6 | Nursing in Practice | Winter 2022
COVER STORY
Climbing the leadership ladder : Why female nurses can struggle to reach the top
Nursing has historically been seen as a ‘ feminised ’ profession – but how much is this still impacting nurses working in primary care , asks Kathy Oxtoby
Nurses are now widely accepted as autonomous , educated professionals , with some holding roles among the top decision makers in the NHS . But for many years , nurses were often viewed as doctors ’ handmaidens – their subordinates . Despite the advances the profession has seen , how much do these old-fashioned views linger and are they still holding primary care nurses – and female nurses , in particular – back ?
Nursing in Practice spoke to women from a variety of nursing backgrounds who hold a range of leadership roles but who all have a shared experience - they have had to work hard for their voices to be heard .
We heard that although women make up the vast majority of the nursing workforce , men in nursing are more powerful than might be expected . And that in primary care , where women account for an even higher proportion of the nursing workforce than in the wider NHS , the route to leadership roles is even less clear cut . So , what can be done to ensure there are no barriers to the progress of female nurses in primary care ?
Female representation at the top A research team at London South Bank University including Professor Alison Leary , the university ’ s chair of healthcare and workforce , revealed stark gender pay inequalities across the UK nursing workforce . 1 Male specialist and advanced practice nurses reach higherpaid posts more quickly , women are more likely to accept dropping a pay grade to land a job they want , and men in nursing are overrepresented at higher pay grades , but underrepresented at Band 5 , the research found .
In primary care , although men make up only 4 % of the nursing workforce in general practice , they occupy 10 % of nurse partner roles ( five out of 50 posts that record a gender for the postholder ).² They also hold 10 % of advanced nurse practitioner and nurse specialist posts ( 395 out of 3,959 posts with a noted gender ).
Nursing by numbers in England
• 96 % of nurses working in general practice are women : 15,706 women compared with just 625 men
• Yet 10 % of advanced nurse practitioner and specialist nurse posts in general practice are held by men , and the same proportion of nurse partner posts
• 76.7 % of 1.3 million NHS staff are women
• 675,699 people on the NMC register identify as female and 82,576 identify as male
• 88.6 % of the 342,104 nurses and health visitors are women
Sources : NHS Digital ; NHS England ; Nursing and Midwifery Council
This pattern extends to GPs too . On the GP register , women outnumber men , with 19,389 female GPs compared with 17,213 males , but data suggest they are also underrepresented in the most influential roles , with only 6,886 female GP partners compared with 9,636 male partners ( meaning men make up 58 % of partner roles , where gender is noted in the data ).²
Clearly the voices of female nurses need to be heard more as decision makers at all levels , such as in their workplaces and at primary care network ( PCN ) and integrated care system ( ICS ) levels . Research over the past two years by the King ’ s Fund think-tank 3 has found that ‘ most clinical directors in PCNs are GPs , many of whom have taken on PCN leadership roles as extensions of their practice partnership responsibilities , or due to previous roles on clinical commissioning group governing bodies ’. The research adds that NHS England ’ s guidance is clear that ‘ clinical director roles in PCNs can be held be GPs , general practice nurses , clinical pharmacists or other clinical professionals working in general practice ’.
Nurses told Nursing in Practice there are too few primary care and community nurses in senior decisionmaking roles . ‘ There aren ’ t enough nurse voices on PCNs and often , therefore , they are not included in decision making ,’ says Maggi Bradley , a GPN in west Lancashire and clinical nurse lead at Sefton Training Hub .
Sara Baldwin is a general practice nurse manager , place lead for digital and health and wellbeing , and general practice education facilitator for Greater Preston , Chorley and South Ribble , and a member of the CNO for England ’ s Policy Network . She says there are ‘ very few nurses on Integrated Care Boards ( ICBs ) and not enough on PCNs , but there is limited data available to confirm the numbers ’.
Jenny Bostock , an advanced nurse practitioner ( ANP ), and a clinical director for Ramsgate PCN , says : ‘ There is still the old-fashioned hierarchy of the GP being the senior person on a board , and the nurse being in the minority in some areas .’
This underrepresentation extends beyond healthcare settings . The Royal College of Nursing , the world ’ s largest nursing union and professional body , was shaken after an independent internal investigation painted a damning picture of an organisation with a lack of female voices and women in key positions , as well as worrying instances of sexual harassment .
Published in October , the Carr report 4 found an organisation and council ‘ riddled with division , dysfunction and distrust ’, where the make-up of the council does not reflect the membership of the college . The report noted that , despite recent improvements in the gender balance , the board is still nearly 60 % male whereas the membership is almost 90 % female .
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