Assessing the
lack of senior
opportunities
for women in
nursing
#womeninwork
June 2016
Introduction
Victoria Short
MD of Randstad Care
Despite the nursing sector’s
predominantly female
workforce, there is still a
disproportionate amount
of men occupying senior
or management positions.
It also saddens me to
see that a pay gap still
exists between the sexes
despite having a wealth of
nurses with the skills and
experience to lead, manage
and excel.
It is disappointing that the
gender spread isn’t more
evenly reflected at the
top but the reasons why
more women don’t go
onto senior positions are
complex.
The NHS needs to continue
its work to ensure women
are treated equally and
fairly and that they no
1
http://www.bbc.co.uk/news/business-35657308
2
longer suffer career
setbacks because of the
“motherhood” penalty. NHS
trusts must also reassess
the flexible working and
childcare options they
offer employees in order to
support women who return
to work after maternity
leave.
Given that 45% of
healthcare professionals
believe not enough is being
done to get women into the
top jobs and cite employer
attitudes as a major reason
holding women back, the
NHS also needs to look at
how women are supported
and trained at all levels.
Empowering female
nurses with more training
and career development
programmes will go
some way to redressing
the balance and greater
attempts should be made to
dispel inaccurate stereotypes
around “aggressive” female
bosses.
As nurses sometimes lack
the confidence to ask
for pay rises, employers
should also help improve
confidence and self-belief
and ensure female nurses
acknowledge their best skills
and achievements.
Nurses really are the
backbone of the NHS and
without them it simply
wouldn’t function. Greater
respect for nurses would in
turn lead to greater
self-belief and ultimately
more women making it into
senior positions and earning
higher wages.
Key takeaways
14%
89.6%
89.6% of nurses and midwives are
women but two thirds of senior
positions are occupied by men
45%
A 14% pay gap exists between
men and women in the nursing
sector
36%
36% of care workers believe a
glass ceiling still exists for women
45% of healthcare professionals
believe not enough is being done
to get women into the top jobs
29%
29% increase in graduate nurses
but 83% of NHS trusts still
reported nursing shortages
84%
84%
84% of women have never asked
for a pay rise compared to 71% of
men
“Nurses really are the backbone of the NHS and without them it simply wouldn’t function.
Greater respect for nurses would in turn lead to greater self-belief and ultimately more
women making it into senior positions and earning higher wages.”
Victoria Short, MD of Randstad Care
3
Demand for nurses and midwives
continues to grow
The UK’s nursing workforce has
grown to record levels as the
NHS struggles to keep up with an
unrelenting demand for healthcare
workers. The UK’s population,
which is expected to hit 74.3
million by 2039, the number of
nurses reaching retirement age and
increasing life expectancies are all
contributing to staff shortages and
the pressing need for more nurses
and midwives.
In 2014, the UK registered the
highest number of nursing and
midwifery professionals in Europe,
and according to our recent
UK nursing report, the number
of qualified UK nurses grew by
18,342 from 2004-2014.
To add to this, figures show that
the NHS workforce has grown by
more than 2.1% in the last 12
months and there were 660,120
registered nurses in December
2015, with London, the North
West and the West Midlands
predicted to see further growth in
the next few years.
“In 2014, the UK
registered the highest
number of nursing
and midwifery
professionals in
Europe”
Graph: Number of nurses and midwives employees (evolution and forecast)
95,430
92,450
London
88,266
84,819
83,054
South East
81,333
North West
68,028
64,659
62,904
West Midlands
60,880
56,169
South West
53,535
East of England
47,633
East Midlands
45,894
36,759
35,133
Wales
North East
35,523
34,584
2012
2013
2014
2015*
2016*
2017*
2018*
* Forecasted number of employees
Source: Nursing Study United Kingdom, Randstad
4
Although approximately £4 billion
is spent on staff nursing in hospital
wards, 83% of NHS Trusts say
they are experiencing workplace
shortages, forcing them to look
to migrant workers to fill the
vacancies.
Such is the demand that during
2014, the NHS recruited 5,778
nurses from overseas, particularly
from Italy, Portugal, Spain and the
The ever-increasing demand for
qualified nurses and midwives
has also led to a rise in nursing
graduates and entry level
employment. According to our UK
nursing report, graduate figures
increased from 20,666 in 2010
to 27,006 in 2013 with 96.5%
moving straight into nursing roles
and one in ten becoming midwives.
90% of these nursing graduates
are hired within the first six months
of graduating and figures show
that there has been a 28.26%
increase in graduate nurses
between 2010 and 2013.
“graduate figures increased from
20,666 in 2010 to 27,006 in 2013
with 96.5% moving straight into
nursing roles and one in ten
becoming midwives.”
