Multiple Segregation in Nursing Careers:Causes and Consequences

WES Conference 2004, UMIST

Sarah Wise

Research Associate

Employment Research Institute

Segregation and Nursing Careers

Vertical Segregation• 40% of qualified nurses and midwives in NHS Scotland work part-time

(ISD 2004) but...• Part-time nurses have been found to be under-represented in higher

clinical grades (G grade and above)• Part-time work and career breaks have been found associated with

slower progression up the clinical grades• Men have been found to be over-represented in higher nursing grades

and spend less time getting there• Davies (1995); Lane (2000); Whittock et al. (2002)

Horizontal Segregation• 90% of qualified nurses and midwives in NHS Scotland are women

(ISD 2004) • However, there has been little research on horizontal segregation and

patterns of employment within nursing

Work-life Balance and Careers in NHS Nursing and Midwifery

Coverage• Qualified nursing and midwifery staff (RN and RM) in a large, acute

Trust in NHS Scotland (2 adult hospitals, 1 paediatric hospital, 2 acute elderly hospitals) 3,700 qualified nurses and midwives

Funding & Partners• Scottish ESF Objective 3 Programme (part-funded)• Napier University, the Trust and RCN Scotland

Objectives of Research Project • To examine availability, accessibility and implementation of work-life

balance policies and practices in NHS nursing and midwifery;

• To examine the role of working hours and shift work in work-life balance;

• To examine the relationship between the utilisation of policies and career development and progression;

• To examine the relationship between work-life balance and retention;

• To identify best practice and recommend areas for improvement.

Methodology

Field Work

• Selection of case study areas - 12 in total• 64 interviews – grades D to I• 3679 distributed 1084 returned – 29% response rate

Data

• Job details – type of workplace and responsibilities• Perceptions of workplace support for career development and

work-life balance• Availability, usage and operation of flexible working and leave

policies• Working hours and preferences• Retention issues• Communication and involvement• Detailed workforce demographics

Profile of Part-timers

• 33% (n=354) of respondents worked part-time– 2% (n=26) had always worked part-time– 55% (n=586) had always worked full-time– 43% (n=463) had worked a mixture of part-time and full-time

• 98% of part-timers were women

• 60% of parents of dependent children, 28% of those with adult care responsibilities only and 16% of those with no care responsibilities worked part-time

• 73% of respondents whose youngest child was under 5 years old worked part-time falling to 35% of those whose youngest child was aged 16-17 years (CHI-SQUARE SIG = 0.000)

• The most common form of work-care strategy was fairly ‘traditional’ - 38% of all parents were mothers working part-time taking primary responsibility for the care of dependent children

Support for Career Development

• Part-timers were disadvantaged in some areas:– A lower proportion of part-timers had an HE degree (partly age-

dependent)– A lower proportion had been granted study leave in the last year (43%

compared to 60% of full-timers) (CHI-SQUARE SIG = 0.000)

– 26% of part-timers compared to 38% of full-timers agreed with the statement “There are plenty of career opportunities for someone like me” (CHI-SQUARE SIG = 0.001)

• However, similar proportions of part-timers as full-timers:– thought their line manager was supportive of their professional

development

– had undertaken post-registration courses (in addition to PREPP)

– had been involved in research and practice development in the last year

Vertical Segregation of Part-timers?

Proportion working part-time / full-time at each clinical grade (%)

• Highest proportion at E grade (experienced staff nurse)

• Lowest proportion at H/I grade (senior line manager)

• Low levels at D grade because of high numbers of young entrants from education

D

E

F

G

H/I

Percentage (%)

part-time

full-time

20

27

30

37

24

80

73

70

63

76

CHI-SQUARE SIG = 0.002

Vertical Segregation of Part-timers?

