‘Delivered by women, led by men’: Female nurses face major barriers to advance into leadership roles

Comprehensively reviewing decades of data, researchers identified the collective sociocultural, professional, organisational, and individual barriers that hold female nurses back from being considered, applying for, or accepting leadership positions.

Published in The Lancet’s EClinicalMedicine, the international review, part of a large-scale National Health and Medical Research Council funded initiative to Advance Women in Healthcare Leadership (AWHL), reveals healthcare systems and organisations limit women nurses in skill acquisition, motivation and opportunities in healthcare leadership, due to inequitable policies, practices and bias.

According to researchers, gender stereotypes, cultural beliefs and real-world scenarios in healthcare show health systems are generally led by men and delivered by women, who are perceived primarily as carers, and not as leaders. Nursing is considered women’s work or a woman’s career and is perceived as feminine. While nearly 70% of the global healthcare workforce is made up of women, including 89% who are nurses, just 25% of senior healthcare roles are filled by women.

The research also highlighted how gendered roles such as disproportionate childcare responsibilities and juggling family with part-time work, limits leadership opportunities. To break down these barriers, researchers argue for systems and organisational change, including industry-wide measures such as cultural change, policies and practices that support women to work to their preferred capacity and incorporate part-time leadership roles.

“The barriers identified show women nurses don’t have the same opportunities for leadership as men, following a common theme throughout healthcare, a sector delivered by women and led by men,” said Professor Helena Teede, Monash University Professor of Women’s Health and Monash Centre for Health Research Implementation Director.

First author Mihiri Pincha Baduge is a PhD candidate with Monash University’s AWHL international initiative, and a critical care registered nurse. She was born and studied nursing in Sri Lanka, and shared her experiences as a woman, a nurse, a mother, a migrant and a person of colour.

“I’ve noticed that healthcare leadership roles often overlook people like me,” Ms Pincha Baduge said.

“When I returned to work after parental leave, I decided to shift from full-time to part-time nursing. Now my eligibility to apply for leadership roles is restricted because these leadership positions lack work-life flexibility and part-time options.”

Ms Pincha Baduge’s work also explores barriers to leadership for nurses when gender intersects with other social identities such as culture and ethnicity. She says she faces many challenges as a nurse in Australia, which is reflected in her global research.

“We’ve found that societal issues and organisational hurdles challenge women’s individual credibility, capacity, and capability in nursing,” she said.

“These barriers make it tough for women to feel confident pursuing leadership roles.

“It’s like a double whammy – women nurses don’t feel confident enough, and this is reinforced as qualified women get passed over for leadership roles. The workplace itself can be a battlefield, with unconscious bias and discrimination making it way harder for women, especially in nursing, which is seen primarily as a feminine caring role, to climb the leadership ladder.”

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