‘And remember that if you don’t want to climb the career ladder, that’s fine too,’ says Ms Irwin. ‘Sometimes people find it more fulfilling to move sideways rather than up. But it’s about having a real choice.’


Further information

Lynne Pearce is a freelance health writer

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