In Australia, women make up the majority of the nursing profession, yet they are under-represented in healthcare leadership. ROBERT FEDELE talks with researcher Mihirika Pincha Baduge about efforts to break down barriers.

---

The glaring under-representation of women nurses in healthcare leadership is currently being explored by Victorian critical care registered nurse and PhD candidate Mihirika Pincha Baduge, as part of Monash University’s broader Advancing Women in Healthcare Leadership (AWHL) initiative to address the issue.

“I am looking at factors and organisational-level interventions to advancing women nurses into healthcare leadership positions,” she says.

“Improving women’s leadership capabilities through skill development alone won’t be enough unless we also tackle the organisational structure and culture to ensure women are provided with the essential support and opportunities they need to flourish.”

ADVANCING WOMEN IN HEALTHCARE LEADERSHIP

AWHL is a Monash University-led national research, implementation, and impact initiative, funded by two National Health and Medical Research Council (NHMRC) partnership grants and partner contributions.

It is seeking evidence-based solutions to drive systemic organisational changes that create and enable equal opportunities for women in healthcare leadership.

Gender equity in healthcare leadership can have wider benefits, it suggests, including improved quality of care, and building a more empowered workforce, with reduced attrition.

“We believe organisational and policy-level interventions are needed to improve gender equity and enable women nurses’ advancement in healthcare leadership,” Ms Pincha Baduge says.

BARRIERS TO ADVANCING WOMEN NURSES IN HEALTHCARE LEADERSHIP

Ms Pincha Baduge’s research has identified numerous barriers hindering women nurses’ progress into leadership roles.

In her 2023 systematic review, which included 32 studies from across the globe involving registered nurses, nurse academics, executives, and leaders, factors included:

• Social and cultural expectations and perceptions of nursing as a feminised profession.
• Gender bias and expectations of men as leaders, women as nurturers.
• Hierarchal leadership structures: medicine dominating with more power in senior leadership.
• Lack of women nurse role models in leadership.
• Lack of formal and informal leadership training.
• Inadequate orientation to leadership roles.
• Limited part-time options for leadership positions.
• Part-time nurses overlooked and perceived as less committed.

“From the findings, it is clear that the prevailing belief that caregiving is a feminine occupation, and the societal expectations of women’s subordinate position, are both significant obstacles preventing women nurses from advancing in healthcare leadership,” Ms Pincha Baduge explains.

“Men were viewed as credible leaders, and this perception has created traditional gender biases for women nurses. Additionally, the lack of recognition and respect for nurses further discourages women from pursuing leadership roles. Once they are in leadership, lack of organisational support, such as giving them minimal orientation to roles, and limited opportunities for leadership training, is a prevalent issue.”

ORGANISATIONAL STRATEGIES TO ADVANCING WOMEN NURSES IN HEALTHCARE LEADERSHIP

To counteract these barriers, Ms Pincha Baduge’s research is aiming to develop evidence-based organisational interventions.

Her 2023 paper undertook a systematic review focusing on organisational strategies that specifically advance women nurses in healthcare leadership roles.

Key organisational-level strategies uncovered included:

• Investing in leadership development programs.
• Policies that recognise the career leadership potential of nurses.
• Opportunities for mentoring and networking.
• Leadership training.
• Career planning opportunities aimed at mid-career nurses’ personal and professional development.
• Targeted recruitment processes for increasing gender diversity in leadership roles.

“Our findings suggest that optimising women nurses’ leadership attainment needs to shift focus from individual strategies to systemic level and organisational strategies and using tailored evidence-based approaches,” Ms Pincha Baduge says.

INTERSECTIONALITY

Meanwhile, Ms Pincha Baduge’s research hopes to also address additional barriers faced by women nurses from racial and ethnic minorities, including migrants, in advancing to leadership positions.

She migrated to Australia from Sri Lanka in 2012 and says global literature shows that women nurses from racial and ethnic minority groups face greater challenges compared to other nurses when striving to land leadership roles.

“Recent research indicates that women from racial and ethnic minorities (REM) including migrant backgrounds are experiencing instances of discrimination by colleagues, supervisors, as well as patients and their families within workplaces,” Ms Pincha Baduge says.

“These experiences have been described as both frustrating and demotivating, contributing to a reluctance to pursue career advancement opportunities. Additionally, studies suggest that having a foreign accent may serve as an additional obstacle to progressing in one’s career. These women often report feeling invisible in their workplaces, experiencing being disregarded, unheard, and facing persistent challenges to the recognition and validation of their skills and qualifications.”

NEXT STEPS

The research project, which is still in its early stages, is tapping into stakeholder engagement so that evidence-based interventions effectively address industry needs.

“It centres around the implementation science, emphasising collaborative efforts rather than working in silos,” she says.

“Nursing stakeholders actively contribute their insights and direction to guide the project’s progression. Engaging these stakeholders presents a valuable opportunity to pinpoint existing industry gaps and co-design, co-produce, and implement evidence-based strategies at the organisational level.”

Looking ahead, Ms Pincha Baduge believes that initiatives like hers can help change the status quo when it comes to healthcare leadership.

“I think having more part-time leadership roles with job sharing will enable more women to progress into leadership positions,” she says.

Her advice for women nurses aspiring to advance into leadership roles?

“Trust yourself. Trust your capabilities. Find new opportunities. Negotiate. Be assertive. If you don’t communicate your expectations and experiences, others won’t know them. Therefore, strive to be a great communicator.”