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Nursing has still not escaped its 'subservient past'

Nurse leadership is ahead of the rest of the NHS in reflecting the gender of its workforce, but concerns remain that nursing’s perception as a “female” profession means it does not get the attention it deserves.

Just over a third, 38%, of senior roles in NHS organisations are held by women, according to a major new analysis of female representation at trust board level.

Despite the fact women make up 81% of the non-medical NHS workforce, men are in the majority on the senior leadership teams in 88% of both NHS trusts and foundation trusts.

Just 17% of medical directors are women, even though 31% of consultants on the General Medical Council’s register are female.

Nursing leadership is far more representative. In total 90% of directors of nursing at acute trusts are women, precisely mirroring the gender make-up of the NHS nursing workforce.

At 70%, the proportion of female nursing directors is lower at mental health trusts, which appears to generally reflect the fact that a larger proportion of mental health nurses are male.

But the data does not tell the whole story, according to Anne-Marie Rafferty, professor of nursing policy at King’s College London.

“According to the figures, everything in the garden is lovely – but it still doesn’t tell us much about how people are able to function in these extremely challenging roles,” she told Nursing Times.

“What’s the nature of the experience? What’s it like to be a woman in a top position in the NHS?”

Professor Jill Maben, director of the National Nursing Research Unit – also based at King’s – said the predominantly female nature of the nursing workforce, combined with traditional notions of women’s place in society, meant the profession’s power did not reflect its size.

She told Nursing Times it made little difference whether a nursing director was male or female in terms of their influence.

“You may be a male director of nursing but your voice still may not be heard because it’s a low status profession,” she said. “It still seems very easy to sideline nursing and the nursing voice.”

For example, she highlighted that there was evidence of the impact of low nurse staffing levels dating back “years”. But it was only now, following the publication last week of NHS England medical director Sir Bruce Keogh’s review, that the issue appeared to be taken seriously at senior levels of the NHS.

Professor Elaine Maxwell, a former nursing director at an acute trust and a trustee at the Florence Nightingale Foundation, said nursing’s “subservient history” was still evident in the profession’s standing today.

“Despite the increase in women in NHS leadership, decision-making still follows a male culture, even if the CEO is a woman… The power in an NHS trust exec team usually lies with the chief exec, medical director and finance director,” she told Nursing Times.

The research found just 36% of chief executive posts and 19% of finance director roles were held by women. After the nursing director, the executive role most likely to be held by a woman was human resources director – just over half of whom were women.

However, Professor Maxwell said it was important to provide training opportunities for women that reflected the fact they often worked differently to men.

“Are we just training women to make decisions in the same way that male dominated organisations do,” she asked.

At 64%, South Tees Hospitals Foundation Trust and Lewisham Healthcare Trust had the highest proportion of women in senior leadership positions.

It was also one of only 17 trusts to have a female chair and chief executive. Its chief executive Tricia Hart, who is a nurse by background, said there were many more opportunities for leadership development within the NHS than there were in the past.

“The fact that more people are having coaching and mentors can support them to look at the opportunities that are certainly out there,” she told Nursing Times.

The research was conducted by Nursing Times’ sister publication Health Service Journal as part of a special issue on inspirational women in the health sector.

A list compiled for the issue and celebrated at a ceremony last week included 19 nurses or midwives – or former members of either profession – out of a total of 50.

 

Discussion

We will be discussing this news story on twitter at 1pm 24 July.
To join in, search for #NTtwitchat and include this hashtag in all your tweets so everyone can see your comments.

 

Readers' comments (19)

  • what a complete and utter load of rubbish! People should be appointed into a position not because of the gender, sexuality, colour, religious beliefs, but because they are the best person for the job.

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  • If 90% of directors of nursing at acute trusts are women and given the state that the profession is in today with morale at rock bottom, it doesnt say much for the support the females at the top are giving to the females lower down !!

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  • tinkerbell

    Anonymous | 22-Jul-2013 2:46 pm

    Precisely, I think once the majority of them have climbed up the greasy ladder they just kick it away so it lands on everyones head down below.

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  • michael stone

    She told Nursing Times it made little difference whether a nursing director was male or female in terms of their influence.

    “You may be a male director of nursing but your voice still may not be heard because it’s a low status profession,” she said. “It still seems very easy to sideline nursing and the nursing voice.”

    We are told that above, and it has got 'may' in it twice, making its claim slightly unclear. But, while the 'low status' of nursing might make it easier to 'not hear the director of nursing', does being XY instead of XX tend to make male directors of nursing, less 'tolerant of being ignored' ?

    I don't know - my gut instinct is that being ignored equals 'confrontational' and that men tend to be 'more confrontational/pushy/bolshy than women in the types of discussions directors of nursing might be involved in' - and I'm just wondering what people's feelings on that are ?

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  • Yes, Nursing is a 'low status profession'. That isn't going to go down well with the majority of nurses. But it is true.

    Nurses behave in a subservient manner. Just read the millions of words written in complaint on these threads. Anyone looking objectively on them would be stunned that not one nurse has taken to the streets in protest at even half of the content of the NT comments.

    Anonymous | 22-Jul-2013 2:46 pm

    ....or vice versa.

    Nurses don't support each other. There's a reason why whistleblowers act alone and suffer so badly. Their colleagues, who are in the same boat and witnessing the same things, are too cowardly to stand with them.