Clinical Grade

H/IGFED

Pe

rce

nt (

%)

60

50

40

30

20

10

0

full-time

part-time4

1212

53

19

7

1413

39

27

Distribution of full-timers and part-timers across the grades

CHI-SQUARE SIG = 0.002

• 53% of part-timers were E grades compared to 39% of full-timers

• 21% of full-timers were G grade or above compared to 16% of part-timers (CHI-SQUARE SIG = 0.052)

• Part-timers were under-represented in higher grades but not substantially so

Part-time Work and the “Experience” Gap

Average years since first registering less career break

Clinical Grade

H/IGFED

Me

an

ave

rag

e y

ea

rs o

f w

ork

25

20

15

10

5

0

full- time

part- time

• Part-timers older than full-timers (41 yrs compared to 36 yrs) (Mann-Whitney SIG = 0.000)

• Part-timers, on average, more “experienced” than full-timers (16.5 yrs compared to 11.7 yrs) (Mann-Whitney SIG = 0.000)

• D to F grade part-timers had worked significantly longer than full-timers

• Reversal at G grade - an indication of changing attitudes?

Part-time Work in Senior Grades

Availability

Opportunities there but not universal. No organisational policy or guidance. Attitudes of senior line managers important (H/I grades).

“Job share is difficult for ward managers [G grades] - you have to find a like minded person with the same goals and aspirations. Job share is frowned upon at this level.” (G grade nurse)

Do-ability

Jobs at G grade and above entailed high levels of responsibility, stress and often long working hours as both clinical and managerial roles have expanded.

“If I can’t get my job done coming in at 7.30 everyday, how will I get it done coming in at nine?” (G grade nurse)

Gender, Part-time Work and Progression

Average years since first registering less career break - always worked full-time only • Men and women

were evenly distributed through the clinical grades

• When part-time working is controlled for, men did not progress more quickly through the grades

• Men were less likely to take study leave and to think the line manager was supportive of their career development

Clinical Grade

H/IGFED

Me

an

ave

rag

e y

ea

rs o

f w

ork

25

20

15

10

5

0

female

male

Horizontal Segregation of Part-timers

Respondents working part-time / full-time by workplace

A&E

admissions

theatres

labour suite

ICU

Elderly

OP clinic

ward

management

other

Percentage (%)

part-time

full-time

47

13

31

43

43

28

32

31

24

23

53

87

69

57

57

72

68

69

76

77

• Popular clinical areas low in part-time working

• Areas with ‘regular hours’ high in part-time working

• Medicine for the Elderly – unpopular area with acute recruitment and retention problems

• Segregation by age, experience and care responsibilitiesCHI-SQUARE SIG = 0.000

Discussion

• The profile of part-time nurses was fairly traditional.

• Part-timers were disadvantaged in access to support for career development (e.g.study leave), but not in all areas (e.g. line manager support).

• Compared to previous studies, vertical segregation of part-timers was much less pronounced although there was an “experience gap” at grades D to F.

• There were greater opportunities to combine part-time work with progression into senior roles than in the past but barriers still existed.

• Male nurses were not over-represented in higher grades and when part-time working is controlled for, did not progress more quickly. However as long as part-time working is gendered, male nurses will have an advantage.

• Part-time working was less common in the popular clinical areas. Why?

• What are the implications for service provision that the nursing workforce is segregated by age, experience and care responsibilities?

Work-life Balance and Careers in NHS Nursing and Midwifery.

For more project information and downloads go to:

http://www.napier.ac.uk/depts/eri/research/esf

or contact:

s.wise@napier.ac.uk

References

Davies, C. (1995) Gender and the Professional Predicament of Nursing. Open University Press: Buckingham

ISD (2004) NHS Scotland workforce statistics for March 2004. Available online http://www.isdscotland.org

Lane, N. (2000) ‘The Low Status of Female Part-Time NHS Nurses: A Bed-Pan Ceiling’, Gender Work and Organisation, Vol. 7 No. 4, p 269 – 281

Whittock, M., Edwards, C., McLaren, S. and Robinson, O. (2002) ‘’The tender trap’: gender, part-time nursing and the effects of ‘family-friendly’ policies on career advancement’, Sociology of Health and Illness, Vol.24 No. 3, pp. 305 – 326