When I talk to nurses about their jobs, as I do constantly, they tell me about the pressures of working with too few staff, and about how it hurts not be able to provide the level of care they would like. We talk about why things have got to this, and chances are they will say something along the lines of: “They wouldn’t treat other professions this badly.” Usually the other professions they are thinking of are dominated by men.
They look around at other all-graduate professions – law, medicine, accountancy – and wonder whether their employees are also expected to put up with high levels of verbal and physical abuse, stress, work pressure and low pay. They also wonder why their own profession can’t seem to shake off the image of being doctors’ helpers instead of the autonomous, highly technical, safety-critical clinical occupation it really is.
Nurses are often put on a pedestal when things go right, and blamed when things go wrong, but too often they are simply not part of the conversation.
In a joint report published on Wednesday by the Royal College of Nursing and Oxford Brookes University, we unequivocally ascribe most of the problems and challenges facing the image and status of nursing to the fact that the profession is and has historically been a female-dominated occupation. The longstanding view that care is a naturally feminine skill or characteristic overlooks and devalues the high levels of skill and professionalism nurses have.
The report, “Gender and nursing as a profession: Valuing nurses and paying them their worth”, asks a fundamental question: in an occupation facing dangerous levels of shortages, why don’t wages rise to attract more new nurses and prevent current workers leaving?
In the NHS there are more than 43,000 empty posts across the UK, and outside the NHS there are high levels of shortages – in GP practices, social care, and independent hospitals and clinics.
We found that nurses are the lowest paid among all healthcare professionals, and that, compared with other occupations, their earnings, which start at just £24,214 in the NHS in England, increase less over their careers. In comparison with healthcare managers and doctors, there are fewer opportunities for progression and access to leadership positions.
Even when they do get access to senior positions, they are disproportionately taken up by male nurses. Although women make up 90% of all nurses, they fill less than a third of senior positions. It doesn’t matter how many vacancies there are, or how much demand there is for more nurses, these structural and deeply embedded pay inequalities don’t shift.
Instead, nursing remains rooted in the past, holding on to such traits as virtue and moral character, while striving to nurture others and display selflessness, as personified by Florence Nightingale – perhaps the most influential nurse of all time – who was born 200 years ago. In the year of the nurse and midwife, it’s clear how much the nursing profession has moved on since Nightingale’s time. Well-educated, highly skilled nurses are needed more than ever – the health and social challenges facing society right now are too great to be holding nurses back from playing a full part in the important clinical, scientific and political decisions needed to improve health outcomes.
Across the UK, there needs to be a step change in how nurses are educated, recruited, employed and developed. For the NHS in England, the forthcoming workforce strategy is an opportunity to do just that. Wherever they work, from the NHS to social care, nurses deserve a wage that fully recognises their level of skill, experience and the complexity of their roles over their career.
It also means giving nurses a bigger voice, with much more investment in training and development of nurses: providing adequate maintenance grants that allow nursing students to learn without the added pressure of worrying how they will make ends meet, and removing them from the tuition fee system entirely.
And we need to listen to them more. It cannot be right that nurses are too frightened to speak up if they think patients aren’t getting the care they need, that they experience bullying or abuse in the workplace, or don’t have the opportunity to express their views. Nor can it be right that policy or workplace decisions affecting nursing are made without listening to nurses first.
For too long, nurses have been invisible and undervalued. Now is the moment for their voices to be heard and their value realised.
• Rachael McIlroy is senior research lead, Royal College Of Nursing