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.
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