1. Multiple Segregation in Nursing Careers: Causes and Consequences WES Conference 2004, UMIST Sarah Wise Research Associate Employment Research Institute

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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 CHI-SQUARE SIG = 0.002

8. Vertical Segregation of Part-timers? 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

9. Part-time Work and the “Experience” Gap Average years since first registering less career break 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?

10. 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)

11. 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

12. Horizontal Segregation of Part-timers Respondents working part-time / full-time by workplace 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 responsibilities CHI-SQUARE SIG = 0.000

13. 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?

14. 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

15. 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