The recent Royal College of Nursing (RCN) report titled Gender and Nursing as a Profession: Valuing nurses and paying them their worth (Clayton-Hathway et al, 2020) argues that nurses are undervalued, reflected in their conditions and pay, because of gender stereotypes. Unfortunately, this research does not fully engage with the real issues that women in nursing are faced with, particularly family responsibilities, the impact of part-time working and culture.
However, it is clear that family responsibilities, particularly motherhood, define a woman's career progression, particularly in nursing. There is a complex process relating to the age of the dependent children, a woman's working hours and any successive career breaks. The degree of a woman's career progression is directly related to the school age of the dependent children: the younger the child the greater the detrimental impact (McIntosh et al, 2015a).
Moreover, women who take a career break of more than 2 years often see their career path become more restricted. Research confirms that, while gender has a relatively positive effect on male career progression, a woman's career progression is reduced incrementally when she has more children; in taking a career break we see the most substantive and the most perceived loss of skills (McIntosh et al, 2012).
As well as motherhood, part-time workers experience reduced career progression, regardless of their parental circumstances—and given that 97.5 % of part-time nurses are female, this further compounds the gender difference in terms of career progression. However, there are many other factors that affect women's career outcomes, ranging from gender bias to gendered constructs, which influence this situation in the qualitative phase that this research explored (McIntosh et al, 2015b).
In certain areas of nursing, career outcomes depend not only on personal circumstances but also on cultural and environmental perceptions. This latter area of research engaged with two enduring sets of social assumptions. First, that a woman with children should prioritise the care of children; and, secondly, that nursing standards require nurses to put their profession above other priorities. Commitment is linked to full-time working, which contrasts sharply with the reality for many women with children, who need to work part-time and are not able to extend working hours. The research observed that in a female-dominated profession such as nursing, there was a resistance to attempts to make the profession more accessible to women with children (Watt and McIntosh, 2012).
However, the part-time workforce, which is invariably female, experienced an even greater detriment. Nurses experienced direct restriction to the access of training when they worked part time. It should be noted that they worked these patterns due to family circumstances. This was a direct product of the institutional value ascribed to working at senior levels. It was at best an unconscious bias, but it appeared to be a more consciously pronounced bias informed by operational requirements and outdated working practices. The relationship between perceptions concerning parenthood, the affected access to training, and gender stereotypes, played a significant part in women's career outcomes.
The career progression of women with children is inhibited and is driven in part by a determination to maintain ‘traditional’ employment practices. The expectation that female nurses with children will prioritise family over work conflicts with the perception that the nursing profession should be prioritised over everything else. Nurses with children are still expected to commit fully to their job, and those who prioritise external obligations are regarded as less committed. The loss of the most experienced and highly trained nurses has clear implications for operational effectiveness, efficiency and productivity.
The causal mechanisms that explain women's relatively reduced career outcomes are therefore clear. Restricted access to training for part-time nurses, and limited opportunity to update their skills following a return from a career break, are determining factors affecting career outcomes. The suggestion is that it is related to the rationing of training for those returning from career breaks, based on the availability of newly qualified nurses meeting the numerical demand, financial constraints, operational imperatives, and organisational values.
In future, nurses must have the right to flexible working in a position that is appropriately matched to their experience, on terms that are no less favourable than their original post. Equally, training workplace childcare provision must be considered. The retention of experienced practitioners can reduce expenditure on the training of junior staff, enhance the quality of care and lessen the likelihood of staff shortages in the future. It can also improve work-life balance and positively confront the choice that many women have to make between career and family.
This represent an opportunity to enhance all women's career outcomes, particularly those with dependent children, while preventing the loss, or the curtailed development, of the most highly skilled members of staff. A career in healthcare involves caring for others, yet the profession seems to discriminate against its own members for being working mothers (and indeed parents). Motherhood can result in the devaluing of women's abilities, and women who take a career break often suffer the penalty of having fewer career opportunities. The skills and experience of all professionals, regardless of their career trajectory, should be valued in the drive for excellence across the healthcare system.