Graph: Number of nursing graduates in the UK
+15.35%
+8.36%
+4.55%
20,666
21,606
23,412
2010
2011
2012
Source: Statista.com
5
27,006
2013
Philippines, 76% more than in
previous years. More than a quarter
of non-British registered nurses are
from the Philippines and another
19% are from India. Together they
account for more than 45% of the
workforce trained abroad.
Gender imbalance at the top
Despite the continued growth of
the nursing workforce and the
efforts being made to employ
more staff from abroad and at
graduate level, there appears to
be a worrying gender imbalance
at the top. Women currently make
up a staggering 89.6% of the UK’s
nursing workforce, yet almost two
thirds of the sector’s top jobs are
occupied by men and a pay gap of
14% still exists.
According to the King’s Fund
study, only 37% of the NHS’s
foundation trust directors are
women and only a small minority
fill chair or chief executive roles.
This seems to suggest that there is
a disproportionately high number
of men in senior roles and that
more needs to be done to improve
the amount of female leaders in
the NHS.
6
Our recent women in work survey,
which involved a cross section
of men and women currently
working in nursing and social care,
appears to support these claims as
it revealed that 36% of healthcare
workers believe a glass ceiling still
exists and 45% believe not enough
is being done to encourage women
into the top jobs.
The survey also revealed that
43% of men believe they are paid
equally compared to just 24% of
women and 13% actually argued
that men and women will never be
paid the same.
The arguments surrounding equal
pay are also supported by the fact
that pay increases at grassroots
level and in senior positions have
varied greatly in recent years.
According to a report published by
“Women currently make up a
staggering 89.6% of the UK’s nursing
workforce, yet almost two thirds of
the sector’s top jobs are occupied
by men and a pay gap of 14% still
exists.”
the Royal College of Nursing, pay
for nurses has only risen by 1.6%
in the last two years, whereas the
sector’s senior executives saw a
much larger pay increase of 6.1%
during the same period.
Decline in senior positions and
wage caps are making matters
worse for women
The lack of senior opportunities
for female nurses is further
exacerbated by a series of recent
cuts to the NHS’s Band 7 and 8
positions. These positions, which
include job titles such as chief
nurses, modern matrons and
nurse consultants have been in
decline since 2010 and tend to pay
employees between £31,000 and
£81,000.
According to our recent UK nursing
report, demands for lower NHS
running costs has seen a 4.5%
decline in Band 7 positions, an
8.4% drop in Band 8a positions,
an 18.5% decline in Band 8b
positions, a 15.8% decline in Band
8c positions and a 3.4% drop in
Band 8d positions.
7
“competition for the sector’s
top jobs will become much
fiercer and women, who are
already held back by a gender
imbalance, are now likely to
find it even harder to climb the
career ladder and earn more
money.”
Graph: Percentage change of nurses by Band ( April 2010 - September 2013)
4%
BAND 5
2%
0%
BAND 6
-2%
-4%
BAND 7
-6%
BAND 8
-8%
-10%
-12%
April
2010
ALL STAFF
October
2010
April
2011
October
2011
April
2012
October
2012
April
2013
October
2013
Source: Nursing Study United Kingdom, Randstad UK
To add to this, it was reported in
2012 that there had been 8.9%
decline in the number of managers
in the NHS altogether.
These cuts mean that competition
for the sector’s top jobs will
become much fiercer and women,
who are already held back by a
gender imbalance, are now likely
to find it even harder to climb
the career ladder and earn more
money.
To make matters worse, caps
on the amount NHS trusts can
pay agency staff (which were
introduced by Monitor and the
NHS Trust Development Authority
in November 2015) are also likely
to have an impact on the gender
pay gap.
8
In a bid to tackle the high fees paid
to agency staff, the latest reforms
mean trusts are unable to pay
agency workers more than 55%
more for a shift than a permanent
member of staff.
The move is intended to curb
spending on agency staff in light of
recent figures which revealed the
NHS in England overspent by £1.6
billion in 2015-2016. It is hoped
the money saved can be invested in
frontline staff and services.
These wage caps will therefore
have a detrimental effect on
agency nursing pay rates, as it’s
unlikely that the pay gap will
improve for female agency nurse
temps in the foreseeable future.
55%
“To make matters worse, caps on
the amount NHS trusts can pay
agency staff are also likely
to have an impact on
the gender pay gap.”
What can women do about the gender
imbalance at the top?
Transparent pay structures and a
clear Banding system allow male
and female nurses to start on the
same salaries, but as they rise
through the ranks a pay gap starts
to emerge and there appears to be
a decreasing proportion of women
as the level of seniority rises.