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  • tinkerbell

    michael stone | 22-Jul-2013 3:18 pm

    I don't actually perceive myself as either male or female in the workplace. My opinion is my opinion regardless of rank or who is addressing me, I do not discriminate.

    If a senior manager, male or female asks me how I feel about a situation that is bothering me I will tell them 'p*ssed off' and then they will usually ask me to elaborate. If they ask me what I think then I may say 'load of b*llocks' and they will usually ask me to elaborate. They might not like my answer but they asked.

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  • Anonymous | 22-Jul-2013 3:25 pm

    So true.

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  • As a female, I can honestly say that generally men are better managers. It's not because they are more intelligent or anything like that. They are just easier to get along with, generally more amiable. This makes working environments calmer. Another aspect I like about them is they leave me alone to get with my job.

    The problems facing the profession are down to the female workforce. Ok, don't bite my head off, but we are the vast overwhelming majority, in nursing. Yes, government has some role in the state we find ourselves. Mainly it is self inflicted, we did this to ourselves, sisters. Imagine the government trying to bully Bob Crow? What do you think his response would be? It's noticeable, Cameron & co rarely say anything about the RMT. There's a reason they don't, can you guess?

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  • "there was evidence of the impact of low nurse staffing levels dating back “years”. But it was only now, following the publication last week of NHS England medical director Sir Bruce Keogh’s review, that the issue appeared to be taken seriously at senior levels of the NHS."

    Ha - I laughed cynically out loud when I read this. How many more years from taking it seriously to the next step? What more is it going to take for radical change to occur? Will nursing become less subservient when the healthcare system becomes more subservient to privatisation?

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  • Anonymous | 22-Jul-2013 4:30 pm

    To say that 'They(men) are just easier to get along with, generally more amiable.' is just your subjective opinion. My boss is male and the worst bully I have ever known. Is it because he is a man? I wouldn't say so. He's just an awful personality.

    There is an increasing amount of research (mainly involving businesses and corporations) providing evidence that women make better bosses than men. They make fairer decisions, rationalise better and have more scruples. Companies with woman board members and leaders perform better.

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  • This article is so true. Of course nurses are subservient on the whole - that is even part of their training and may go into the new NMC code - be nice to the patients even when they
    are abusing you . . .-

    This is why nurses (and other female dominated health care professionals) have poor incomes and working conditions relative to their responsibilities.

    This confirms the theory of radical feminism - that is, women are subject to conditions in society as a whole.
    This is old fashioned and we are supposed to be post-feminist, but we are NOT.
    Nurses do not realise the power they could have to influence services and patient care.

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  • tinkerbell

    time to escape I say.

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  • While we accept this is still happening and perpetuate it and react to it with some of the commens, it will persist! Treat it with contempt, better still ignore it.

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  • .... should have read 'comments'

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  • tinkerbell | 22-Jul-2013 3:17 pm

    Anonymous | 22-Jul-2013 2:46 pm

    Precisely, I think once the majority of them have climbed up the greasy ladder they just kick it away so it lands on everyones head down below.

    Well put Tinkerbell. Lets face it nursing is not only a female orientated profession but a bitchy one too.

    I don't class myself as subservient to anybody. My role as a nurse is so varied, from the proverbial wiping bottoms to far more intricate and technical nursing care.
    We are part of a team and we each play an important role. I don't think the Doctors could actually do their job as well as they do without our "subservient" input.

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  • Jayne Wilson

    I have had some brilliant managers of either gender and some complete machiavellian evil ones as well! gender is not an indicator of performance or people skills!
    In various other sectors it is well researched that women are under-represented, and are reluctant to "get ahead" due to being perceived as a b*tch etc for essentially behaving the same as their male equivalents.
    To be fair am more concerned about the glaring inequalities between doctors and nurses. have worked with some doctors who's prescribing has been shocking, one making errors with mental health act paperwork that were startling. but looking on the nmc website, i saw a nurse struck off for giving amoxicillin at the wrong time. doctors appear untouchable and we have to check their prescribing thoroughly. that is nothing to do with gender, but perhaps class, as few people can afford to train as a doctor
    (and i have had to explain to two consultant psychiatrists now what "forced normalisation" is in regards to epilepsy and other disorders)
    i digress. a lot... :P

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  • tinkerbell

    consider how much more subservient they will want us to feel when we are all working for the private sector. Only a matter of time now before we have a two tier system. The workhouses and proper hospitals.

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  • I am seriously scared for the future of the NHS and for nursing. For too long nurses have put up with what no other "profession" puts up with. In my opinion this is because the NHS has its own culture, basically it exists in a bubble. It's only when the public become aware of what is really going on (e.g. Mid Staffs) that things change. The staff within the NHS bubble seem somehow brainwashed into thinking that what they see, hear and do are somehow normal and OK, even if it goes against their own conscience or belief system. I think it's because although the NHS exists within a democracy, it is not at all democratic in how it operates. It's top down line of management for example immediately creates a culture in which bullying is rife. The only way to change things for nurses is to change the system in which we work. And of course that ain't gonna happen anytime soon. Too much power at the top and the people with power aren't going to let go of it without a fight.

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  • Tugs forelock, but thats what you get when you base things on how the Army is run!

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