There are many reasons and
contributing factors for this and
many will argue that a culture
change needs to take place in
order to improve the situation. A
recent study by the Kings Fund
revealed that almost half of female
respondents said having children
put their career in healthcare at
a disadvantage. Having children
usually means taking a career break
and some respondents felt they
had to work twice as hard to keep
up with colleagues who hadn’t
taken time off.
they had encountered gender
discrimination and 52% said they
had been bullied in the workplace,
surprisingly sometimes by other
female leaders.
Many respondents also felt
that women had to work much
harder to establish themselves
and earn the respect that has
been routinely granted to men.
Some said they felt pressure to
adopt more masculine traits in the
workplace and that developing
an authoritative style that wasn’t
perceived as a negative stereotype
was difficult.
Victoria Short, MD of Randstad
Care, addressed these issues when
she recently argued that: “Both
sexes feel like they are treated
reasonably equally but the work to
publish clear pay structures needs
to be ongoing and organisations
must be careful not to penalise
women for taking career breaks to
raise children or look after family.
The NHS and private sector
employers also need to look at
ways to promote women into
In addition, 37% of women said
“half of female respondents said
having children put their career
in healthcare at a disadvantage”
senior positions to redress the
imbalance at the top of the
profession.”
Results from our recent women in
healthcare survey also reveal that
confidence also plays a huge role
in holding women back from the
top nursing jobs, especially when
it comes to pay rises. According
to our research, 84% of women
have never asked for a pay rise
compared to 71% of men.
The top factors for not asking
were lack of confidence or belief
in their own ability (35%), fear
of being turned down (23%) and
fear of how colleagues or senior
management might perceive them
(23%).
Another 23% of women believe
employers’ attitudes also hold them
back in the workplace, as female
respondents felt fear of their boss’s
reaction (19%) and worrying about
having to justify themselves (18%)
had a big effect on whether they
asked for a raise or not.
Graph: Reasons women give for being held back in the workplace (486 respondents)
35%
lack of confidence in own abilities
fear of being turned down
23%
fear of how colleagues might perceive them
23%
believe employer’s attitudes hold them back
23%
fear their boss’s reaction
worry about having to justify themselves
Source: The level paying field: UK working women and pay rises, Randstad UK
9
19%
18%
Female nurses beginning
to receive more support
In order to address the issue of
gender imbalance in the nursing
sector, a number of schemes and
initiatives have been set up to
ensure women receive the training
and confidence they need to
succeed at a higher level.
‘The Athena Programme’ was
established to support and help
women fulfil their potential as
leaders across the public sector.
The programme, which welcomes
applicants from the NHS, focusses
on personal development and
aims to help women overcome
the barriers they face in leadership
positions; both real and perceived.
The Health Service Journal has also
launched an initiative which aims
to celebrate the healthcare sector’s
most inspirational female leaders.
The HSJ’s Inspirational Women list
has been created in order to give
women in healthcare more role
models and has helped shine a
light on the achievements of the
sector’s most remarkable female
leaders.
“Empowering female nurses with more training and career development programmes will
go some way to redressing the balance and greater attempts should be made to dispel
inaccurate stereotypes around “aggressive” female bosses.”
Victoria Short, MD of Randstad Care
Finally, an organisation called
‘Disruptive Women in Healthcare’
also helps to provide a platform
for female healthcare professionals
to share provocative ideas and
solutions to workplace problems.
The scheme has over 100
influential contributors and
regularly showcases work from
prominent female figures from
across the globe. The organisation
also hosts networking events
which aim to bring female
healthcare professionals closer
together to share ideas and
discuss issues surrounding female
underrepresentation.
10
Sources
The level paying field: UK working women and pay rises, Randstad UK
Nursing Study United Kingdom, Randstad UK
www.statista.com
http://www.kingsfund.org.uk/blog/2013/07/why-aren%E2%80%99t-there-more-women-leaders-nhs
http://www.nhsemployers.org/news/2015/12/nhs-women-in-leadership-report
http://www.nhsemployers.org/~/media/Employers/Publications/NHS%20Women%20in%20leadership_Br1322_WEB.pdf
http://www.kingsfund.org.uk/press/press-releases/women-continue-face-barriers-taking-senior-leadership-positions-nhs-new
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/468432/Agency_rules_consultation_final_document.pdf
http://www.nursingtimes.net/roles/nurse-managers/growth-in-nhs-workforce-outstripped-by-demand-on-services/5083642.fullarticle
http://www.theguardian.com/society/2014/jan/21/nhs-not-promoting-female-leaders
http://www.hsj.co.uk/topics/workforce/women-are-80-pc-of-the-nhs-workforce-but-only-a-third-of-the-board/5091277.fullarticle
http://www.theguardian.com/society/2014/jun/15/nhs-chiefs-pay-rise-condemned-nurses